Maxine Vaccine asks whether the current horse-trading between health and social care is a version of trading in derivatives. How much of this theoretical money ends up providing real care?
Everyone supports the principle of integrated care. The more closely healthcare and social care teams work together, the more effectively the needs of communities – and especially, the growing elderly population – can be met. Putting local government in charge of public health aligns it with social care, strengthening the role of both services in promoting and protecting health, and thereby reducing the clinical and economic burden on the NHS.
That was the basis of Duncan Selbie’s recent statement that local government could make a better job of improving public health than the NHS. The new head of Public Health England was arguing that councils have “a much broader view of the world” through their long-term role in such functions as education, housing and sanitation. Some might question, of course, whether councillors – who owe their jobs to the murky world of local politics – can really compare with a workforce of dedicated health specialists. But in principle, public health can only benefit from being seen in the right context: the actual lives of communities, where and how people get along from day to day.
The problem starts when you ask: who is investing in the social care that will provide the basis of a stronger public health strategy, while reducing the burden on the NHS? That has been a major concern from the early days of this Government, which declared it would not reduce NHS funding but then conceded that the NHS would have to make up for the drastic cuts in social care funding. If you spread salmon paste too thin it becomes tuna. If integrated care means passing the buck of austerity obsessively back and forth between CCGs and councils, all that will be shared is pain.
Just as the DH has drafted legislation that will force CCGs to give contracts to private sector health providers if the latter tick ‘efficiency’ boxes defined by the Government, it has drafted legislation to expand the market for private sector providers of social care – and backed it up with the Developing Care Markets for Quality and Choice programme, which helps local authorities to shape the social care market.
Meanwhile, the Dilnot proposals for enabling more elderly people to afford the care they need have become a political liability. The Government has expressed support for the principle of capping individual contributions, but will not commit to a figure or a funding mechanism for it. There is talk of funding it by cutting £2bn out of the NHS budget – which, understandably, has horrified the NHS Confederation. Finding a workable solution to the challenge of social care is hard enough for a government that believes the market can solve everything, without some pesky economist telling it to spend money.
And now former Social Care Minister Paul Burstow has accused George Osborne of trying to put the Dilnot proposals “in the trash bin”. I’m gutted that he has not provided photographic evidence of this. Burstow claimed that detailed plans were drawn up to implement the Dilnot proposals, but Osborne refused to sign off the funding. He also accused his own leader of having failed to recognise the popular support that Dilnot commands.
Of course, Burstow was speaking during that surreal week in the LibDem calendar when the party exchanges the Orange Book for the Little Red Book in an attempt to convince its membership at conference that it believes in ‘liberal’ values. Like Clegg’s talk of a mansions tax, Burstow’s accusations of a Dilnot-dustbin interface will shortly be forgotten when the LibDems resume their coalition role of voting through everything the Chancellor suggests.
All this talk of social care reform, public health reform and (let us not forget) NHS reform helps to keep the private sector interested in the services that are currently being franchised. The funding promises and the ‘partnerships’ they attach to are closely allied to the derivatives that keep ‘wealth creators’ involved in finance. The more the money goes round from the NHS to local government and back again, the more can be hived off into the accounts of investors – and the less there is to pay for actual care. Whether it’s healthcare or social care doesn’t matter when the game is austerity: nothing split two ways still doesn’t come to much.
Maxine’s views are not necessarily those of Pharmaceutical Field.