10.11.15
Divide between health and social care ‘bad economics and bad social policy’
The former health secretary and current chair of NHS Confederation, Stephen Dorrell, has written a letter to the chancellor urging him to treat health and social care as a single sector.
In the letter, Dorrell said the recent trends of rising NHS budgets and sinking social care cash cannot continue. Integrating both sectors is not a controversial policy, he said, as it has been indirectly promoted by the government in every step of the way.
He argued that adding another £8bn to the NHS purse while taking £2bn away from social care budgets means the resources available to both only realistically increased by £6bn.
“This approach guarantees that the increased resources are used less efficiently than they should be, because reduced social care support leads to avoidable illness and increased demand; that is bad economics, but more importantly, it is bad social policy,” Dorrell wrote.
The former Conservative secretary of state urged Whitehall to take advantage of the upcoming Spending Review to safeguard a financial framework for the health and social care sector as a whole and, in doing so, reflecting its integration rhetoric.
To achieve this, he said, George Osborne would have to make a “critical leap of logic” to create a ring-fence around health and social care expenditure as a co-ordinated activity – a move which Dorrell claims to be backed by 86% of the Confederation’s members.
Within that ring-fence, Whitehall would have to establish a clear year-on-year spending framework, covering both the £8bn for the NHS and plans for social care budgets designed to support Simon Stevens’ Five Year Forward View.
“Changing the shape of health and care services to reflect changes in demand and technology is always sensitive, but always necessary,” he wrote.
“A clear medium-term spending framework will be very well received and encourage commissioners and providers to work together to plan for and deliver necessary and sustainable service change.”
But this medium-term framework would require a transformation fund, Dorrell said: “History is replete with examples of spending increases which postpone necessary change rather than facilitate it; the government’s welcome support for the Stevens Plan needs to include front-loaded resources for his proposal to create a fund to support service transformation.
“Failure to do so will guarantee continuing service inefficiency – and with it avoidable illness and service pressures.”
The Confederation chair also emphasised that reducing cash allocated to workforce, training and research will hit frontline services directly, as well as undermine the sector’s capacity to reform services. These budgets should not be treated as “desirable extras”.
Lastly, he urged Osborne to stress the importance of public health in the context of local government expenditure: “It remains as important to good local government as the Department of Health and Public Health England are to good national government.”
He said radically upgrading prevention measures cannot be done against a background of falling public health budgets. But while this may be taken on board in the Spending Review, the Department of Health has already confirmed that it will press on with £200m reductions in the form of a 6.2% flat rate in 2015-16.
Dorrell concluded his letter by saying that integrating health and social care is not easy, and issues embedded in the reform affect both local government and the NHS.
But he is adamant that reshaping service delivery is necessary, and that the institutional consequences of these changes are “important but secondary concerns”.
Ongoing recommendations
His is not the first high-profile call for real integration between the two sectors.
Just yesterday (9 November), authors behind last year’s ground-breaking Barker Commission came forward with a statement expressing dismay that the same recommendations from their report had not been implemented.
They said the care system, instead of improving, was now “crumbling around us” and the need to bring health and social care together was more pressing than ever.
Last month, the North East Combined Authority said it would establish, in partnership with the NHS, a Commission for Health and Social Care integration after the region signed its devolution package.
In June, the King’s Fund expanded Barker Commission conclusions to include recommendations that all areas of the country work towards having a single local commissioner and budget for health and social care by 2020.
And in April, the president of the Association of Directors of Adult Social Services warned that in order to create an integrated system, central government would have to ensure social care funding is protected and aligned with the NHS.
(Top image c. NHS England