The NHS will be near the top of the in tray for the next government and social care will not be far behind. The King’s Fund has led the warnings about the perilous financial prospects facing local government and the NHS from 2015. All parts of the system of health, care and wellbeing are already under sustained financial stress. Maintaining financial balance whilst protecting the standards and quality of care for patients and people receiving support is becoming an increasingly thankless task for managers, clinicians and other front line professionals.
Alongside the financial squeeze, rising demand and the relentless rise in the number of older people living with long term health conditions, dementia and frailty are exposing the inadequacies of an outdated model of care which is reactive and fragmented rather than preventative and coordinated. Too much money is spent on the costs of failure rather than supporting independence, healthy lifestyles and wellbeing. Flatlining NHS budgets and real terms cuts in social care spending make it really difficult to turn the tide by investing in prevention, as the recent ADASS budget survey showed.
What needs to be done? Immediate action will be needed to stabilise the financial position of the health and care system. But this must not be more money for more of the same. Shifting to a model of integrated care – which commands universal support – will involve transition costs while new services are developed. There is a strong case to move beyond the limited timescales and scope of the Better Care Fund and establish a proper transformation fund with genuinely new money as both The King’s Fund and the LGA have recently argued.
A second priority for the new government is to revisit the 1948 settlement and address fundamental questions about entitlement and funding for needs which can no longer be shoe-horned into historical categories of ‘health’ and ‘social care’. The fault-line between universal health care free at the point of need and a social care system that is becoming increasingly residual is not sustainable.
The independent commission established by The King’s Fund to consider these questions, chaired by the economist, Kate Barker, concluded in its interim report that we need a new settlement based on a single, ring fenced budget for health and social care. Its final report in September should offer a prospectus for change. How we fund this will demand hard choices and will not be achieved overnight but with a financial cliff edge for health and social care looming in 2015/16 the public conversation about what the choices are needs to start before the election. The strengthening economic recovery affords greater optimism about what is affordable and an unprecedented opportunity to tackle one of the pressing public policy challenges of our time.