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Health warning over funding care reform

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The cost of reforming social care should only be met by the NHS if there is also a wider move towards fully integrated services, LGC’s sister title Health Service Journal has been told.

Health reporting HSJ and LGC logo

The calls followed the publication last week of the government’s social care white paper.

A progress report on funding reform released alongside the paper affirmed ministers’ commitment to implementing a cap on the amount any individual would have to pay towards their care costs, and introducing national standards determining who is eligible for care.

However, it said this could only be implemented “if a way to pay for it can be found”, and no decision will be made about funding until the next comprehensive spending review in 2015.

The independent Dilnot commission report into care funding said last year that with a cap of £35,000, the reforms would cost £2.2bn a year in 2015-16, rising to £3.6bn by 2025-26.

Nuffield Trust chief economist Anita Charlesworth said it was “questionable” whether £2.2bn could be found through extra efficiencies in the NHS, and a cap on costs would not necessarily pay for itself through cutting demand for health services.

However, spending around £1.5bn on “stabilising” social care, and ensuring all older people with needs deemed either “moderate” or “substantial” are cared for, could lead to savings if it is part of a wider programme of integration, she said.

She said if NHS funding was diverted to social care, it should be spent on new forms of integrated health and social care services. Ms Charlesworth argued this investment should come from NHS cash clawed back by the Treasury. Analysis published by the Treasury this month shows the NHS underspent by £1.5bn in 2011-12.

NHS Confederation deputy chief executive David Stout said that although the required £2.2bn was “at the margins of healthcare spend”, “we’re not paying a fixed game where [poor social care] is the only pressure”.

The efficiency challenge in the NHS is mirrored in the social care system, he said. “You need to look at them together [and ask] ‘What is the efficiency challenge for health and social care for the next 10 years?’”

Richard Humphries, senior fellow specialising in social care at the King’s Fund, warned against “just raiding the NHS budget to bail out another”. This would be no more than “robbing Peter to pay Paul”, he argued. “We need a much more integrated approach across the system, whatever the size of the pot.”

Mr Humphries added that ministers were effectively making the case for a higher cap than that recommended by the Dilnot commission.

One passage in the progress report suggests there could be a cap of £75,000.

The report also includes a table of figures that shows a cap of £100,000 would cut the cost of the reforms to £1.8bn by 2025-26.

According to the document the “financial services industry” believes the most appropriate level for the cap would be £50,000 or higher.

Ministers also announced £300m from Department of Health budgets is to be paid to councils from 2013 to 2015, intended to “support the transformation of services” and improve integrated working between health and social care.

Care services minister Paul Burstow said this would be paid for from savings made under the quality, innovation, productivity and prevention programme.

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