The head of the NHS Simon Stevens has called for long-term solutions to funding care, particularly for older people, to be in place by 2018.
In doing so he has opened a huge can of worms. The issue has defeated successive governments and eggheads like Sir Andrew Dilnot.
Simon Stevens is right that we need to tackle this major challenge for our society and our ageing population. In the grand scheme of things, funding care is a relatively small problem compared to turning round a vast ocean tanker like the NHS. And solving care funding would make a massive difference to the NHS.
So why hasn't it been done already?
There are several reasons. There is a long-established orthodoxy that, unlike the NHS, social care should be means tested and people should pay for care unless they have relatively low income or assets. This makes joined up funding of health and care very difficult. While the NHS remains a nationally funded system, much of care funding comes from councils and has been subject to substantial cuts.
Politicians have not been brave enough to address the funding gap - or when they have, they have been shot down, for example, for proposing a 'death tax'. They haven't agreed on who should pay.
Even the most recent plan to cap care costs has been postponed. And for many politicians, the care of some of our most vulnerable citizens simply hasn't been a top priority.
That seems to be changing. Increasing numbers of people recognise that the care system is on the brink of collapsing, leaving many older people and their families without support and undermining the NHS.
So what can be done? Perhaps the biggest reason for inaction has been the failure to agree on a solution. Ultimately it's highly political and all about our priorities as a society. It's a trifle naïve therefore for Simon Stevens to call for a political consensus on such an issue. But can we get any agreement on what should be done?
I would argue for a new system of care funding that has three key principles - it should be fair, simple and sustainable.
Care should be free at the point for delivery, like the NHS, and based on national eligibility criteria (as currently for continuing health care). Individuals should be responsible for paying their housing costs in residential care. Care could be commissioned by joined up local health and council bodies that have one unified budget. This would help older people get the care they need where they want it - at home and by supporting family carers.
So would this be fair, simple and sustainable?
Firstly, the fairest way to pay for care is through taxation. Tax revenues could be diverted from current spending priorities or additional sums could be raised. This might be done by reducing pension tax relief or fairer taxes on the income and wealth that have been accumulated by richer older people. This would also address Simon Stevens' concern about intergenerational fairness. As one of the wealthiest nations in the world, Britain could invest in a first class care system if we chose to do so.
Secondly, simplicity is key. Every change to the care system has made it more complicated and required a growing legion of advisers and information services to guide families through the maze. Being free at the point of delivery would be very clear and remove an army of bureaucrats responsible for overseeing the millions of transactions in the system. A national system locally delivered would be both fair and simple.
Thirdly, how do we ensure that it is sustainable to meet the needs of our ageing population? We need better, fairer care now and for generations to come. To be intergenerationally fair, people need to know that what they pay for now will be there when they need it. Many of the current older generations mistakenly thought they had already paid for their health and care in later life. We can't make the same mistake again. To be sustainable, tax revenues need to be linked to the growth in our ageing population and its wealth.
Simon Stevens has opened a huge can of worms. Let's use the opportunity to create a much better care system that is fair, simple and sustainable and really meets the needs of all older people, now and throughout this century.Suggest a correction