Politics

Underinvestment in local care services is crippling the NHS

Philip Hammond should have addressed this in his Autumn Statement

November 30, 2016
©Peter Byrne/PA Wire/PA Images
©Peter Byrne/PA Wire/PA Images

The Autumn Statement provides an opportunity to begin to take stock of the implications for health and care services of the circumstances created by Brexit.

The background has, of course, not changed. There is still a welcome trend for people to live longer, with the result that the demands placed on the health and care system will continue both to grow and to change in ways which reflect the changing needs of the people they serve.

Although the implications of some of these changes inevitably involve uncertain forecasts, most of the trends are well established, and represent the day to day lived experience both of the citizens who use the services, and the staff who work in them.

Most obviously there is growing demand for the care and support services which enable people to live independent and fulfilling lives and reduce their experience of discomfort and ill-health.

None of this is the result of Brexit; the trends are well established, and they are reflected by similar trends in every comparable country.

The additional headwinds created by Brexit have however not helped. The prospect of slower economic growth, with the resulting pressure on public finances, has made it more difficult for the Chancellor to respond to well-documented spending pressures across the health and care system.

Furthermore, it is likely that Brexit will create some specific issues for the health and care system, in particular through the impact of tighter control of migration. As the largest employer in the economy of staff from elsewhere in the world, the health and care sector faces the prospect of significant additional pressures on both the cost and availability of staff, at a time when commissioners’ budgets and operators’ margins are already under pressure and capacity is falling.

Against this background it is surprising and disappointing that the Chancellor did not include any provision for the health and care sector in the £23bn additional spending commitments he made towards productivity improvement in the economy.

While each of the individual commitments he made through this programme is no doubt desirable in its own right, it is hard to believe that any of them offers the opportunity for productivity gain which would be unlocked within the NHS if local authorities were able to provide a broader range of care and support services.

People often talk about operational inefficiencies within the NHS, and they are certainly there, but the biggest inefficiency in the health and care system is the growing tendency to use acute hospitals as care homes; it is demoralising for staff and damaging for patients, as well as being a massive waste of money, but it is the consequence of our failure to develop a more balanced range of local care services.

It also raises some more fundamental questions about the way the health and care sector is financed in Britain.

This is often oversimplified into a question about the funding of the NHS, but that is only part of the issue—and it is not the most important part.

We should remind ourselves that the key underlying issue is growing demand for care and support for people who do not need or want sustained acute care. They need better services to allow them to live independent and fulfilling lives. The perverse consequence of over-emphasising the importance of the NHS is that we under-invest in the broader range of public services, with the result that the NHS becomes the provider of last resort of services which would be better provided by others.

That is why I have argued, together with Norman Lamb and Alan Milburn, that it is time that both the financing and structures of these services should be reviewed on a cross party basis. Demand is both changing in nature and rising in total. We need organisational and funding solutions.

The key theme of the Chancellor’s Autumn Statement was his commitment to invest in productivity improvement. The health and care sector accounts for 10 per cent of the UK economy; rather than averting his eyes, he should embrace the opportunities which it offers to deliver his objectives.