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Properly integrate health and social care, urges Dorrell

Former Tory health secretary calls for financial and policy integration to support change

Louise Prime

Tuesday, 10 November 2015

Chancellor of the exchequer George Osborne must make a ‘critical leap of logic’ and ring-fence public expenditure on health and social care as a coordinated activity, a former Tory health secretary warned him this morning. Stephen Dorrell also urged the chancellor not to cut budgets for workforce, training and research, which he said would only undermine the sector’s capacity to deliver the required service change.

Stephen Dorrell, who is now chair of both the NHS Confederation and the Health Select Committee, told George Osborne that taxpayer resources committed to the whole health and care sector must be used efficiently, and health and social care treated as a single sector financially as well as at policy level, in order to reduce the level of avoidable illness and demand on the NHS.

He wrote: “To have NHS budgets rise while social care budgets fall is bad economics and bad social policy. Without investment in social care and public health, unnecessary pressure is being placed on other parts of the service, including hospitals, leaving an already significant dent in the £8bn promised to the NHS.

“Reshaping how care is delivered to patients must be a priority for this parliament. Yesterday’s announcement by George Osborne shows how close we are to the final decision on the spending review – there is no time to waste. In the spending review the government must take a bold step to ring-fence budgets for health and social care and make the commitment to transforming patient care a reality.”

He called on the government to use the spending review to put in place a financial framework for the health and care sector as a whole, to reflect its policy commitment to the development of a more integrated health and social care sector. He urged it to take several steps to realise this objective:

  1. Make a critical leap of logic – create a ring fence around public expenditure on health and social care as a coordinated activity, as supported by 86% of NHS Confederation members.
  2. Establish within that ring fence a clear year-by-year spending framework through this Parliament for the health and social care sector as a whole, covering both the £8bn for the NHS and the plans for social care budgets – at a level to support the Stevens Plan – to encourage commissioners and providers to work together to plan for and deliver necessary and sustainable service change.
  3. Within the medium-term framework, make provision for a transformation fund. Failure to do so “will guarantee continuing service inefficiency – and with it avoidable illness and service pressures”.
  4. Budgets for workforce, training and research are not desirable extras; they are allocated to front line organisations to support service delivery and transformation. Reductions in these budgets would hit front line services directly and would undermine the capacity of the sector to deliver the service change that is required.
  5. Stress the importance of public health within the balance of local government expenditure; the radical upgrade in prevention set out in the Stevens Plan cannot be achieved against the background of falling public health budgets.

Stephen Dorrell concluded that, although none of this would be easy, he strongly believed that it is right to focus on the requirement to reshape service delivery – and regard the institutional consequences of those changes as important, but secondary concerns. He said: “I believe that this approach commands widespread support within and beyond the sector and that it makes both economic and social policy sense; the immediate challenge for the Government is to use the Spending Review to create a financial framework which reflects this approach.”

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