Ever the optimist, I find myself looking elsewhere for examples of integrated social and health care, supported by realistic and sustainable funding, and hoping that a kinder society back home might grasp the opportunity to follow suit sooner rather than later. Unfortunately, now that the dust is beginning to settle on the autumn spending review it seems it has done little but place a sticking plaster over a gaping wound.
But let’s search for the positives. Surely allowing local authorities to raise and ring fence council tax by 2% (producing about £2bn according to George Osborne) is a welcome move? As is the government pledge (?) to put a further £1.5bn into the Better Care Fund between 2017 and 2019/2020. To those not close to the funding realities of both the NHS and Social Care this may seem to be a substantial gesture. To those who are closer than me, it has been described recently as “short sighted”, “another setback”, and a “high risk strategy”, “defying demography”, “meaningless” and even, according to the think-tank The Kings Fund that focuses on the health system in England, based on “completely implausible assumptions made by the Treasury”. Surely not I hear you shout!
According to the Kings Fund, the 2% will raise at most £800m a year – far less than the £2bn the Chancellor predicted. This is at least partly because the £2bn figure relies on all of England’s 152 councils deciding to levy it. It ignores any lack of enthusiasm for this measure, or election promises of no council tax rises. Furthermore, the money raised will not be equitable or effective due to the fact that those local authorities that have the greatest need for publicly funded social care are least able to meet it because of their relatively low council tax base, further embedding inequality. Other commentators have made the point that as the 2% ring-fence sits on top of a largely discretionary budget it surely means that while councils will spend that 2% on social care, they will simply reduce the amount of money that they would otherwise have allocated to social care from their main budget, making little or no difference to the overall amount spent on social care in their area.
As for the Better Care Fund, designed to more closely integrate social care and health care, much of the funding that is already in place for this has been created by redirecting NHS funds from the budgets of acute hospitals on the assumption that better services in the community will result in fewer people being admitted to hospital. The extra £1.5bn announced in the autumn spending review is to be paid for out of cash from the new homes bonus, which is supposed to incentivise councils to speed up planning. It all sounds depressingly like ‘chairs on the Titanic’ to me, and it’s difficult to see any of this leading to material increases in what is actually spent on social care, despite the inevitability of an inexorable and unavoidable increase in demands on this service.
Despite all the rhetoric, by the end of this parliament, spending on social care as a proportion of GDP will have fallen (yes fallen) to 0.9% – the lowest level since 2001. In the face of an increasing older population, this clearly defies demography. So I suggest (without much hope!) that our political leaders should start to be more honest about the situation. The reality is that publicly funded social care is currently the thinnest of safety nets for the most vulnerable in our society and the NHS as a cradle to grave safety net for us all is unsustainable without a completely new approach to funding. Without such a total rethink, the fundamental problem remains; there is simply not enough money in the health and care system to allow it to do what we want it to.
At the end of the day it comes down to the electorate deciding exactly what kind of society we want to live in going forward. But to be able to make an informed decision, some political honesty and intelligent debate wouldn’t go amiss. I for one would like to live in a society that looks after its older people better than it does today. And as one of the 10 richest countries in the world is that really such a big ask?
Anthony Miles
Director, Miles Associates Ltd