Campbell McDonald, Managing Director at Baxendale, shares his thoughts on what the Spring Budget means for Health and Social Care.
Our social care system is frail and elderly. For too long it has been left alone, isolated and prone to minor trips and falls. And like preoccupied adult children with all-too-busy lives, successive Chancellors and Prime Ministers have not quite found the time to address its growing support needs. But stern calls from worried neighbours have prompted a dawning realisation that social care may be heading for a major fall – one from which it will struggle to recover.
Social care’s growing vulnerability is a mammoth problem for Government. Hope for the best, plan for the worst. That’s the sentiment coming out of Treasury today for the economy writ large. Seems like common sense. And yet this simple idiom exposes the deadly gulf between benign intent and lack of meaningful action.
Bean-counter-in-chief Philip Hammond would dearly love each and every one of us to hope for the best and plan for the worst in our own lives. Many aspire to such prudence, but more of us fall short. That’s where Spreadsheet Phil gets left to pick up the cost of a problem which will only get worse if left unaddressed – which it has been for far too long. In a different role under a different regime over a decade ago, I was asked to draft a Government response to a national newspaper campaign highlighting the growing funding gap for social care. It ended up as a kind of muted apology note: a rhetorical sigh and shrug. The No10 advisor who’d issued the request explained that social care just fell into the ‘too hard to do’ category.
Fast forward to today and are there any glimmers of silver lining around this grey cloud that provide grounds for the hope Mr Hammond is peddling?
The Chancellor – with his reported Sherlock-like eye for detail – has spotted that left alone any longer the local authority-funded end of the social care market will topple over.
Is Phil the carer this sector has been waiting for?
Budget Intervention No1 – £2bn of additional grant funding for social care over the next 3 years, front-loaded to put £1bn into 2017-18. This is significant and frankly a remarkable volte-face in the three and a half months since the empty-gestured Autumn Statement and a welcome recognition that the problem is here today. However – on a par with the now annual ritual of bailing out under-performing NHS Trusts – this won’t do much more than pick the sector up off its knees and keep it standing for a while.
Budget Intervention No2 – Er… well, otherwise the measures announced in the budget are all essentially directed at propping up the NHS. Small beer in the grand scheme but £325m over 3 years to support capital investment in STP plans; £100m to roll-out onsite GP services in A&E units; and confirmation of additional devolution of health spending in London. (And this after weeks of the rest of us having to endure Treasury and NHS England dance the ‘we’re not giving you anything – we’re not expecting anything’ dance.)
In truth, even the social care £2bn is really about the NHS. There are already unnamed NHS sources grumbling that they have no hard controls over how that care funding will be spent. Phil is making noises that local authorities will be expected to work closely with NHS colleagues, and there’s a clear sub-text that this needs to show tangible results in reducing delayed transfers out of hospitals, with the number of 2-3,000 freed up bed spaces already being cited.
No doubt the cash is gratefully received, but alone these measures clearly do not offer a sustainable long-term solution to the problem. They put off the worst, rather than constituting a (care) plan to avoid it.
For starters, it’s not quite clear yet how much of this cash constitutes new money (rather than shuffled around from elsewhere). More importantly, we’re being promised a Green Paper (note that – green not white, intentions not actions) addressing the inescapable but still unaddressed long-term funding challenge. So far this doesn’t appear to be yet another external dignitary commissioned to come up with answers the Government can subsequently distance themselves from, which is welcome. But all we do know is timing (the frighteningly vague refrain ‘later in the year’) and that it won’t be a tax levied on people’s estates when they die (Labour’s so-called ‘death tax’).
So no plan, not yet.
For too long, successive governments have failed to grip and address this problem. There are some fundamental truths in this space which are well known, increasingly reflected in policy intent but often lost in the noisy mess of implementation:
• We need a system that dovetails health and care as people’s independence diminishes, which wherever possible offers continuity of care from familiar faces as needs change, and which helps put the right support around people in the right setting at the right time (with as little actual relocation as possible).
• We need a sensible solution to the cash. People who can pay should, but they shouldn’t have to subsidise those that can’t. If we’re building a capital pot to cope with the complexity and impact of Brexit, we can build a pot and set of mechanisms that address the complexity of funding social care and ensure we offer dignity to those approaching the end of their lives without the means to pay for it themselves.
• We need a grown up dialogue about ageing and dying that puts responsibility on individuals to get in front of the inevitable challenges they know will come. This is more than just public health, it’s about how we help people to take responsibility for managing specific long-term conditions or reaching for home adaptations to stay safe at home for longer; how we help younger generations accept and plan for the support role that will fall to them; how we help local communities activate what capacity there is to counter isolation and protect quality of life.
The hope we’re clinging to today comes in no small part from a concerted campaign waged by NHS England Chief Executive Simon Stevens to get the Treasury to recognise the impact the ailing social care system is increasingly having on NHS performance. However, we must ensure Stevens’ STPs revolution doesn’t get stuck behind a system obsessed with hospitals.
No, we cannot continue with bankrupt acute institutions but as the King’s Fund powerfully addressed last week, only by building up capacity in community settings will we get out of the hospital trap. Those community settings include primary care and community health facilities and – critically – people’s homes, recognising someone’s home is wherever they live at that moment, be that sheltered housing, extra care, care homes or behind their own front door. We need up front investment modernising and building capacity in this community infrastructure if we’re going to make the break away from haemorrhaging cash by stacking up older people to languish in hospital beds.
Today’s budget heralded good intent and – at last – a bit of immediate action. But the sector will not survive long-term on intentions alone. More thinking, more solutions and more actions are required, and soon. What we saw today were the first steps of a Chancellor who has recognised he needs to plan for the worst. That alone is grounds for hope at this point.