Health and Social Care: Dribs and Drabs
The Department of Health and Social Care (DHSC) announced on 2nd October that another £240M would be made available to local authorities to “reduce pressures on the NHS by getting patients home quicker and freeing up hospital beds across England.” This is in addition to:
“£145 million given to the NHS in September to boost winter resilience, which will go toward upgrading wards, redeveloping A&E departments and paying for an extra 900 beds,
£36.3 million awarded to ambulance trusts in June to prepare for the colder months, which will go towards buying 256 new state-of-the-art ambulances,
As announced in last year’s budget, an additional £1.6 billion has been given [to the NHS] for 2018 to 2019.”
No mention here of the £800M increase also for the current year that Mrs May announced in June as part of the £20bn five year uplift. There were two curiosities about that:
The plan for spending the money will not be available until the autumn. How can one establish the budget without first assessing the need and how it should be met?
Furthermore, despite the previous Secretary of State’s insistence that the NHS and adult social care must be considered together, the Green Paper for the latter is not due for some months. They are being considered separately.
This new £240M exemplifies disconnected, dribs and drabs, thinking. The headline claims it will be used to relieve bed-blocking. £240M is equivalent, according to the arithmetic above, to 1,490 extra NHS beds. But that headline is contradicted by the following body copy which says the £240M “could pay” for “one of” three options, none of which, it seems, has yet been chosen. The first is relevant: “more than 71,500 home care packages to help patients get out of hospital quicker”. In other words, 1,490 NHS beds cost about the same as 71,500 places at home. It looks like local authorities need the money a lot more than the NHS and the latter could afford to divert more of their resources to achieve that without additional funding.
The link to relieving bed-blocking, however, is then broken by the methodology used for allocating the money to local authorities, namely the “adult social care relative needs formula”. In case you don’t have that, or more accurately those, at your fingertips the one for older people looks like this:
The point here is that the formulae being used to distribute the extra moolah have no relationship with the intended purpose: unblocking beds. If that really was the intention, one would total the number of beds capable of being unblocked and distribute the funds pro rata to the local authority recipients of those patients.
Mushy thinking aside, there is a much bigger issue undermining the DHSC. No one is looking at the health and care picture as a whole. No one is ensuring that waste is removed. As Lord Carter of Coles warned on 27th September “£20bn cash boost for NHS ‘could be lost to waste’”. MPs have been saying much the same but there has been no response. No one is establishing the boundaries and the priorities. Instead, money is being parcelled out in dribs and drabs on the basis of oiling the wheels that squeak the most.