Posted on July 5, 2018 by Abdool Kara
It is the 70th anniversary of the NHS and, like most 70-year-olds who haven’t taken good care of themselves, the NHS is starting to show its age and is creaking at the seams.
Despite the fact that many of the treatments and procedures available under the NHS today would seem like science fiction seventy years ago, we also see evidence of a tired, inappropriately sized and located health estate; a lack of investment in prevention, early intervention and public health more generally; and the absence of an integrated approach to service delivery, not least joint working with social care. This is an issue the Comptroller and Auditor General (C&AG) explored in an interview with the Guardian and our recent blog looking into the NAO’s role supporting improvements to the NHS.
Although the Prime Minister announced some additional funding as a 70th birthday present, many of our studies have demonstrated that more funding is not of itself the solution. There are underlying issues that the NHS will continue to struggle with unless there is meaningful change, in particular achieving real integration with social care services, and long-term financial planning for both health and social care services.
Our recent report Developing new care models through NHS Vanguards highlights the problems the service has with long-term financial planning. Money for transformation, including better integration with social care, was reallocated to reduce trusts’ financial deficits. In 2015, the Department of Health approved £2.2 billion transformation funding, however, actual direct funding was £329 million over three years. Much of this was reallocated to reduce deficits in the system, rather than addressing the long-term financial needs of the service. This approach does not support the transformation that is desperately needed.
Integration of health and social care services offers the greatest potential for the delivery of holistic care for patients and service users, and the renewed focus on integrated working between the NHS and social care through the Improved Better Care Fund is positive. But the gap between the two still exists. It is fair to say that despite goodwill on both sides, the different statutory basis, funding mechanisms, regulation, governance, structures and cultures of the NHS and local government have not lent themselves easily to better joint working. Our report The health and social care interface explores these issues in more detail.
Nonetheless, there is much good work being undertaken locally to overcome these barriers, but often this is not happening at the scale and pace needed. The additional funding announced for the health service is welcome, but it is just that, additional funding for the health service, while social care services continue to struggle. After 12 white papers, green papers, consultations and five independent reviews and commissions in the last 20 years alone, progress has been patchy and the historic issues remain. Better coordination between the different elements of health and social care delivery must therefore remain as the primary focus for any future transformation of services.
Despite the recognition that change needs to happen following the controversial Lansley reorganisation, the health sector is understandably apprehensive about large-scale reform. But there is a window of opportunity for both services with the Social Care Green Paper promised in the coming autumn to coincide with the updated NHS Plan, particularly if this paves the way for the creation of integrated care organisations and capitated budgets which promote whole-person care and better access to essential services in community and home settings.
There needs to be a much wider strategic vision encompassing all the services that contribute to the health of the population – not just social care, but housing, leisure, good education, community safety and so on. Without this wider vision, a long-term financial plan, and a commitment to closer integration, any additional funding will not enable the NHS to make the essential changes to services, adopt new technologies, or significantly increase the number of clinical staff needed to improve the quality of its services.
As always, we welcome comment on any issue raised in this blog-post and invite you to contact us if you have any queries.
About the author: Abdool Kara joined the NAO as Executive Leader, Local Services, in February 2017. His previous roles including working for four different councils up to and including chief executive level, and seven years at the Audit Commission on both value for money and inspection. He also worked at the Cabinet Office on public service improvement.
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