Commentary on honesty in the care funding debate
The health service yesterday offered a refreshing response to Philip Hammond’s Budget: honesty.
“The NHS will likely not be able to do everything being expected of it,” an NHS England paper bluntly said of the funding available next year.
It appeared to contradict the chancellor by saying the additional £1.6bn he announced for 2018-19 was less than that requested in NHS England’s Five year Forward View.
Waiting time standards “will not be fully funded and met” unless there are cuts to mental health, cancer and primary care services, the paper said. Meanwhile, it would be unfair to set “unattainable goals which staff would then be criticised for not meeting”. Health secretary Jeremy Hunt was being told his waiting time objectives were undeliverable.
There may be many people within local government who afford themselves a wry smile at the NHS’s predicament (just about the only thing they can afford).
The NHS will receive £335m this year for winter pressures, followed by an extra £1.6bn next year and £900m the following year. And, in addition to this revenue funding, there is £2.6bn of capital funding to aid sustainability and transformation partnerships.
In contrast, social care received diddly-squat in the autumn Budget. Literally zilch – there was not even a single mention of social care in the Budget red book.
Those with long memories will recall social care did receive £2bn (over three years) in the spring Budget, won with the explicit support of the health service, including NHS England chief executive Simon Stevens.
However, in the end this has come with so many conditions attached that at times it almost feels it is there largely for the benefit of existing NHS services. And it comes at a time the ageing of the baby boomer generation results in dramatically higher demand for services, following devastating cuts to overall council funding which have forced authorities to dramatically cut expenditure in other areas to shore up social care. Yet this is still not enough leading to eleigibility for care being increasingly restricted. Councils have long been aware that they cannot deliver everything expected of them.
There was a reminder of the devastating impact of social care cuts yesterday in a report from the Competition & Markets Authority on the care home market.
The care home market is not sustainable without additional public funding, it said. “The fees currently being paid by local authorities are not sufficient to sustain the current levels of care under the current funding model.” Self-funders are subsidising council funded care and “nearly all new care homes being built are in areas where they can focus on self-funders”.
This is all pretty bleak.
For local government there will be no golden goose any time soon. Theresa May’s brave and bold (foolhardy and flawed) attempt to make social care sustainable blew up dramatically during the general election campaign. And, as the LGC Briefing recounted last night, the fairer funding review, supposed to direct resources to the councils needing it most, is a bit up in the air right now.
For the NHS there is also no golden goose (although there is perhaps a scrawny duck whose egg-laying fails to keep up with the perennial growth in egg-eating).
At times it feels like local government and the NHS are at permanent loggerheads. This is exemplified by the unending row over delayed transfers of care. This boils down to a cash-strapped health service threatening to fine the even more cash-strapped councils that fail to cut delayed transfers. And, of course, there are the STPs, set up with the noble purpose of redesigning services and shifting resources accordingly, which have more often than not degenerated into rows as participants strive to protect their own services, and short-termism as decision makers have strived to bail out struggling hospitals.
At times of pressure the easiest option is to be defensive. And there are times when it is vital to defend one’s own turf.
However, there is a danger that councils and their health partners are being driven apart by the very pressures that make their coming together ever more vital. When the two unite there is scope for them to make ground-breaking change, as Rob Walsh, chief executive of both North East Lincolnshire Council and North East Lincolnshire CCG wrote for LGC yesterday.
While the NHS may have received more extra resources than social care, both have more in common than drives them apart. They both need more resources to remain sustainable, they both face rising demand, both could become more efficient from using technology whose up-front costs are hard to fund and they both need to integrate services more around the needs of the patient or service user.
This is not a ground-breaking revelation: all council and NHS leaders know this. But the vast majority of them are increasingly being blown off course from integration and indeed cooperation by immediate financial strife.
Surely now is time to talk about uniting on a joint campaign, urging a more realistic debate about how extra resources are essential and what the benefit of them will be for care recipients. Amid the bickering it is often easy to forget that by international standards Britain spends relatively little on care. Our system is actually relatively efficient. However, services are increasingly threadbare and stretched. Now is the time for NHS and council leaderships to make a case to the public and Parliament for them to be brought up at least to the international average.
While LGC will continue to report on disagreements between health and local government, now is time to keep strife largely in-house. It is time for the two sectors to present a united voice to demand the resources that will bring about a world-class care system. And this new unity would lay the foundations for the delivery of a world-class integrated care system.
Nick Golding, editor, LGC