Sir Humphrey’s most famous piece of advice runs: “If you want to be really sure the minister doesn’t accept it, you must say the decision is ‘courageous’. Controversial only means ‘this will lose you votes’. Courageous means ‘this will lose you the election’.”
‘The leaders of many of England’s hospitals believe they can hear the camel’s back beginning to break’
So NHS England finance director Paul Baumann’s declaration that the level of savings needed to finance the planned £3.8bn joint health and social care commissioning budget would require “a heroic undertaking” will whistle like a warning shot across the coalition’s bows.
Mr Baumann makes it clear this level of spending cannot be generated by “salami slicing” other services. To find that amount of cash you need to stop doing something else. Mr Baumann’s boss, Sir David Nicholson, told HSJ in June this would mean “radical changes” to hospital services.
“A good thing too”, claimed several NHS England non-executive directors – whose backgrounds in the local authority and the third sectors make them a lot less sensitive to the plight of NHS bricks and mortar. But the leaders of many of England’s hospitals believe they can hear the camel’s back beginning to break.
For these new integrated services to be ready in April 2015, they will have to be designed and put in place during the 2014-15 financial year. Mr Baumann calls it the “90 week challenge”. It also means this “radical change” is likely to take place during the run up to a closely fought election.
But even if disinvestment can be achieved, will the money to fund new services be available? Local authorities will see the joint pot as a way of patching up budgets gutted by spending cuts.
‘CCGs, their providers and social care directors are busy attaching an “integration” label to as many existing projects as possible’
Many, including the health secretary, will point out that the government announced an integration fund, not a social care fund, and steps are being taken to route some of the funding through clinical commissioning groups – but the gravitational pull from cash starved local authorities will sometimes prove irresistible.
So what will happen? Here are two predictions. First, the NHS’s integration efforts will largely be delivered through redirected hospital services rather than new primary care driven initiatives to avoid both political noise and system disruption. Second, across the land CCGs, their providers and social care directors are busy attaching an “integration” label to as many existing projects as possible.
Health and social care integration will move forward – but expect pragmatism, not heroism, to be its defining characteristic.