Social care in England faces an acute funding crisis within two years, with the current raft of NHS reforms likely to distract from the black hole in funding, MPs on the Commons Health Committee have warned. They believe the arguments about the Health and Social Care Bill are drawing attention away from a demographic timebomb; demand for social care is rocketing, but the budgets to deal with it are set to fall rapidly in real terms.
When it came to power the coalition set up the Dilnot Commission on care for the elderly, which reported last year and recommended wide-ranging reforms for how it's financed. But the government has yet to formally respond to Dilnot, and in the meantime efficiency savings are creating a potential "pinch point" in funding, which some MPs believe could kick-in within two years.
The Health Select Committee is chaired by Stephen Dorrell, a Tory MP and former health secretary in the Major government. It worries: "The Government’s response to the Dilnot Commission’s proposals due in the first half of this year will, we hope, set out how a sustainably funded system will continue into the future. The challenge for local authorities and the Government is to continue to provide a meaningful service until a new system is in place."
Stephen Dorrell told Today on BBC Radio 4 that: "non-headline grabbing services are being cut in order to achieve short term budget savings. Very often that can be physiotherapy services provided to elderly people. There are examples around the system of care not being delivered to the standard that we want to see."
Speaking to HuffPost UK Dr Sarah Wollaston, A Tory MP who sits on the committee, warns: "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," she added.
MPs are worried that for all the furore being generated by the government's NHS reforms - enshrined in the Health and Social Care Bill currently stuck in the House of Lords - a separate set of efficiency savings, commonly known as the Nicholson Challenge, are being overlooked. The Nicholson Challenge, named after Sir David Nicholson, Chief Executive of the NHS, requires efficiency savings of 4% year-on-year. At the moment MPs see little sign that acute services provided by NHS hospitals are being co-ordinated with the social care aspects of local authorities, something they believe absolutely must happen if the efficiency savings can be met without compromising patient care.
Although NHS budgets were ring-fenced by the coalition shortly after it took office, local government budgets were severely cut, more so than any other department, and the Personal Social Services grant was absorbed into the more general grants given to councils by the government. Some MPs believe that unless the NHS and the services run by councils learn to work together more effectively, serious problems could present themselves within a matter of months.
MPs also believe uncertainty about the NHS reforms - which although still yet to clear Parliament have been trialled in parts of the country for more than a year - aren't helping. They say reform: "creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings."
But the health select committee notes: "A common thread running through these issues is the marked disconnect between the concerns expressed by those responsible for delivering services, and the relative optimism of the Government."
Health Secretary Andrew Lansley said on Tuesday morning: "We are integrating health and social care more effectively, and the Health Select Committee report acknowledges that."
In a sign the government might allow further revisions to the Health and Social Care Bill, Lansley said: "The Lords are making many significant and constructive suggestions... but the principle of the Bill is supported."
Dr. Wollaston tells HuffPost UK she's not even convinced the NHS reforms needed to be put through Parliament at all. "Monitor, the financial regulator and the Health and Wellbeing boards should be tasked with helping to make health, social care and housing work together," she says.
"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."
The next stage of the Health and Social Care Bill is in the Lords at the beginning of February. MPs conclude: "The need to provide high-quality and efficient services that meet local needs within the funding available must be addressed as a matter of urgency."
Labour responded to the report saying: "The Committee’s conclusion is unambiguous; the Government has placed the NHS on an unsustainable path and it simply has to change course if serious damage to patient care is to be avoided.
"The report gives powerful voice to what the vast majority of people across the NHS are saying. Last week, the Government tried to dismiss the concerns of nurses and midwives but today find themselves in the uncomfortable position of hearing them echoed by senior Conservative MPs."
On the issue of whether the government should abandon the Health and Social Care Bill, Stephen Dorrell was more cautious, telling Radio 4: ""We wouldn't have set out down this management change path, but the truth is it's very difficult to see how you could go back, that would only prolong the issue."
"The truth is demands by patients have to be met today, tomorrow and the day after," he added.
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