I suspect there might have been a combination of local government frustration, anger and “why not social care as well” when the Prime Minister recently announced that the NHS would receive more money as part of a long term funding settlement ahead of the next Spending Review.
Interviewed on the Today programme the following morning, I argued that all of us in the NHS recognise that this has to be a long term funding settlement for both health and care. Given the near state of collapse in local authority funded adult social care for older people in many areas, it would be the utmost folly to try to sort out long term NHS funding without sorting out social care funding at the same time. Local government colleagues can rest assured that NHS Providers will continue to make this argument wherever and whenever we can.
It would be the utmost folly to try to sort out long term NHS funding without sorting out social care funding at the same time.Chief Executivetweet this
Governments usually want a significant reform “get” for any funding “give”. So an interesting question for all of us is what should be in any reform package. We will all agree on the top line direction of travel - consistent, full, integration of health and care services.
But reflecting on the last five years worth of initiatives in pursuit of this goal is a somewhat dispiriting exercise. The Better Care Fund’s attempts to combine small amounts of health and care funding as an incentive to integration have not been particularly successful, though it has acted as a useful spur in a few places. Most argue that the BCF has created a lot of extra bureaucratic pain, covering a small proportion of total health and care spend, in return for relatively little integration gain.
Attending a recent MJ round table with a group of local authority chief executives I was also struck by the strength and ubiquity of the view that, apart from a few obvious places, Sustainability and Transformation Partnerships (STPs) had not made the progress we had hoped for. Worryingly for the NHS, the Chief Executives were already looking past the STP form to see what should follow in its place.
Worryingly for the NHS, chief executives from local authorities are already looking past the STP form to see what should follow in its place.
Perhaps we shouldn’t be too surprised at the slow progress here. The Barker Commission - always a key touchstone in this policy space - set out how difficult and complex it would be to fully integrate health and care. Not just organisationally, structurally, financially and legally. But culturally, on the ground, bringing services and staff together and, most importantly of all, creating a seamless experience for service users with better outcomes.
We expect any new funding settlement to be announced in Budget 2018. So a key task for us all, before then, is to agree what “integration next steps” should accompany a sensible long term funding settlement for both health and care.
This article was first published by the mj.co.uk on 26 April 2018