Treating the NHS as sacrosanct inevitably imposes costs on other services. Have we got our priorities wrong?
Politicians of all parties are anxious to say that the NHS is safe in their hands and that it will always have priority when it comes to funding. They feel they have to say this. As the former Tory chancellor, Nigel Lawson, once said, the NHS is the nearest thing the British have to a religion.
But treating the NHS as sacrosanct inevitably imposes costs on other services. Now even NHS managers are saying it makes no sense. In particular, they say that cutting the money spent on social care for the elderly is bad not only for old people but also, ultimately, for the NHS too. Have we got our priorities wrong?
Over the last decade spending on the health service has increased by around a quarter in real terms. It might not seem obvious if you’re queuing in A&E for hours or see waiting times for non-urgent operations getting longer, but that’s because demand for NHS services keeps rising at an even faster rate. And the main reason for that? We are living longer.
Over that same period spending on social care has remained flat, even while demand has been soaring. The number of people aged 65 or over has risen by a third over the last decade and it is forecast that it will rise by a further 40% by 2033. By then it’s estimated there will be 16 million people in this age category.
Meanwhile, there are now 200,000 fewer elderly people getting social care help from the state then there were five years ago. The number of beds available in care homes has fallen and the number of council-funded places has dropped by 26%. It is reckoned that the social care budget would need an extra £5bn a year simply in order to restore the service to where it was a decade ago.
The pinch is felt mostly by elderly people themselves, for whom it is harder to get care workers to visit them at home to help with the mundane business of getting themselves up, and washing and feeding themselves, or to find a place in a care home when they can no longer safely live in their own homes.
But it’s also felt by the NHS. That’s because without help at home, elderly people are more likely to fall and break a limb or have chronic diseases such as diabetes turn acute. When such things happen, the elderly inevitably turn to the NHS for help and the result is avoidable extra pressure on the health service.
This week inspectors from the Care Quality Commission reported that almost six in ten A&E units are inadequate simply because they are overwhelmed by the demands of elderly people. David Behan, the chief executive of the CQC said: ‘Where people aren’t getting access to care … they are presenting in A&E’.
Furthermore, when elderly patients in hospitals are unable to return home after their treatment has finished simply because there is no care available there to make it safe for them to do so, it is estimated around 184,000 ‘nights’ a month are lost in NHS hospitals. So-called ‘bed-blocking’ has increased by 25% in the last year alone.
Now NHS managers themselves are complaining about the madness of a system that they see as starving social care budgets in order to fund the NHS. Stephen Dorrell, the chairman of the NHS Confederation and a former Tory health secretary, said this week that governments should stop ‘fetishising’ NHS funding. Social care not the NHS should be at the head of the queue when the Chancellor loosens the purse strings in his autumn statement next month.
He said the fact that Simon Stevens, the chief executive of NHS England, had himself called for more money to go to councils who provide social care ‘reflects that fact that even NHS managers recognise that they can’t do their job properly if social care is falling over’.
Mr Dorrell said: ‘Fetishising the NHS budget and imagining it’s the only public service that relates to health is fundamentally to miss the point. It is not true to say we are supporting the health service by asking it to do social care. We are using the health service as a very expensive social care service and then talking about efficiency. It’s insane economics and very bad social policy’.
For politicians to follow this advice, however, will require not only accepting the analysis but also taking a very different view of the politics of the matter. One of the reasons why NHS funding has had such a priority is that it has been in the hands of national politicians to dole out and, incidentally, claim the credit.
But it is the responsibility of local councils who get the blame for any shortfall, even though the bulk of their own funding comes from central government. The current government has pledged to increase the money it gives to councils by £3.5bn by 2020, but few observers think this will deal with the problem.
Many of those involved in the health and care sectors argue that the fundamental problem is that they are kept separate and need to be integrated. Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: ‘The NHS and social care go hand in hand – we cannot fix one if the other remains broken’.
Some moves towards integration have already begun. In Torbay and South Devon, for example, local NHS leaders and the local council have coordinated their services with the result that emergency hospital admissions among the elderly have been dramatically cut. The government’s plans to devolve services to the new mayors of city regions like Manchester, Liverpool and Birmingham, may have the same effect of saving overall costs for the care of the elderly.
But in the end, however big the savings through integration of health and social care may be, it is likely that the NHS budget for everyone else will have to take a hit. That is the implication of what Mr Stevens and Mr Dorrell are saying.
Are we prepared to accept that? Are we prepared, for example, to accept new sources of funding (including charges) for some of the NHS treatments we now expect to be funded by taxation in order to release enough money for social care for the fast-increasing numbers of the elderly who will need that care? In short, are we prepared to compromise some of the articles of faith in our NHS religion in order to deal with the crisis in social care?