Health and Social Care

Happy birthday NHS

Happy birthday NHS. There’s no doubt that what you do is a marvel, a national treasure.

The NHS birthday present is in, well sort of. We will believe it when we see the cold hard cash. I wrote a little on this a few weeks ago

I’ll stray off my normal pitch and offer some reflections on social care

The LGA struck a positive tone in response

The NHS and social care are intertwined

One might readily characterise a significant proportion of NHS problems as a result of 8 years stripping out of social care budget.

In a very tight system, marginal changes in service availability can have a massive impact.

The changes in social care are NOT marginal

Some elements of social care funding need are nationally determined, or / and demand for social care is heavily dependant on downstream consequence of NHS activity.

Finances in your Town Hall are increasingly under strain, I don’t know if anyone noticed. For those in NHS who think times are tough, as they undoubtedly are, consider whether you could keep the show running with a 45-50% cash cut in your budget.

Social care is NOT there to “help health”, but it is an investment that can help NHS with service demand pressures.

Does the NHS & DH at the very highest level understand local government finance

There maybe significant ignorance in the way local government works, financially and otherwise in DHSC – civil service and political – and NHSE. I hope this isn’t wilful ignorance, but the result of silos between sectors and govt depts.

Some may conclude that Local Govt can’t fund social care on the basis of Business Rates and Council Tax. It CAN fund a council without social care on the basis of these funding sources.

I accept this like cuts two ways

Nationalised Social Care?

There is certainly a lack of national policy and thought to sustainable funding is a glaring hole. We all hope this will be adequately addressed when the Green paper turns White. History says we may be disappointed

A (probably unlikely) national policy position response from DHSC might be to take a line of internalising social care to NHS. Will likely only be interested in adults, not children.

If NHS wants social care it must 1) address the current funding & demand gaps and 2) address to policy conundrum between free to all at point of need (NHS) and means tested fees (social care). That dichotomy is non tenable within NHS. It may be be prohibitively expensive to correct this.

Little to no evidence that NHS led model of social care provision would lead to cheaper or better and possible cost would be loss of personalisation and local flex.

There are many advantages of locally led & owned social care. Many of these arguments will also apply to the NHS. I don’t know if there any clear disadvantages. It is worth a re read of this LGA think piece. I’d encourage you to especially read what Jon Rouse and Izzy Seacombe wrote.

There IS something important about the N in NHS, no doubt. Common standards etc. Same applies to social care, but less of a “thing” is made of it.

The advantages of local include ability to flex, to give an unequal offer where there is unequal need in our places

Invested in place – Rooted in local place and democracy

The ability to manage a market in a way that has proved difficult in NHS commissioning

There are many more benefits of locally run social care

Side effects of the cash injection?

All medicines come with side effects.

The birthday present may have the unfortunate side effect of significantly dampened any impetus for NHS to actually transform the model of delivery.

Of course there is a need to invest in the NHS, without some change surely it becomes a sticking plaster for another period of time. (remember the Wanless 3 reports and what we all said would happen if we only responded to report 1)

This no change seems likely to, as a result, have consequent impact on social care demand.

Back to the beginning

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