Will Jeremy Hunt be able to join up health and social care?
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Version 0 of 1. When the Queen delivers her speech from the throne today, the one thing there won’t be is new legislation on health or social care. The word in Richmond House is Carry on Quietly, or as quietly as possible, while trying to navigate through a potentially catastrophic debt crisis among NHS foundation trusts that only adds to the familiar pressures of demography and the need to reform. But Jeremy Hunt starts with some advantages, not least that for him this is of course not a start, merely a return to business. Not since Norman Fowler back in the 1980s has a health secretary stayed in post through an election. And although he has yet to clock up three full years in the post, Hunt has already served longer than anyone since Alan Milburn set off with reforming zeal in 1999. So at least he knows what he has to do. Once again the professionals are nervously circling the utopian future of integrated health and social care But that is never the same as doing it. In particular, the question is whether he can – in the midst of this cash crisis that means the deficit among NHS providers is already likely to be close to £1bn – oversee the transformation in health provision that is envisaged in NHS England boss Simon Stevens’s Five Year Forward View. It seems, the long-term viability of the health service depends on the capacity of providers to construct new (more cost effective) models of care. Will crisis make reform imperative, or impossible? Once again the professionals are nervously circling the utopian future of integrated health and social care, trying to calculate quite how to get to it without letting go of what they’ve got. Some argue for piling in transformational cash now, others fear it will only be used to shore up the present. “What will happen to the Better Care Fund?” one expert in local government pondered. “No one wants it. But no one has any better ideas.” At a King’s Fund event last week an NHS boss came to just the same conclusion. The £5.3bn programme announced in the 2013 spending round is supposed to drive pooled health and social care budgets and better collaboration. But different funding arrangements – of which only the most obvious is that healthcare is free at the point of use unlike social care – and different cultures drive a wedge between the two. The obvious difficulty is that while the NHS is in dire straits financially, social care is being bled dry. Local government has already had cuts over the past five years averaging more than 23%, and over 40% in some areas like Westminster, and it’s only going to get worse. At the same time, the Care Act, which came into force last month, will create real pressure in costs of provision of social care. By raising the amount of assets people who need care can keep before they have to meet their own care costs, many more will be entitled to support from their local authority. At the same time the cost of providing care is likely to rise as demand grows and pay slowly begins to pick up with the economic recovery. Local government is bracing itself for a significant increase in costs just as the cash to meet it gets tighter still. The Local Government Association has predicted a £4.3bn funding gap in adult social care by 2020. Much hangs on the success of the pioneering project to devolve the health budget in Manchester So while councils moan about a lack of constructive engagement from their local foundation trust, health providers look at the sums and accuse councils of preparing to spend precious cash from the health budget on school dinners or meals on wheels. There is a damaging, possibly unbridgeable, culture gap between health and social care that at the very least underlines an institutional failure of imagination and an inability to focus on what individual patients want and need to lead healthier (less expensive) lives. Much hangs on the success of the pioneering project to devolve the health budget in Manchester that was announced in March. Its overarching ambition is to improve health outcomes, and optimists hope it could lead to a real revolution in the way healthcare is managed and delivered. Pessimists fear it will be another structural challenge to an organisation that is already weakened by multiple and conflicting accountabilities. Right now, it’s hard to envy the health secretary. Anne Perkins is a Guardian leader writer |