David Behan – We need to solve the crisis in old age care in the UK

Former chief executive of the Care Quality Commission discusses why radical solutions are needed to help care for Britain’s ageing population

In 2017, Sir David Behan was described as the third most influential person in health by the Health Service Journal. At the time, he was chief executive of the Care Quality Commission (CQC) - the regulator of health and social care in England. This summer, Behan decided to step down after six years, but he wants to avoid using the “r word”: retirement. Instead, he wants to continue making a difference to the experience of those people who use health and social care services and do this by contributing to the sustainability and resilience of services. In November, he was announced as a new non-executive director for HC-One, a British health care management company.

Behan began his career 40 years ago as a qualified social worker. After gaining further experience, he began to take on more managerial roles. During his time at the UK government’s Department of Health, he helped develop and design policy for Britain’s ageing crisis – an issue affecting both health and social care sectors.

Attempts have been made to reform the care of older people since 1997, but the system remains more or less unreformed. Behan says, “It’s an issue that everyone has a view on what they would do if they were in power but actually introducing those changes is very, very, difficult.”

Behan was involved in designing the first dementia strategy in England, but he thinks we need to look at wider changes in demographics: He says, “It’s not just a story about ageing; it’s also a story about what’s happening in terms of the number of younger people.” The good news is people are living longer, but the downside is healthy life expectancy is not keeping up with life expectancy, according to Behan.

Tax-funded health care has meant care is free at the point of use in the UK, but this has never been the case for social care. Dependent on their income, people have to pay a contribution for social care in their old age. This decision has meant if an elderly person has cancer they will be treated for free by the NHS, which is not the case if they have Alzheimer’s, a situation which appears inherently unfair. Does it stand to reason then that in the future we should make social care free for everyone?

Behan made headlines when he suggested workers should have their pay docked to pay for their care, advocating a compulsory insurance system for younger people to save up while older people should be expected to contribute through their assets.

Behan looks pragmatically at the wealth distribution in the UK when he says this, as older people have assets in terms of property, even if they don’t income wise. If social care is made free through a public buy out, the burden of this will fall on younger people who are currently paying tax. This approach would mean the generation who don’t have the wealth and assets will be paying, burdening younger people with an unresolved issue.

This is a problem which can’t be ignored. By 2066, the Office of National Statistics estimates a quarter of the UK population will be 65 and above. However, political progress has been slow, with Brexit currently dominating political conversation. The government promised a green paper on this topic during the March 2017 Budget that was due to be released by the end of 2018, but that has been delayed yet again.

Behan also acknowledges Britain’s ageing population isn’t the only problem NHS England has to face, as austerity has hugely impacted local authorities’ ability to provide care. His new role as chair of Health Education England will look at the workforce not just today, but 10 years into the future. Workforce support is another crucial issue as think tanks have warned the NHS could be short of 350,000 staff by 2030.

Through his work, Behan has experienced the health and social care systems from many sides. He says, “I’ve worked as a practitioner, I’ve been responsible for delivering care, I’ve been responsible for developing the policy in care and responsible for regulating that care.”

When looking back over his career, Behan says, “I wanted a job where I could make a difference to people’s experiences of health and care systems, and I feel very privileged as I come towards the end of my working life, I feel that every job that I’ve had has had that… sweet spot between the organisations I work for and my personal values… [my job] is still about making a difference and making a contribution for a more socially just society.”