What have we learnt in the government’s first 100 days?

After 100 days in office, the outline of the government’s health policy is now clear. The main focus is on reinstating financial discipline through controlling the costs of agency staff and management consultants, and a request to providers to redouble efforts to bring spending back into line with budgets.

For the public, the government has emphasised its commitment to seven-day working and to continue work to improve the quality of care and patient safety begun before the election. For NHS insiders, there is particular interest in the devolution of public services in Manchester and other areas, Jeremy Hunt’s ambition to reduce reliance on targets and encourage self-directed improvement, and the drive to publish more data on performance to increase ‘intelligent transparency’ in the NHS.

The decision to postpone implementation of the Care Act’s cap on care costs until 2020 marks the most important change from the path taken by the coalition government. The cap owed a great deal to the influence of the Liberal Democrats and its postponement reinforces concerns about the future of social care. The Fund shares these concerns and is about to begin a major piece of work led by Richard Humphries, Assistant Director of Policy, to analyse growing pressures in the social care market and their impact on users and carers.

There are similar worries about public health funding which has been reduced by £200 million this year in the first tranche of public spending cuts announced by the Chancellor. While not entirely unexpected, these cuts undermine the credibility of the government’s expressed commitment to prevention in the new parliament. As my colleague at the Fund, David Buck, has argued, taking money away from public health is short-sighted in the extreme, making it more difficult to moderate the rising demand for care from obesity and related challenges.

This autumn’s Spending Review assumes even greater importance in this context. The government has made a welcome commitment to not only protect the NHS but also find an additional £8 billion by 2020/21 to support implementation of the NHS five year forward view. The big uncertainty is how the £8 billion will be phased in. At a time when most providers are struggling to balance their books and are collectively forecast to be in deficit by £2 billion by the end of the year, there is an overwhelming case for the additional resources to be provided early in the parliament to avoid standards of care deteriorating.

The protection afforded the NHS creates a temptation for the government to increase the permeability between health spending and that on social care and public health. This is already being done through the Better Care Fund and the prospect of a £4 billion gap in social care funding opening up by 2020 may result in a decision to expand the scope of the Better Care Fund to soften the impact of further cuts in local authority budgets. The obvious difficulty in doing this is that it will add to the pressures facing an already overstretched NHS which will also be expected to find resources to implement new commitments like seven-day working.

To make these points is to underline the arguments of the Commission on the Future of Health and Social Care in England (Barker Commission) for a new settlement for health and social care in which there is a single, ring-fenced budget with sufficient funding to meet current and future needs. This would be paid for through a mix of increased public funding, reallocating resources from other areas of public spending and changes to prescription charges, phased in over a decade as economic growth returns and the deficit is eliminated. As the commission argued, the aim should be to spend 11-12 per cent of GDP on health and social care to fund a system that progressively aligns entitlements to social care with those of the NHS, and removes the complexities and inequities of the current fragmented system.

There could be no better way for the government to fulfil the Prime Minister’s commitment to govern for one nation, expressed strongly after the election.

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Comments

#544444 Derek fisher
House manager

I think money would be better spent on funding for more carers and better training for care staff. More front line staff in a&e and less money spent on red tape . It's a waste of time having someone work out performance tables and targets . Let them get on with their jobs and help them , don't hinder them . NHS staff in the main are dedicated and devoted to the job so gove them the correct status by upping the pay and leave them to do the caring . Enough pen pushing and more emphasis on care please.

#544453 terry bamford
chair
Healthwatch Bexley

The broken Manifesto commitment on capping care costs is deeply disappointing.

The crisis in adult social care seems to be recognised by everybody except the Treasury which ploughs on with its deficit reduction agenda. Inadequate support in the community leads to increased hospital admissions and higher costs to the taxpayer. And the situation will worsen with further cuts demanded in local government spending at the same time as care costs will rise. The clever games-playing of the chancellor with his increase in the minimum wage will add between 10 and 15% to the costs of domiciliary and residential care. Even Mr Micawber could work out what the consequence of lower income and increased costs will be for current providers.
That the minimum wage increase is to be financed by reducing tax credits and thus reducing incomes of the working poor is an irony which demands the satirical pen of a contemporary Jonathan Swift.

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