22.10.18
A goal without a plan is just a wish
CIPFA’s health and social care policy manager, Dr Ellie Roy, makes the case for a long-term funding plan for social care, and welcomes the Public Accounts Committee’s (PAC) latest findings.
The UK Government has committed to the goal of better integration of health and social care, but the financial squeeze and lack of clarity over its future funding is acting as a barrier to this goal. The recent report from the Public Accounts Committee calls for a 10 year funding package for social care, which, although welcome, may not solve the problem in its entirety.
Integration of health and social care has widespread support as being the route to deliver the most effective outcomes for patients, their families and communities. The PAC’s report in the interface between health and social care highlights that, despite 20 years of effort, the government is “still experimenting” with ways to join up care, and that with the financial squeeze on local authorities, there is “no real prospect of progress.”
Successive governments have attempted to address the integration issue; with numerous white and green papers and five independent reviews in the last 20 years alone. Recently, additional funding for the NHS has been secured but is yet to be allocated, and we await a 10-year plan for the NHS.
In relation to social care, another green paper is expected to propose options for funding social care for older people, but in relation to wider social care, it’s all quiet. There is no whisper of similar additional funding or long-term plans for social care, nor any intention to address the extremely complex system of funding across the whole of social care. So far the approach to social care funding has been of the ‘quick fix,’ short term variety.
In order to develop sustainable solutions it is essential that the challenges of funding social care, not only health, are understood. Thus, the PAC’s call for a 10-year funding plan for social care, to sit alongside that for the NHS, is extremely welcome, and perhaps long overdue.
CIPFA has identified six key challenges which have made it difficult to respond appropriately to social care needs:
- Public funding has not kept pace with demographic demands;
- The right long-term investments are not being made to the extent required;
- Individuals face the possibility of severe financial impact as a result of social care costs;
- The market, unaided, cannot provide what is needed;
- The health and care systems do not fit together as they should;
- Wider determinants of social care need are not sufficiently integrated into planning processes.
Whilst we do not recommend any given level of spending, nor any particular system for organising the split between state and individual contributions to the costs of social care, CIPFA does believe that it is vital to make a strategic change, not to defer a substantive decision as has already happened several times.
There is a critical need to improve the long term financial sustainability of the whole health and social care system. This can be achieved either by adjusting funding, or by adjusting service expectations. Such a choice is a political and economic one – but if neither option is taken, as unsustainable position will result.
CIPFA have proposed a five point plan:
- Identify and implement a mechanism to provide stable and adequate means of long term planning for social care spending in the context of the whole system – such as setting a minimum percentage of the tax take to be allocated to health and social care;
- Reconsider all spending programmes, not just social care, supporting older people on a ‘zero-based’ perspective – with an expectation that some rebalancing between various programmes will be appropriate;
- Direct funding/introduce incentives/sharpen reporting arrangements to give headroom for, and encourage, preventative actions which will maximise longer term sustainability and value for money;
- Protect individuals from the possibility of extremely high social care costs by means of pooling risk;
- Reduce the sharpness of the differential between social care, as a largely paid for service, and health as an essentially free service.
Such an approach, together with the PAC’s proposals for a long-term plan and legislative change, may go some way towards balancing the financial pressures and challenges which are currently preventing the integration agenda from proceeding, and place the whole system in a more sustainable position for the future.
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