Second Nicholson challenge required says top Lib Dem

The NHS chief executive Sir David Nicholson’s statement that the NHS needs to make £20bn of efficiency savings, roughly over the current spending review period, has since been dubbed the “Nicholson challenge” by politicians.

Paul Burstow, who was replaced in the ministerial reshuffle earlier this month, said the exercise should be repeated. He said the discussion should cover social care as well as the NHS and indicated the debate should consider what funding was needed, to contribute to the next government spending review.

Mr Burstow was speaking at a fringe event, hosted by Demos and Sue Ryder, at the Liberal Democrat conference yesterday.

He said the government had had no discussions about NHS and social care funding – and whether the NHS budget could be used to fund the latter, as has been suggested in recent months.

But he said the issue  was “a serious question for the spending review”.

He said: “The Nicholson challenge was a thoughtful and sensible [approach]. This time I think we need a Nicholson challenge two, which is not just about the NHS but about the NHS and social care.

“We can’t think about the two systems as separate.”

Mr Burstow told HSJ after the event: “We’re halfway through the current spending period. It’s the right time to start having that kind of debate.”

The consideration of the NHS and social care needs together indicates the former could help fund the latter, although Mr Burstow declined to comment on that specifically.

NHS Confederation deputy chief executive David Stout said the NHS would already face “really serious problems” in coming years without a budget cut to fund social care, so opposed that approach.

However, he said: “Unless we solve the problem of social care funding and implement Dilnot then the health service – not only social care – is in deep trouble.”

Speaking at a separate event later, the new Liberal Democrat health and care minister Norman Lamb said he was considering a process for cross-party agreement on funding the Dilnot proposals for long-term care. He said all three major parties needed to want to find a solution, and he could appoint an independent person to oversee discussions.