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Theresa May’s determination to announce a long-term funding plan for the NHS to coincide with its 70th anniversary has reportedly prompted much manoeuvring among ministers over how much annual funding should increase.
Today’s report on comprehensive and detailed modelling by the Institute of Fiscal Studies and the Health Foundation should provide the government with further food for thought over what is possible, when and how.
But the focus of coverage and debate in the media – and, one suspects at the top of government - has largely failed to fully consider the core interdependence of the NHS and social care and other public services, and acknowledge how this is vital to improving services and the health and wellbeing of the public now and in the future.
As the report states, while spending on the NHS and social care between 1996 and 2010 both increased by about 6% above inflation, since the dawning of the age of austerity in 2010 NHS spending has increased by 1.4% per year while social care funding has fallen annually by an average of 1.5%.
Despite relatively slow rises in health spending in recent years compared to before, the share of all public spending dedicated to the NHS also increased rapidly between 2009-10 to 2016-17.
This has has been made possible with real-terms cuts to spending in other areas which impact on population health.
Severe reductions in local government funding combined with rising demand have undoubtedly had an impact on adult social care, but many other council services supporting struggling families and maintaining community wellbeing have been depeleted or abandoned altogether.
Reductions in funding for public health, the police, housing and the prison service also place further demand on an NHS facing rising pressure from an ageing population with increasingly complex needs.
To treat the NHS in isolation may enable the beleaguered prime minister and a fragile government to score political points in the short-term, but claims that a long-term funding plan for the NHS alone will achieve the required goals without investment in wider public services is likely to see the prime minister caught offside.
Without similar long-term security for social care in particular, efforts to manage rising demand across the system will become increasingly difficult.
Rumours abound that the social care green paper, which health secretary Jeremy Hunt recently said he hoped would be delivered before the summer, will be delayed – possibly until the Conservative Party conference at the end of September.
The longer the delay – and the lack of conviction and/or ministerial friction this suggests - the more nervous councils will get that it will not deliver the required sea change in approach so desperately required.
The suspicion is that the Treasury is yet to be persuaded to make the required funding available for significant reform of the social care system, as detailed in today’s report and a recent joint analysis by the King’s Fund and Health Foundation.
An unwillingness at the top of government to adopt a bold and broad view of spending priorities and act with the essential inter-connectedness of public services in mind is likely to stifle improvement, do nothing to drive down demand, limit opportunity, and undermine the quality of lives.
NHS Confederation chief executive Niall Dickson has warned today’s report shows “without new ways of delivering services and sustained investment, NHS and care services will not cope, and we will face a decade of misery in which the old, sick and the vulnerable will be let down.”
Similarly, to continue with a narrow approach to specific public services, with our beloved NHS protected while other services dwindle, is not only irresponsible and illogical, it could be devastating.
Jon Bunn, senior reporter