What’s going on with NHS funding?
George Osborne announced a £3.8 bn pooled budget for health and social care in today’s Comprehensive Spending Review. To a certain extent this was a cheeky political attempt to steal some of Andy Burnham’s policy on health and social care integration.
Genuinely building a system that links health and social care is good policy. It could help people stay in their homes, reduce hospital admissions and support people to lead dignified lives as they get older or deal with long-term conditions. With proper planning, training and upfront investment it could also be more cost-effective in the long run.
But Osborne’s move fails on a number of fronts.
First, the Health and Social Care Act passed in the face of huge opposition last year is a recipe for fragmentation, not integration. A system based on competition instead of collaboration can’t be fixed by a bolted-on pooled budget.
Second, it comes at a time when local government funding is under massive pressure, with social care eligibility thresholds and services cut as a result of council budget cuts. Despite the promise to protect NHS funding, health service budgets are also under pressure due to rising demand, an expensive top-down reorganisation, and £20bn ‘efficiency savings’ being sought in over 4 years.
Finally, the figures involved in today’s funding announcement are opaque to say the least. The announcement is for a pooled health and social care budget of £3.8bn, including an additional £2 billion through the NHS. The overall local government cut is 10 per cent, but the SR paperwork says that once other changes are factored in the effect is only 2 per cent. How much of this is due to reallocation of funding for social care from the NHS? Certainly in the short term £200m seems to be going from the NHS into the pooled budget for ‘investment in new systems’ next year. There’s also the £335m going into local authorities to prepare to implement the Dilnot reforms to social care funding – is this part of the pooled pot? It’s likely we’ll have to wait for more details from departments before we can be clear, but it’s one where all might not be as it seems.