Behind closed doors in Whitehall, the Conservatives are again at war, and this time the future of health and care is in the balance. According to recent reports, Jeremy Hunt is battling with Philip Hammond and the Treasury over how much money the NHS will get as part of the government’s long-term funding deal.
That funding, whatever the final sum, is likely to be announced to coincide with the NHS’s 70th anniversary in July. Many in government will no doubt be hoping that it will help to demonstrate that the Tories can be trusted to run one of the nation’s best-loved institutions by giving it a long-awaited birthday present. They know that voters will not tolerate many more news stories about queues of ambulances and patients dying in hospital corridors – and these extra funds are desperately needed to reduce waiting times and relieve huge pressures on urgent and A&E services.
Now is not the time for political timidity. The interim report of the independent Lord Darzi Review, which was published last month by IPPR, found that annual spending on healthcare will have to rise from £123bn last year to £173bn by 2030. Although these are huge sums of money, there is clear international evidence that failing to invest public funds will end up costing the taxpayer a lot more money. It’s clear that the NHS urgently needs new funds, but the really tricky task will be ensuring any new money does not get eaten up by the spiralling demands of hospital care, without regard for how to build sustainability into the system as a whole.
Most experts agree that, faced with an ageing population and the increased prevalence of long-term and chronic diseases, the best way to reduce long term pressures on hospitals is to radically increase investment in community-based care models that allow for far more people to be treated outside of a hospital setting, and to ensure that they can be quickly and safely discharged once their hospital stay is over. But this involves tricky discussions about shifting the balance of NHS funds away from investment in hospitals and acute care, and towards primary health care and social care.
One example that epitomises the problems caused by the current system is that of end of life care. On Sunday IPPR published a report, part of a wider collaborative programme of work, led by the Centre for Health Policy at Imperial College London, which shows that increased public investment in long term care in the community is associated with better quality care and reduced pressure on hospital beds.
Care at the end of life is disproportionately expensive compared to other life stages, and it is particularly expensive in a hospital setting. There is a strong case that shifting the location of care will lead to improved outcomes for patients, as well as cost savings to the taxpayer. But this shift won’t happen on its own – instead it will require significant additional financial investment in community-based care.
Making the case for greater parity between health and care is hardly a new argument, but it feels like one that still needs to be made. The government will announce new money for the NHS along with warm words about creating a long term plan for a sustainable system but it is far from clear that whatever funds are allocated to social care will be enough to put it on a firmer setting. Not that anyone needs a reminder but substantial cuts to local authorities’ budgets have had severe consequences on the frontline including rising unmet need and pressures on quality and safety. And this is only likely to worsen, particularly given growing signs that the slow motion car crash that is local government funding is gathering fatal momentum.
To date the government has indicated that any funding solution for social care would continue to involve individual contributions - and has shown little inclination to set out how it will make local government finances more secure. With a forthcoming Green paper on care and support for older people, Jeremy Hunt has the opportunity to set out a radical and sustainable solution for how to do this. He should not pass it up.
Jack Hunter is a Research Fellow at IPPR North. He tweets at @JackIPPR