MPs from the Health Committee on which Sarah Wollaston sits have signalled grave concerns that budget cuts combined with NHS reforms could have severe consequences, particularly for social care in the NHS. HuffPost UK asked Dr Wollaston for her take on the rapid changes which are expected over the next 12 months...
What's your assessment about how the Health and Social Care Bill reforms sit alongside the budget pressures you clearly identify? Are these "disruption and distraction" elements you highlighted potentially catastrophic ?
The Select Committee report did draw attention to the financial pressure on the system but of course the spend on health has been protected, especially in comparison with other departments. The problem is the underlying increase in demand as a result of an aging population with complex needs. The fact is that unless we also change the way we spend the available funds the system will not cope. The lesson from previous large scale reorganisations is that they distract management from the more pressing need to deliver a better service on the ground and usually cost more than anticipated.
Do you get any sense that the government realised when it called for the savings it did that many of these would be one-off savings and that the 'cuts' - perceived or otherwise - would actually become more severe in the subsequent years?
The problem is that too many Local Authorities and PCTs are salami slicing current budgets or restricting the criteria for support rather than putting in place the kind of changes where social services and the NHS pool resources and care teams to make savings and deliver a service that keeps people out of hospital. There are many examples of good practice and some were happening without the reforms.
Break it down for us, Tell us how you're feeling about the pace of reform.
Competition doesn’t have to be at odds with developing pathways of care which are integrated across health and social care or across GPs and hospitals. Let commissioners develop the best and most efficient systems locally but don’t waste money on endless legal challenges to make a point about competition.
Monitor, the financial regulator and the Health and Wellbeing boards should be tasked with helping to make health, social care and housing work together. As to the need for the Health and Social Care Bill, much of it has already happened without the Bill even being passed. Few PCTs were doing a great job of driving integration but some were, so the question remains as to whether we would have been better to look at examples of best practice and roll these out. Some argue that it couldn’t be achieved everywhere without an almighty shove but the Bill has been acrimonious and that was perhaps unnecessary.
There appear to be some parallels with what's happening at the Ministry of Defence in terms of a rush to save money taking priority over operational issues. Is that a fair assessment?
The MOD had to sort out an even greater procurement fiasco although the scandal of PFI is going to threaten the viability of several trusts. Poor Labour decision making with contracts that can’t be broken...yes that sounds like the MOD.
Given it could take a considerable amount of time to implement, do you forsee a 'pinch point' taking place within social care. If so, how soon and how servere?
The pinch point will be coming in the next couple of years unless health and social care can make real changes to the way care is delivered and start working together everywhere instead of in pockets of good practice. The Coalition also needs to look at implementing the Dilnot report but in a way that recognises that Health, Social Care and Housing are all closely linked when it comes to making sure that people can keep their dignity and independence at home.
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