HSJ exclusive: NHS to take responsibility for social care

In what is claimed by Department of Health sources to be the most radical change to the NHS in decades, a paper to be published by health secretary Andy Burnham on the future “vision” for health policy is thought to include proposals to give the health service much greater involvement in social care.

The vision, considered a trailer for Labour’s manifesto commitments on health policy, is expected to emphasise the need for much closer integration of acute services, community services and social care.

It comes ahead of the social care white paper in the new year, in which options will include merging of commissioning functions across health and social care. Ministers are understood to have instructed officials to work up different options for the ways in which primary care trusts and local authorities can work much more closely together.

The possibility of pooling budgets and joint commissioning of services have already been discussed. The government is also considering handing control of and funding for social care to primary care trusts. This would remove the incentive for health and social care to “shunt” costs from the NHS to local government and vice versa.

Social care is currently provided by local authorities, the majority of which are now Conservative controlled. A move towards greater control of social care by the NHS has been described to HSJ by an NHS source as one way to “rip the guts out of” Tory-controlled councils.

Since becoming health secretary, Mr Burnham has repeatedly said he wants to make the future of social care one of the top three issues in the general election campaign. A long-awaited green paper on the future of social care - and how to fund it in the face of the demographic time bomb caused by the ageing population - was published at the start of the summer.

Both Mr Burnham and the prime minister Gordon Brown have described their intention to set up a National Care Service to run alongside the much-loved NHS.

In a speech to NHS medical directors two weeks ago, NHS chief executive David Nicholson said: “We have got to think about how local government manages provision and whether we can integrate directly health and social care horizontally across the system.”

He said: “One of the bits of evidence we do know is that the real productivity gains, the real quality and productivity gains in the future, are at the interface of secondary and primary care, at the interface between NHS and social care, at the interface between empowered patient and the service.”

Mr Nicholson cited mental health trusts as a good model for the provision of integrated services. Several mental health trusts already provide both mental health services and social care through one organisation.

He said: “We’ve got a whole set of really good models for the integration of whole systems working and that’s our mental health trusts. Many of our mental health trusts run complete systems and do it fantastically effectively.

“And over the last few years have dramatically shifted the balance between hospital and community services. It seems to me that’s a really powerful model that we should think about much more seriously for the future.”

The Department of Health said at the time that further details on the implications of Mr Nicholson’s comments would not be available until after the pre-Budget report, which will be published tomorrow.

In addition to Mr Burnham’s vision for the future of the health service, the Department of Health is expected to publish its annual “operating framework”, setting out its expectations for the NHS in 2010-11, within the next two weeks.