What are the prospects for health and social care in 2013?

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‘Ring out the old, ring in the new’ declared Tennyson in his New Year’s elegy, though 170 years later the lesser known line ‘ring out old shapes of foul disease’ may be more apposite to prospects for health and care in 2013. 

The closing months of 2012 offered little cheer. In November, the Care Quality Commission’s annual assessment of the state of care services warned that the increasing complexity of conditions and the growing number of people with more than one condition were affecting the ability of providers to deliver person-centred care. Then, the Audit Commission’s Tough Times 2012 report found that although most councils were coping with cuts, stresses were starting to show with many planning to make big reductions in adult social care spending. In a similar vein, our own mid-term assessment of the coalition’s health policy concluded that whilst NHS performance is generally holding up, cracks were starting to emerge. In December the Chancellors’ Autumn statement raised the spectre of at least four more years of austerity and a further 2 per cent cuts in local government grant (on top of the 28 per cent already announced in the last spending review). The numbers of people receiving publicly funded social care is already plummeting and little is known about what happens to people who fall outside the system.

Against this bleak backdrop, the spending review promised for the first half of 2013 looks to be the bloodiest yet. An outcome that sees the NHS continue to be protected from real-terms cuts will come with a heavy price of even deeper cuts in local government spending, of which the biggest controllable item is adult social care. The drumbeat of support for integrated care as a response to these pressures will grow louder still in 2013 – yet the boundary of health and social care will be where financial and service pressures will be at their fiercest. The potential impact of the welfare reform changes for health and social care has yet to be quantified. There are real worries that the financial squeeze on providers will compromise efforts to tackle poor quality care epitomised by Winterbourne and the Mid-Staffordshire Hospital (Francis) inquiry.

And what about social care? The wettest winter on record has not stopped the grass growing around the Dilnot report. The coalition’s mid-term review is expected to reiterate commitment to its principles, but it will be for the spending review to determine the level of cap beyond which the state will pick up the tab for individuals’ social care costs. A cap as high as £75,000 will seriously diminish the impact, especially on those with modest assets who suffer the most under the current system.

Government handwringing about Dilnot has helped divert attention from a bigger set of questions about how we pay for care that will become more urgent in 2013. The first and most fundamental question is what level of resources we need to fund good health and care services (which is not the same as projecting the future costs of our existing, dysfunctional system); the second is to what extent these costs should be shared between the individual and the state (the question Dilnot was asked to consider in relation to social care). The third, and probably the most contentious question, is where the money comes from (in terms of re-prioritising existing public spending, changes to taxation, or new forms of taxation, insurance or charging).

These questions are just as valid for the NHS as they are for social care, yet history has bequeathed very different answers, crafted in the different world of the 1940s. As a result, means testing, co-payment and self-funding are firmly embedded in social care to an extent many would consider unthinkable for the NHS. A generally benign post-war economic climate has meant that the consequences of these differences could be fudged, ignored or in some cases camouflaged by policy complexity (for example, by creating the concept of continuing health care). Demography and austerity has put paid to that. And rising levels of people with more than one illness will defy efforts to compartmentalise needs into ‘health’ or ‘social’ care categories. 

Our Time to Think Differently programme aims to stimulate ideas and debate about fundamentally changing the way services are delivered and funded. In 2013 pressures on local authority and NHS budgets will become so great – and the clamour for better co-ordinated services so loud – that it will be increasingly impossible to duck the big questions about what kind of health and care system we are willing to fund, how this can be achieved and where the money comes from. 

This blog is also featured in Health Service Journal.


