An increase in funding for social care services announced in today’s budget must also help deliver reductions in NHS delayed transfers of care, the chancellor has said.
In his spring budget speech earlier today, Philip Hammond told MPs that the government would inject £2bn for adult social care spending over the next three years, with £1bn frontloaded to be available in 2017-18.
“The social care package I have announced today will help to free up beds by easing discharge”
The chancellor also announced plans to publish a green paper on the future of social care later this year, although he emphasised the government would not be “exhuming Labour’s hated death tax”.
Mr Hammond made clear that councils will need to work with the NHS on how best to spend the additional social care funds and suggested the focus of the funding would be on measures to tackle delayed transfers of care..
He also said the Treasury would work with Department of Health on capital budgets for the 44 regional sustainability and transformation plans (STPs), with an announcement due in the autumn. However, for a select group of more advanced STPs, £325m capital will be available immediately.
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In addition, £100m will be available for accident and emergency triage projects at 100 hospitals, involving initiatives such as onsite GPs, to be ready “in time for next winter”.
Mr Hammond said: “To enable elderly patients to be discharged when they are ready, freeing up precious NHS beds, and ensuring that elderly people are receiving the care they need – today I am committing additional grant funding of £2bn to social care in England over the next three years, with £1bn available in 17-18. This will allow local authorities to act now to commission new care packages.
“Alongside additional funding, the health and communities secretaries will announce measures to identify and support authorities which are struggling, and to ensure more joined up working with the NHS,” he said. “These measures, and greater collaborative working under NHS STPs, will bring short and medium-term benefits.
“But the long-term challenges of sustainably funding care in older age requires a strategic approach. And the government will set out its thinking on the options for the future financing of social care in a green paper later this year,” said Mr Hammond in his budget statement.
“Extra support for experienced clinicians to triage patients at A&Es is a sticking plaster”
He added: “The social care funding package I have announced today will deliver immediate benefit to the NHS, allowing it to re-focus on delivering the NHS England forward view plan.
“The social care package I have announced today will help to free up beds by easing discharge of elderly patients,” he said.
Reinforcing the message from the chancellor, documents also published today by the Treasury make clear ministers expect the extra funding for social care to deliver benefits for the NHS, in a similar way to the existing Better Care Fund programme spanning both the health service and local government.
They said: “Building on the approach to the Better Care Fund, councils will need to work with their NHS colleagues to consider how the funding can be best spent, and to ensure that best practice is implemented more consistently across the country.”
The documents stated that the funding would come with “targeted measures to help ensure that those areas facing the greatest challenges make rapid improvement, particularly in reducing delayed transfers of care between NHS and social care services.”
“The current system is not fit for purpose and it is time we all admitted it”
In response, Janet Davies, the Royal College of Nursing’s chief executive and general secretary, said: “Some financial support for NHS STPs is welcome, but the government needs to clarify how many plans will be supported by this limited pot of money and guarantee that it will be channelled into struggling community services.
“Extra support for experienced clinicians to triage patients at A&Es is a sticking plaster,” she said. “If the government wants to properly support patients outside of hospitals and take care closer to home this needs to be organised in a way which integrates health and social care and is properly funded. The clinicians in A&E will needs to have access to community services, including patients’ own GPs.
“Investment in social care may help hospitals to discharge patients when medically ready and better support older and vulnerable people in their own home, but it is not a magic bullet,” noted Ms Davies.
“Hospitals and community services are chronically understaffed and nurses are working unpaid overtime to hold things together. Today’s budget has done nothing to keep patient services staffed at the right level for safe care and nothing to value nursing staff after six years of real-terms cuts to their pay,” she added.
“Social care is also about far more than just reducing delayed transfers from hospitals into the community”
Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations across England, Wales and Northern Ireland, said: “The government has finally woken up to what many of us have been saying for some time – that hospitals and community services are desperately struggling, and that huge numbers of vulnerable older people are receiving inadequate or non-existent care.
“The extra funding will definitely help, but we await the details,” he said. “We also welcome the announcement of a green paper on the long-term funding of social care – let us hope this time it results in action and not more words.
“The promise of additional capital funding to support local transformation plans is also welcome, but again we await the detail. Without this money it will be impossible to develop the new services that are so desperately needed,” said Mr Dickson.
“We now urge the chancellor to continue listening,” he said. “While the social care review is important, we believe there is a need for a wider cross-party consensus based on objective evidence about what funding is needed for both health and social care over the longer term and how this should be paid for.
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He added: “The NHS and local government need to find new ways of working and of working together, which embrace prevention and help to keep people healthy for longer, thereby reducing pressure on overstretched services. The current system is not fit for purpose and it is time we all admitted it.”
Jonathan Bruce, managing director of agency Prestige Nursing + Care, said: “Today’s intervention – while long overdue – continues to fall short of what is needed and will ultimately do little to ease the crisis.”
