This government and its predecessors received a dressing down from the Select Committee on the Long-term Sustainability of the NHS last week. The committee of peers published its report on the health service and its ability to deliver under increasing financial and demand pressures. Criticism was firmly focused on the ‘short sightedness’ of successive governments for failing to plan effectively for the long-term future of the health service and adult social care.
The report reiterates the challenges facing the health service we are all too aware of: the need for a political consensus on the future of the health and care; the poorly-coordinated nature of the health and social care systems despite their interconnectedness; as well as the lack of a credible strategy to encourage uptake of technology and innovation. The scale of the workforce recruitment and retention challenge, which the report dubs the biggest internal threat to the sustainability of the NHS, and the “short-sighted” and “counter-productive” cuts to funding for public health budgets are also highlighted.
The above challenges are all well-documented and were brought into sharp focus with last month’s publication of NHS England’s Next Steps on the Five Year Forward View. The review marked a significant refresh of Simon Steven’s original vision for the NHS’s transformation into a modern, more sustainable health and care service. We saw the NHS, and by proxy the government, finally ready to put on record the need for the NHS to prioritise services within the confines of its over-stretched budget.
Last week’s report comes to similar conclusions: for the principle of a tax-funded, free-at-the-point-of-use health service to remain, many aspects of the way the NHS delivers healthcare will have to change.
Whilst it was confirmed the government is set on sticking with the current funding model for health and will not be exploring any other options at this time, the willingness to explore other funding streams for social care in particular is noteworthy.
Revisiting the pensions triple lock; introducing incentives to individuals to save and invest to pay for care; developing a compulsory personal insurance-based system starting in middle age to cover care costs; and improving arrangements for accessing revenue from housing assets are all ways that new funding streams could be developed to provide funding stability for social care. These are options the government may look to consider – so it will be important to keep an eye on how thinking develops in the short to medium term. It may be the answer lies in pursuing a combination of the above approaches.
The green paper on the future of social care funding due out for consultation late this year may give serious consideration to the introduction of an insurance-based scheme, which would start in middle age to cover care costs, as the committee calls for. It will also likely want to hear other approaches to sustainable funding options for social care, giving stakeholders opportunity to engage and shape the agenda.
For health policy more widely, the report includes some equally bold recommendations, such as the merging of NHS England and NHS Improvement to create a new body with simplified regulatory functions and strong local government representation. This makes sense given that policy is now increasingly focused on integrated, placed-based care. It has already been announced NHS England and NHS Improvement will take an increasingly unified approach to regulation – from 1 April they are jointly running a “light touch process” to encourage STP areas to come forward as potential Accountable Care Systems (ACSs) and offer a “one stop shop” on regulatory issues once the systems are established.
Crucially, the committee underlines the importance of government initiating cross-party talks, as well as encouraging a meaningful national conversation more widely, on what the NHS should focus on and be expected to deliver. Whether the government will heed the committee’s counsel remains to be seen.