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Lamb calls for fiscal devolution to fund care

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A locally set health and social care tax should be established alongside the pooling of budgets between the NHS and local government to create a sustainable system, according to one of the main architects of the Care Act 2014.

Norman Lamb

Norman Lamb

Source: Peter Searle

Norman Lamb

Norman Lamb MP, who was care and support minister in the coalition government, told LGC the social care green paper is “ultimately a flawed process” that will not provide a sustainable solution, as it is set to focus on one part of the system.

He said a cap on care costs, which was included in the Care Act but has been abandoned by the government, should be implemented.

But Mr Lamb, the Liberal Democrat health spokesperson, added that greater investment is also required, and devolved tax-setting powers would help create long-term sustainability.

He added the proposal was gaining support, including from former Treasury permanent secretary Lord Macpherson.

Mr Lamb said: “I favour a hypothecated NHS and care tax. If you base it on a reformed national insurance, you could make sure it was fair between the generations.

“I would favour the ability to set it locally and I would tie that in with a more decentralised approach.”

He said reforms being implemented in Greater Manchester, where health funding is devolved and NHS and social care budgets are pooled, should be introduced more widely to create fully integrated systems.

Mr Lamb added: “It is much better if you can take a locality and pool the budgets between the NHS and social care so there is one budget, one commissioning process and move towards integrated care organisations, bringing together mental health and physical health – but also healthcare and social care.”

He said the Care Act, which attempted to shift the focus to individual wellbeing through direct payments and personalised budgets, was being “massively undermined” by the “impossible financing” of the health and care system.

Financial pressures have led to personal budgets “being trimmed back to the point at which they become much less meaningful”.

He said the current model of just allocating funding to support people’s care needs should be replaced by an asset-based approach, with “greater collaboration between communities and the state”.

“We need to be moving away from this sense that people are just becoming dependent but instead looking at what they are able to do and facilitating and promoting that ability,” Mr Lamb added.

However, he said the “depressing reality” is that he expects the green paper to be a “discussion document”, which means there will be no legislation this parliament.

Mr Lamb has led attempts to persuade the government to establish a cross-party NHS and social care “convention”, which would involve NHS and social care staff.

This would deliver proposals within a year, with a commitment it would be implemented at the conclusion of the process.

And Mr Lamb warned a lack of decisive action by the government would hit the most vulnerable, with ”more and more failures of care”.

“This places an ever-growing burden on informal carers, many of whom themselves are frail and struggling to get by,” he added.

“There are real human consequences of this inertia from this government. It must be confronted.”

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