It is widely accepted that the health and social care sector is under serious financial pressure.
However, this is not going to be solved by continually pouring valuable public resources into the machine.
What is needed is a financial framework that allocates sufficient funding to the right places, to ensure that the right outcomes are achieved.
What we currently have neither supports the government’s policy rhetoric on integration and prevention, nor helps us move towards place-based care with a focus on outcomes.
There are a number of distinct but related issues at play – the overall financial position of the NHS, barriers to integration created by funding flows themselves and the absence of a long-term sustainable funding solution for social care, to name a few.
The NHS long-term plan and the related consultation on legislative change are beginning to recognise some of these issues, albeit mainly within the NHS itself.
'The NHS long-term plan and the related consultation on legislative change are beginning to recognise some of these issues, albeit mainly within the NHS itself.'
Proposals to improve the financial position of the NHS are welcome, and indicate some acknowledgement that the money is not always reaching the right parts of the system.
There is also perception of some of the barriers to integration, with proposals to alter funding flows, increase flexibility of payment systems and contract arrangements to encourage better collaboration and integration within the NHS.
These are positive developments – they begin to address some of the mismatch between objectives and incentives – but are unlikely to provide a lasting solution.
The proposals look only as far as the boundary of the NHS. Existing legislation already allows for limited pooling of budgets with local government, and there is a commitment to review the Better Care Fund.
Those areas where health and local government are working in an integrated manner have been calling for further improvements – but, despite commitments in the Long Term Plan, these issues remain unaddressed.
The recent consultation on proposed legislative changes commits only to working with local government to see how existing provisions might be improved.
A major barrier to integration is failure to address the funding of social care, which faces a £3.6bn shortfall by 2025 (not accounting for any increase in demand).
Without a long-term social care funding settlement, it will be increasingly difficult to make the NHS sustainable.
Read here PF’s recent analysis on integrated working solutions for the NHS.
