Following the Chancellor’s statement this week, Paul Healy, head of analysis of the NHS Confederation, reflects on the settlement agreed and how it reflects what health and social care organisations have been pushing for many years.
We can only guess what happened over the winter period to change the Government's position on the sustainability of the social care system.
Last November, the Chancellor announced £33 billion in new spending commitments
with no mention at all of the NHS and social care. This triggered a chorus of concern from the health and care system. This included an important intervention
from our chair Stephen Dorrell on the BBC’s Andrew Marr Show
and the Confed working alongside key organisations like the Associations of Directors of Adult Social Services (ADASS) to increase the pressure in the national press. Yet, there was little recognition from the Treasury that they saw this as anything more than the usual noise in response to financial statements.
The following week saw the Communities Secretary dispatched to quell the concern
. Unfortunately, he had little to offer: some leftover money from the New Homes Bonus and a strange restructuring of tax-raising powers already granted to local councils. A further commitment was made for a rapid review, conducted by the Cabinet Office, into how to make services more sustainable.
Barely three months later and following more private and public pressure
from our new CEO, Niall Dickson, the Government is fully behind major reform of social care
, and is now willing to put billions of new money into the system. We don't know the findings from the Cabinet Office review, but we can probably assume it reassured the Prime Minister that the health and social care sector was not simply making noise.
When the NHS Confederation said back in 2012
that something needed to be done immediately to prevent a crisis from emerging in social care, we meant it. When an unprecedented alliance of health and social organisations submitted a joint representation to the Spending Review
in 2015 highlighting how services were running close to collapse, we meant it.
This is what the system has been telling us with increasing volume over the last five years.
We don't know what the impact will be from ignoring the calls for so long. The nature of social care is preventing people from losing their independence and being trapped in a cycle of declining care. The tragedy of underfunding is some people may have already been sucked into this cycle in recent years. Possibly, some of the 400,000 people who lost access to state-funded services
in the last parliament.
We must though look to the future and how we can best deliver sustainable reform in the interests of the public, who demand more security and certainty about how they will be supported in old age.
The Prime Minister has been quick to state that the Government's Green Paper is not simply about funding, although not quite as quick as the Chancellor was to reassure parliament that an estates tax would not be considered
. Additional funding would seem necessary, but not sufficient.
What is needed is continued progress in the integration of health and social care services. It’s been apparent to everyone for years now that more resources are needed to support people with long-term conditions in the community, with less to treat episodic care in hospitals. And yet, the last five years has seen spending increase in hospitals and cuts in primary care, community, mental health and social care.
No wonder the Government seems irritated by repeated calls for action on social care. No doubt the public is also tired of hearing about the impact of cuts on an NHS struggling to manage an ageing population. But, in the face of overwhelming evidence and a clear lack of action, there has been little choice other than repeat the call louder and with more voices across the health and social care sector.
It was extraordinary last year for the NHS to call for any additional money that might be available to go to another budget. This deserved a better response
than what it got in the Autumn Statement.
Thankfully, the Chancellor is now in full listening mode and hopefully he will go far and wide in considering proposals for the Green Paper. It should consider all the possible options, including those often deemed too difficult, to test what the system needs to be more sustainable. Maybe it should also consider the political environment that prevented a solution being considered before now and which continues to prevent these issues being addressed in a cross-party manner.
Regardless of what does emerge, the Government can at least rely on strong representation of the health and social care system with organisations, like the Confed, LGA and ADASS, keen to ensure it resonates with the reality on the front line.Paul Healy is head of analysis at the NHS Confederation. Follow him and the organisation on Twitter @nhsconfed @NHSConfed_PaulH