Saffron Cordery on why the chancellor must pledge serious investment in social and primary care in his Autumn Statement
With no emergency budget or Queen’s Speech since the prime minister took office, the forthcoming Autumn Statement will be one of the new government’s first major setpiece announcements.
At the end of November the chancellor, Phillip Hammond, will set out spending intentions for the coming financial year, including for the NHS. All eyes on him, then, but given his recent letter to the Commons health select committee chair we perhaps shouldn’t expect too much for the NHS, or even social care.
As ever, when we talk about the NHS the focus is on hospitals. How do we keep them going? Will they survive the winter? What’s happening in accident and emergency? These are important questions; vital in fact, if you are one of the millions who use those services every year. The hospital sector is suffering. Demand is rising, we need to wait longer to access services, the costs of providing care are going up and there is no more money available to fund it. It’s hard not to wonder if the NHS will ever be sustainable.
And these issues will remain intractable if we look solely to hospitals for the solution. We need to invest any additional resources in those areas of greatest need, which can be a real challenge. Health and care is a mosaic of organisations, with different approaches and aims, which broadly fit together to create the current system. So we must look across them all to understand why demand is increasing and how can we curb it, why A&E is the default destination, and how can we tackle the delays in transferring medically fit patients out of hospital.
Primary care is also under huge pressure, meaning that significant numbers of patients who could and should be dealt with out of hospital are attending A&E departments
In our submission to the Treasury for the Autumn Statement, we have emphasised the need to invest in the care side of the equation – both social and primary care. Unusual perhaps for an organisation representing hospitals and other secondary care providers?
However, we know that social care is struggling. Funding cuts have limited the scope of services, eligibility criteria are narrowing and private care providers are exiting the market. Together with the capacity gap in community and mental health services, this translates into the largest number of delayed transfers of care on record.
Primary care is also under huge pressure and is unable to cope with the level of demand it is experiencing, meaning that significant numbers of patients who could and should be dealt with out of hospital are attending A&E departments.
Bang the drum
Our solution for social care is to bring forward the investment already planned for this parliament. The money is needed now as well as later. So release the promised Better Care Fund uplift next year to help ease the delayed transfers of care and allow councils to increase further the money they can raise locally through the “precept” for social care. It might be worth thinking about who controls the funds to ensure they are spent effectively. Should it sit in NHS budgets, council budgets or both?
We also need to boost primary care so that it can be better supported to meet the needs of patients, including using the existing access fund to increase capacity in general practice
We also need to boost primary care so that it can be better supported to meet the needs of patients, including using the existing access fund to increase capacity in general practice. Also, why not use the hospital funds already available – such as money raised through contract fines and the marginal tariff payments for A&E – to give greater support to primary care to directly reduce demand for secondary care services. That was, after all, its original intention.
However, where we do bang the drum directly for secondary care is to call for the return of some money for capital investment and maintenance. Last year, to manage the £2.45bn provider deficit, trusts were asked to transfer the funds put aside for large scale investment in bricks and mortar, infrastructure and maintenance, into their day to day running costs. Understandable but not sustainable.
Sustainability and transformation plans which bring together health, care and wider local services are in their infancy, but many will require capital investment to make their proposals for integration a reality. So we should make sure there are adequate funds available in the £100bn national infrastructure delivery plan to support these plans for service transformation.
And we should consider how we use investment in other parts of the public sector, such as public works loans for councils, to benefit the NHS. We do hope there is scope in the government’s plans to be creative on capital, including exploring options to make joint ventures with the private sector an attractive proposition.
It is critical that we all act as responsible stewards of the health service and its assets. So far, when given the right level of support, the NHS has delivered a return on investment. Over 2010-2015, the NHS met the £20bn savings challenge. More recently we wiped £300m off the predicted increase in spending on agency staff for 2015/16 in just six months. And, the deficit reduction measures currently in operation – the 2015/16 £1.8bn of sustainability funding – are having a better than pound for pound return on investment.
So, all eyes will be on the chancellor in a couple weeks. Let’s hope he says the right things.
Saffron Cordery is director of policy and strategy at NHS Providers