Divide between social care, public health and NHS ‘bad economics and bad social policy’

The former health secretary and current chair of NHS Confederation, Stephen Dorrell, has written a letter to the chancellor urging him to treat social care and health as a single sector and rescue dwindling public health budgets.

In the letter, Dorrell said the recent trends of rising NHS budgets and sinking social care cash cannot continue. Integrating both sectors is not a controversial policy, he said, as it has been indirectly promoted by the government in every step of the way.

He argued that adding another £8bn to the NHS purse while taking £2bn away from councils’ social care budgets means the resources available to both only realistically increased by £6bn.

“This approach guarantees that the increased resources are used less efficiently than they should be, because reduced social care support leads to avoidable illness and increased demand; that is bad economics, but more importantly, it is bad social policy,” Dorrell wrote.

The former Conservative secretary of state urged Whitehall to take advantage of the upcoming Spending Review to safeguard a financial framework for the health and social care sector as a whole and, in doing so, reflecting its integration rhetoric.

To achieve this, he said, George Osborne would have to make a “critical leap of logic” to create a ring-fence around health and social care expenditure as a co-ordinated activity.

He also urged the chancellor to stress the importance of public health within the balance of local government expenditure, even though it does not have any ring-fence.

“The function of public health was transferred to local government in order to empower local authorities to play a fuller role in shaping local communities; it remains as important to good local government as the Department of Health and Public Health England are to good national government, and the government needs to find ways to demonstrate that it understands that,” Dorrell wrote

“The radical upgrade in prevention set out in the [NHS Five Year Forward] cannot be achieve against the background of falling public health budgets.”

But while this may be taken on board in the Spending, the Department of Health has already confirmed that it will press on with £200m reductions in the form of a 6.2% flat rate in 2015-16.

Dorrell concluded his letter by saying that integrating health and social care is not easy, and issues embedded in the reform affect both local government and the NHS.

But he is adamant that reshaping service delivery is necessary, and that the institutional consequences of these changes are “important but secondary concerns”.

(Top image c. NHS England)


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