Pool NHS and social care budgets, says Confed acting chief exec

In his opening speech to the Confederation’s annual conference in Liverpool, Mr Edwards told delegates the NHS would need to work constructively with other sectors to overcome the current “hostile economic environment”.

He said: “I’m particularly concerned about social care.”  

He said it faced a “huge challenge” from the squeezing of local government budgets “without the relative protection the NHS enjoys”.

“The NHS won’t be able to make the large scale changes we need to if we can’t discharge people or prevent their admission because their social care has broken down or is not available,” he told delegates.

“I think we should have a debate about pooling health and social care funding for adults locally to create a single commissioning budget.”

Mr Edwards cited the examples of Torbay and Lincolnshire, where money is delegated by local government to GP consortia with input from social care experts.

He said: “You might object that money would leak from health to social care – well it’s going to anyway and it might be better if this is carefully planned so that money is used in the way that is in the best interests of the users of services rather than following the niceties of budget silos.”

In his speech, Mr Edwards also posed a number of questions that the government needed to answer in order to achieve its “ambitious agenda”.

For example, he questioned whether there were enough GPs interested in commissioning. He said: “Don’t the enthusiastic GPs actually want to be providers rather than commissioners?”

He added: “How do you stop the [NHS] independent board from becoming huge, centralising and directive but without leaving it powerless?”

He said the Confederation was in continuing talks with health secretary Andrew Lansley about these and other questions.

Mr Edwards repeated a warning to delegates that the government’s reforms would be a lot more radical than had been previously thought.

He said: “I think – based on our discussions with the secretary of state and other officials – that the ideas you will hear about over the next few days and in the upcoming white paper are an attempt to make a fundamental shift in how power and accountability works in the NHS.

“If it succeeds, this is much more radical than many have realised and will alter the landscape profoundly.

“It’s important that we shouldn’t view the proposals through the lens of previous reforms or use current structures and power relationships to understand what is proposed for the future.

“This is not a return to previous reforms such as GP fundholding or primary care groups. The answer to the question “isn’t this just going back to….?” is no. This will look quite different if it can be brought to fruition.”

However, he said that to achieve the reforms talking about just engaging clinicians needed to be replaced by asking “more to step up and lead”.

“Not necessarily as chief executives but at levels, both GPs and specialists, need to take a lead in taking some difficult decisions about redesigning services, reducing variation, improving quality and eliminating waste.”

He noted that specialists “seem to have been written out of the reform process”. He said: “I think that could be a problem.”