No journey's end for care funding

12 Jul 12
Richard Humphries

The transfer of £300m from the NHS will help care funding in the short term. But robbing Peter to pay Paul is not a sustainable long term solution 

There’s a scene in the war film ‘Ice Cold in Alex’ where John Mills and Antony Quayle are pushing a broken-down ambulance up a steep sandbank in the Sahara desert, only to see it roll back all the way down to the bottom. The sense of their exhaustion and despair is palpable.

One of the most pressing policy challenges of our age is finding a fair and sustainable way of paying for the success of longevity and ageing.  There’s been so much effort over the last 13 years to find a solution - two independent commissions, three public consultations and now three white papers. Yet reading the government’s progress report on funding, it feels like ground has been lost and the way ahead has become even more of an uphill struggle. Why the pessimism?

First, the government seems to barely acknowledge the existing pressures on services, instead repeating its insistence that councils have ‘sufficient funding’ to maintain the existing offer, a mantra surely discredited by evidence of two consecutive years of cuts in adult social care budgets while the numbers needing support rises inexorably.  Secondly the government is committing only to consider the principle of the Dilnot model. It’s clear the Treasury want to examine variants including voluntary options for financial protection.  This seems to re-open the debate which many thought Dilnot had concluded.

Third, there is no timescale for decisions about funding and the timetable for the next Spending Review through which this will be addressed has yet to be announced. And finally there are no provisions in the draft Care and Support Bill to implement any funding changes. The upshot is that we can expect no reform before 2015 at least - five years after the coalition’s commitment in its programme for government that it recognised the ‘urgency of funding reform’.

There are some positive and necessary proposals in the care and support White Paper and it describes a vision of a transformed care system based on personalised choice and control from a range of quality services. But there’s a financial vacuum at the heart of the proposals. Laudable aspirations for higher quality services offering more choice are completely disconnected from what they will cost, how they will be paid for, and where the money will come from.

This leaves local authorities and the NHS with a big financial headache. The transfer of £300m from the NHS will help in the short term, but robbing Peter to pay Paul is not a sustainable long term solution at a time when the NHS is facing the severest financial challenge in its history.

Further delay will not alter the simple arithmetic that care costs will soar as more of us grow older. Without reform they will fall indiscriminately on councils, individuals and their carers, providers and the NHS. There isn’t a no-cost option and in the absence of a clear framework in which local authorities, NHS partners and private individuals can plan ahead, the pressures will only get worse.

In the film, John Mills made it to Alex and enjoyed his ice-cold beer. Where this journey will end - and when - has become a lot less clear.

Richard Humphries is a senior fellow, at the The King’s Fund think tank




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