Government omitting social care funding from NHS reform plan is like 'rebuilding a house without mending the roof'

The government’s White Paper unveiling proposals to integrate health and social care has been welcomed by care providers, however its decision to leave social care funding out of the reforms has been met with dismay.

The measures in the 'Integration and Innovation: Working together to improve health and social care' White Paper include modernising the legal framework to make the health and care system fit for the future and putting in place targeted improvements for the delivery of public health and social care.

The DHSC say the reforms will make health and care services less legally bureaucratic, more accountable and more joined up.

Health and Social Care Secretary Matt Hancock said: “The NHS and local government have long been calling for better integration and less burdensome bureaucracy, and this virus has made clear the time for change is now.

“The proposals build on what the NHS has called for and will become the foundations for a health and care system which is more integrated, more innovative and responsive, and more ready to respond to the challenges of tomorrow, from health inequalities to our ageing population.”

Key reforms

• Every part of England will be covered by an integrated care system (ICS). These will be made up of an ICS NHS Body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners.

• The health and care minister will be given more power to make direct payments to adult social care providers when needed. The White Paper states this would only be in exceptional circumstances.

• The Health and Care Bill will include a new duty for the Care Quality Commission to assess local authorities’ delivery of their adult social care duties. The Secretary of State would have the power to intervene, if the CQC decides a local authority is failing to meet its duties.

• The new proposals will see an end to competitive tendering for contracts, which came in when David Cameron was prime minister, with the NHS and local authorities left to collaborate and run services themselves.

• The upcoming Bill will put the Healthcare Safety Investigations Branch permanently into law as a Statutory Body.

• Legislation will help support the introduction of new requirements about calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed.

• The Secretary of State for Health and Social Care will be given the power to directly introduce, vary or terminate water fluoridation schemes.

Social care funding reform urgently needed at the same time

Care providers welcomed proposals to reform the way the NHS is run but urged the government to press on with vital reform of social care at the same time.

The Independent Care Group (ICG) warned care providers looking after older and vulnerable people were in danger of again being left the poor relation to NHS care.

ICG Chair Mike Padgham said: “It is welcome news that NHS reform is happening but aside from mentioning social care, the government hasn’t gone far enough in outlining its future. It is vital that both are reformed at the same time, otherwise social care will be left behind once again. Reforming NHS care without reforming social care is like rebuilding a house without mending the roof.

“We have argued for more than a decade that NHS care and social care need to be equal partners and ideally merged. But how can that happen when £8bn has been cut from social care budgets since 2010, some 1.4m people are living without the care they need and there are 100,000 vacancies for social care staff?”

'Welcome shift' away from focus on competition

Richard Murray, chief executive of The King’s Fund, said: “Most important in these proposals is the welcome shift away from the old legislative focus on competition between healthcare organisations, towards a new model of collaboration, partnership and integration. The White Paper marks a decisive step away from the Coalition’s 2012 reforms.”

He added: “The thrust of these reforms is about giving local health and care leaders the freedom to make decisions based on the needs of their local population. Yet, running counter to that ambition, Ministers are also proposing they have the power to intervene earlier in local decisions about the opening and closing of NHS services. The government and national NHS leaders should be looking to step away from the damaging model of top-down command and control in the NHS.”

He called for the government to address “deep-seated challenges” such as long term reform of social care, chronic staff shortages and health inequalities.

He also expressed concern over the NHS and the local authorities having to implement the reforms at a time when they “are still battling COVID-19”.

'Little recognition or understanding' of the care sector

Bob Hudson, a visiting professor in Public Policy in the Centre for Health Services Studies at the University of Kent, said on the face of it the "new NHS White Paper’s recoiling from the primacy of competition and markets warrants a warm welcome. Yet reactions have been underwhelming because there is remarkably little detail on how this ambitious mission is going to work."

He added: "Given the recognition of ‘care’ in the White Paper title and the emphasis on ‘integrated care’ throughout, there is remarkably little recognition or understanding of the sector.

"There is little to dispel the fear that social care is simply perceived as a handmaiden to the priorities of the NHS, especially the reduction of hospital costs. Not only will the local government voice be relatively weak, but the powers given to the Secretary of State could see councils losing control of their social care and public health services to the priorities of the ICSs."

Professor Martin Green, chief executive of Care England, said: "The publication of the NHS White Paper is an opportunity to recognise the interrelationship between health and social care and craft a long term vision for both sectors. Care England looks forward to working with the government to develop this vision."

Failure to 'fix social care'

GMB Union also highlighted the failure of the White Paper to fulfil the government’s promise ‘to fix social care’.

Rehana Azam, GMB national secretary, said: “The Prime Minister promised 18 months ago to ‘fix’ social care within 12 months of being in government.

“For too long politicians have kicked social care into the long grass. The pandemic has vividly shown what that has meant for those getting care, their families and the workforce.

"We don’t need further reforms, we need a properly funded, publicly delivered National Health and Care Service - one that values the backbone of our health services, our staff.”

A Bill will be laid before Parliament later in the year.

The government said it intends to bring forward separate proposals on social care reform later this year.

To view the White Paper ‘Integration and Innovation’ click here