In the jungle that is the politics of public spending, there are few bigger beasts than the NHS. Rarely out of the news this winter, it emerges from recent polling evidence as the top issue of public concern.
So it was altogether unsurprising that Theresa May recently told the Commons liaison committee the NHS was “a critical priority” and that she intended “to come forward with a long-term plan ahead of next year’s spending review”.
The prospect of the NHS leapfrogging competing claims for extra resources should ring alarm bells for local government, having already taken the biggest hit since 2010 largely as a result of the relative protection afforded to the NHS.
There are many unanswered questions about the prime minister’s commitment, but perhaps the biggest is: “What about social care?”
Many in the NHS and virtually all independent commentators – including The King’s Fund – agree that a long-term plan for the NHS will not work unless social care funding pressures are addressed as well. Yet so far the prime minister and Jeremy Hunt have talked only about the NHS, with social care the subject of a separate consultation promised by the summer.
Recent history offers an important lesson here. A great mistake of the 2010 spending review was to protect the NHS from real-term reductions but leave social care exposed to swingeing cuts in local government grant.
The resulting pressures led to the better care fund, in effect taking the wire cutters to the NHS ring fence to let some money through for social care. But the National Audit Office’s forensic dissection of the BCF last year concluded that – although it has encouraged joint working in some places – it has created fresh problems, adding another layer of central oversight and failing to deliver the expected benefits for patients, the NHS and local authorities.
The BCF illustrates the dangers of a piecemeal response that sees social care as a secondary adjunct to the NHS, overlooking the deeper problems in local government finance.
It is almost certain that any new money for the NHS will come with strings attached. That will go for any new social care funding as well. Routing it through the NHS is one possibility, but raises the grim spectre of the BCF on steroids.
So while there are cautious grounds for optimism that the government understands the need for a joined-up plan covering social care as well as the NHS, it should avoid past mistakes, adopt a single timetable and seek more imaginative opportunities to align health and social care around place.
Richard Humphries, senior fellow – policy, The King’s Fund