Steven Burnell

Focused_On Ltd
Comment date
03 January 2013
We need a complete redesign & transformation of Health & Care Service policies & provision, instead of the current piecemeal default.
The optimum number & size of General, Specialist, or Mental Health Hospitals ( £1Bn per annum.
Care of the Elderly needs to be delivered with the same patience & compassion as Care of the very Young and we need tangible Outcomes to be delivered by the Dementia Strategy.
GP's need to add more value to QOF outcomes.
Government Policy on Competition needs to put far more emphasis & incentive on Cooperation instead.
Front-line Staff (Ward Nurses, CPN, Soc.Workers, Health Visitors etc) must carry Caseloads that are challenging but safe & appropriate.
Mental Health needs to be regarded as just another branch of medicine.
Systems, processes, & policies & incentives need to remove all vested interests that are not the Service User's best interests.
Priorities to reverse the increasing prevalence of Obesity, Diabetes, & other Long Term Conditions including Dementia must be supported by Strategies of significant Invest-to-save.
The £20Bn Nicholson Challenge must be seen to be reinvested in Service Transformation & not just absorbed by unmanaged shifting of Demand.
The NHS culture of Bullying is corrosive & needs to be replaced by one of Care & Responsibility.
Every single individual working in Health & Care Services (whether in Accounts or an Ambulance or Acute ward or GP or in a Community Crisis Team) must understand & accept how & why they must help improve Standards of Care & give excellent value for money.
Some aspects need Redesign & Transformation, but every aspect needs to deliver demonstrable Continuous Improvement.
We need everything & everyone to focus on what is best for the Patient / Service User & this includes getting the Public to accept our share of responsibility for looking after own health.
We do not need to have fat kids, so Schools must provide more physical activity & Councils must be allocated funds for this too. Prevention is much cheaper than the pending tsunami of bad health.
Cuts-for-the-sake-of-cuts is a fool's game. We urgently need to drive service Quality Up if we want to drive unit Costs Down because to design & deliver ever higher levels of QUALITY is the only viable way to deliver affordable & sustainable Services.
The Health & Care industry must accept a new & everlasting Challenge: There is a Ceiling to what the public can afford but there is no limit on the Quality of Service we demand. Now, you are paid to meet this Challenge every day, so learn to love it.
Until then, I am not convinced that the Standards of Service that Patients & the Public require are unaffordable if this Challenge & all of its inherent consequences remain unattended.

Mike Nicholls

Chair Social Care Retired,
Comment date
14 January 2013
Whilst integration of services, the redesign of services and the use of technology may help these measures in themselves are not a panacea. The plain fact is that more money is required. I do not believe there is the political will to face up to this problem. It does appear that old things are more important than old people. Just recently there have been proposals to preserve the nuclear missile bunkers or the money that is spent to save works of art " for the nation". A concept I really do not understand. A painting that is hung in a gallery in London and is seen by a few tens of thousands of visitors each year is hardly for the nation. A question was asked in parliament recently about the cost of floodlighting the Palace of Westminster. For technical reasons they could not supply an answer, but does it need the current level of illumination?

There are many other examples of where prestige comes before necessities.

In this category we must include the Olympic Games. I for one was enthralled, transported, uplifted by the games, as was the whole country and would not have missed it for the world, but they did cost the country £10bn.

The people who should be most worried are those in their 40's and 50's. If we look forward 30 years, then even if, the forecasts are 30% too gloomy, the situation they will find themselves in will be far worse than the current situation.

I am sick to death of being told how important is choice. For far too many it is choice for the few and the abandonment of the majority.

Whilst relatively short and intensive interventions can be most effective, in regaining lost abilities, these are a small fraction of the elderly population. For those elderly carers in their 70's and 80's, often themselves suffering the chronic conditions of old age, who are caring for a dementia sufferer and cannot leave the person they are caring for on their own for more than 20 or 30 minutes. They need practical hands on support. At present there are many sources of advice Social Care, NHS, and at least three other organizations locally. This is all to the good, but it does not give the carer any time to themselves or help with the many practical tasks to which dementia gives rise. Whilst things are slowly improving it is far too slow for an eighty year old carer, they cannot afford to wait.


senior practioner,
national autistic sociaty
Comment date
24 January 2013
I have been working for the organisation now for 15 years. Many Staff have come and gone . We havent had a pay rise for 4 years and i am sure we wont get one this year. Everyone is feeling the cut backs. But if staff are payed peanuts then they will surely become none productive. Thus bringing the duty of care they should be providing down. Now with low care standards comes abuse.and we all know where that leads to. Supervisions or MSDs cannot combat this.nor safeguarding. staff moral will be at a all time low. sickness and stress has also becoming a major issue. i have foundout from my staff that they are worried about the rising cost of house hold bills. And thier wage cannot cover them. These staff are very committed to the job they do. The prospects in care work has become extinct. We understand the funding must be reduced in these harsh times to continue to give support .our workload has risen due to competition from other companies.and we have been given a proposal to take a pay cut in the coming months. What next .

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モンクレール ダウン レディース
Comment date
13 January 2015
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