He described the £2bn in additional funding over three years as a “significant improvement on the previous plan to raise the council tax precepts by 5%, but was a “case of too little, too late”.
Mr Bruce added: “Inadequate funding has dire consequences for the NHS too, with huge numbers of patients unable to be discharged from hospital due to a lack of social care to look after them.
“The upcoming green paper must consult widely and provide an opportunity for the industry to work together to consider an overarching, long-term and dignified approach for social care, but does not change the fact that government must eventually deliver and put its money where its mouth is,” he said.
Meanwhile, Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, defended the “excellent track record” of councils on managing their resources and protecting adult social care.
“They must remain trusted to continue using their resources effectively and efficiently to meet the needs of residents,” she said, in relation to reports that the Care Quality Commission would in future inspect how councils spent money on social care.
“Social care is also about far more than just reducing delayed transfers from hospitals into the community. It is about aspiring to help all people with a care and support need live their lives to the fullest, and with dignity,” said Ms Seccombe, who also called for more money on top of that announced today.
“Councils need at least £2.6bn of permanent, genuinely new funding by 2020 to plug the funding gap facing social care and make the market more sustainable, so our loved ones can continue to receive the dignified care and support they deserve, and also alleviate the pressures on the NHS,” she added.
Responding to extra funding for social care announced in the budget, Margaret Willcox, president-elect of the Association of Directors of Adult Social Services, said: “We welcome this important step towards closing the growing gap in government funding for adult social care.
“We are keen to build a consensus on a long-term, sustainable solution about how we provide and pay for care for years to come, and we hope the green paper helps to achieve that,” she said.
Professor Jane Dacre, president of the Royal College of Physicians, said the increased funding would help “ease some of the issues we currently face, but we know that the NHS and social care are inextricably intertwined – with current NHS performance being significantly affected by the record number of patients stuck in hospital”.
The verdict from the analysts:
Chris Ham, chief executive of The King’s Fund
“The additional money announced today is welcome recognition of the huge pressures facing social care. It will provide some short-term relief for older and disabled people, families and carers who are being let down by the current system.
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“The plan to publish a green paper on the future of social care funding is encouraging, but we have been here before. This time, the government must break the mould and deliver the radical reforms that are so badly needed.
“A starting point for this should be the report of the Barker Commission, which recommends a new settlement for health and social care and a single budget to put them both on a sustainable footing for the future. This will need to be funded by reforms to existing benefits paid to older people, increases in national insurance and changes to taxation.
“Our recent report highlighted lack of capital funding as a significant barrier to the success of STPs so on the face of it the decision to make money available to invest in the most promising plans is a step in the right direction.
“This winter the NHS has been buckling under the strain of meeting rising demand for services and maintaining standards of care. The chancellor must address this in his autumn budget or be honest with the public about the standards of care they can expect with the funding the NHS has been given.”
Nigel Edwards, chief executive of the Nuffield Trust
“The £2bn announced for social care over the next three years is welcome and desperately needed – but the £1bn share of that cash promised for next year will plug only half of the funding gap we’ve identified for that year. £1bn is also only the sum that’s already been cut from local councils’ adult social care budgets over the last five years. More and more vulnerable people are therefore going to be denied the help they need in the next year.
“It’s good news that the government has recognised the need for a complete reform of the whole system of paying for care in later life, but there have already been four independent reviews of this subject in the last two decades, none of which have led to significant change – so this one will need to lead to concrete action to make any difference
“It’s a sensible idea to make extra capital funding available immediately to help the new local health partnerships put their plans for new facilities into practice. But given that £1.2bn has already been taken from the NHS’s capital budget this year by the Department of Health simply to plug the gap in Trusts’ running costs, there is no point topping up capital reserves if they’re going to be raided in this way in the future.
“Putting family doctors into A&E departments to help treat less sick patients is a good idea, and the capital funding the chancellor has announced today will help hospitals which don’t currently have enough space to do it – but the big question is whether we actually have enough GPs to make this policy a reality”.
Quentin Cole, PwC health industries leader
“The chancellor’s announcement shows the government realises that the pressures on the health and social care systems are interrelated, and the answer lies not just in efficiency savings.
Extra £2bn for social care must benefit NHS, says Hammond
“The £2bn injection of cash over the next three years, announced today for social care, is welcome as are the additional commitments for capital expenditure, but this is not a long term solution.
“Today’s system was designed to deal with yesterday’s problems. Instead of just looking for quick solutions, the system itself needs to be reshaped to deliver improved outcomes, optimise resources and empower patients.
“PwC research shows that, in the long term, the balance of power needs to be shifted to local areas so they assume greater accountability for financing and control of services – passing down funds to a local level which can be spent in a tailored way by leaders who understand the problems facing their own areas.”