A Legless Healthcare Announcement

The PM’s £20bn. healthcare announcement may remind you of Dudley Moore auditioning for the role of Tarzan even though he had “one leg too few”.  Back in January, the Government made a big deal of adding “Social Care” to the name of the Department even though it had already had that role for six years.  The announcement reflected the widely held view that the NHS and adult social care should be seen together and, indeed, the NHS could only work if social care was adequately funded and integrated with it.

Last year the Department of Health (DHSC) announced it would free up the 5% of beds occupied by people well enough to move to social care. But discharging patients earlier is only part of the potential savings from integration. With better funding and management of adult social care, fewer older people would need to visit their doctors or be admitted to hospital in the first place. Naturally the Government did not provide any money to achieve those aims and they were not realised. The funding adult care green paper, due these past two years, is still not expected for some months.  Insiders predict it will be a damp squib. On Monday, The Independent put it this way “Theresa May to warn social care must wait until 2020 for extra funds, despite pledging £20bn for NHS.”

Since 2009/10 the NHS has figured out that their own funding of adult social care actually saves money for the NHS. In 2015/6 they provided nearly £2bn and this year it is probably close to £4bn. No one in the DHSC, it seems, has worked out the optimal diversion of resources between the NHS and adult social care. As a starter, it could redirect the £760M it spends on unnecessary quangos. Don’t hold your breath on that. The DHSC does not spend any money on adult social care at all: the funding mostly comes from local authorities with a declining contribution from the Ministry of Housing, Communities and Local Government. This has been topped up with three extra contributions:

• “A Social Care Precept, under which local authorities are able to increase council tax levels by up to 2% or 3% (above the referendum threshold)…..
• An improved Better Care Fund –to include additional social care funds of around £4.4 billion between 2017/18 and 2019/20
• An Adult Social Care Support Grant which will provide £240 million to local authorities in 2017/18 and £150 million in 2018/19.”

How the Sajid Javid, then Secretary of State, determined, in February 2018, that £150M would fix the £2.3bn. funding gap passeth all understanding.

Unsurprisingly, omitting social care from the new health funding has been greeted with horror by local authorities: “Glen Garrod, president of the Association of Directors of Adult Social Services (ADASS), said the Government’s plan to increase funding for the NHS while leaving out social care was similar to ‘pouring water down a sink with no plug in.”

Health care in England should be seen as a whole, a trinity of Health England (prevention), NHS (curing) and social services (caring). The DHSC has responsibility for, and funds, the first two but the third escapes their consideration.  The whole structure, with its commissions and quangos, trusts and advisers, managers and independent primary practices, is such a mess we need a non-partisan convention or commission to make sense of it and then what the optimal spending mix should be. 

Lord Darzi is a surgeon and former (Labour) Health Minister and has, with Lord Prior, his Tory equivalent, been demanding an extra £50bn. which turns out to be 3.5% p.a. - not far from the government’s £20bn, which is actually 3.4% p.a.  Don’t ask me to explain politicians’ arithmetic. Although he preaches integration, Lord Darzi’s his arithmetic does not practice it: his £50bn is just for the NHS. He does, however, agree that NHS reform should come before the necessary funding is evaluated, the right leg of healthcare provision, the NHS, does need more money and should have it.  But this £20bn. announcement is one leg too few.  As Cook put it “I have nothing against your right leg but then, neither have you.”