A health and care symphony harmonising on social care concern | Paul Healy

Paul Healy

With pressures mounting on public services, the government has today announced some relief for adult social care. Our head of analysis, Paul Healy, takes a look at how the NHS Confederation has influenced the health and social care spending settlement in recent years.

The NHS Confederation has always been clear with the government that it understood how difficult it is to allocate public service funding while finances are so tight. It has long recognised that tough choices were needed by the Treasury on which services should be protected and which needed to be cut to make the budget balance, or to deliver a deficit-reduction strategy in accordance with its democratic mandate.

As far as possible, we’ve wanted to assist the government in making these decisions. We put together a strong, evidence-based representation to last year's Spending Review, which gave a sober and realistic view on what our members needed to deliver transformation. 

When the final settlement was announced, we were constructive and highlighted that while it was a fragile arrangement, there was enough to give the NHS at least a “fighting chance" to implement the Five Year Forward View.

We were clear though on what was missing: action to address a crisis in social care. This was a central part of the message we put to the Treasury and was demonstrated by an unprecedented joint representation to the Spending Review from across the care and support sector.

Our members are unequivocal about the impact of cuts to social care funding on the NHS. There is, in our view, little debate left to have on this issue, and this has been reinforced by Full Fact, which substantiated our claim on the pressures on hospitals

Cuts to social care have increased the number of people who need care but can’t access state-funded services to support them – this means they have no other choice but to turn to the NHS.

Faced with overwhelming evidence of what was happening to our member organisations, we had a duty to promote our case more forcefully. We didn’t make it alone, as it was important to reflect pressures felt across the system. We’ve been fortunate to be able to join with influential organisations from across the care sector, including the Local Government Association, the Association of Directors of Adult Social Services, the Care and Support Alliance and Care England.

At a time when there is universal agreement on the need for health and care integration, it’s great that our organisations can speak as one on this shared agenda. It’s also useful for the government to see representative bodies come together and point out where money could be best spent.

Simon Stevens set the tone at our annual conference in June when he made clear that extra money should not go to the NHS, but to social care. Since then, he’s been joined by a number of NHS leaders making a similar plea to the government.

It was exceptional for the NHS to argue that money would be best spent elsewhere, and this deserved a better response than what came in last month’s Autumn Statement. That’s why the sector came together again to highlight concerns in response to the Chancellor’s failure to even mention the NHS and social care in his report.

Fortunately, this weight of concern has encouraged the government to revisit the situation. They have decided to redirect some £240 million from the New Homes Bonus and to enable councils to access additional funding from local taxpayers for a short period of time. 

Existing plans had allowed local taxes to increase by six per cent over the next three years and the announcement made today would appear to mean this remains untouched, aside from enabling a small amount to be accessed earlier.

In truth, however much we welcome an intervention to support social care, this is not a long-term solution and the government itself would appear to accept this. Hopefully, they welcome the role of representative bodies in alerting them to the challenges being faced on the ground. Hopefully, they will enable social care money to reach the right places at the right time. What we can be sure of though is that a review of the long-term sustainability of care is now firmly on the government’s agenda.

This is important for the reasons outlined by the Prime Minister yesterday. People need to be sure that health and social care services can be relied on to be there to support them in old age. This means thinking boldly about how to support the transformation of provision, as well as of funding. 

As such, it’s helpful for the government to access the input of health and care organisations, which the Chancellor this week described as a “cacophony”. This though ignores the harmony in what is being said across the sector, which is more a symphony on the importance of developing services better suited to the needs of people today.

Hopefully, we will see a similar common purpose shared by politicians from all sides as we look to review health and care for the future.

Paul Healy is the head of analysis at the NHS Confederation. Follow him and the organisation on Twitter @nhsconfed @NHSConfed_PaulH

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