Published by Andrew Haldenby on 23 November 2016
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- The Reformer Blog
12 December 2016
The front page of the Times today reports that Ministers will allow councils to raise more council tax to pay for social care. Certainly this would provide more income for social care. It would not, however, help to deliver the sustainable, coherent health and care system that England needs.
Many people argue that social care is substantially underfunded. The Coalition Government protected spending on NHS (medical) care but did not protect residential and other forms of care for elderly people (social care, part funded and delivered by local government). (The NHS spends around £110 billion a year and social care in England costs around £20 billion.) The number of places available in taxpayer-funded social care has fallen since 2008-09 (see this excellent NAO report, p.16). The Government introduced a £3.8 billion fund, the Better Care Fund, in 2013 with the aim of (in effect) moving funds from the NHS to social care.
What is also the case, however, is that major reforms in this area of policy have not taken place. It has been recognised for many years that the division between the NHS and social care holds back both services. That division remains in place, with the result that there are far too many elderly people in hospitals who should not be there, as the NAO has reported. On the funding side, it should be possible to find ways to fund social care from new sources, including housing wealth. Successive governments (going all the way back to John Major) have been nervous of doing that.
The big problems, then, are the ringfence around the NHS budget; the lack of drive to reform the provision of health and social care; and the nervousness about greater funding from private sources. The idea of higher council tax doesn’t solve any of these.
To his great credit, the Chancellor said in the Autumn Statement that he will look at ringfences at the next Spending Review, but not until then. With the NHS ringfence in place, no increase in council tax could provide social care what it is asking for, as the LGA said today. There has been little evidence so far that the Better Care Fund has succeeded in shifting resources between the services.
The NHS is currently developing plans to integrate health and social care (as well as reform the NHS completely): the so-called Sustainability and Transformation Plans, or STPs. These plans have to find a way to bring the budgets of social care and the NHS together. An increase in social care spending, funded by council tax, will not do that. It sends the message that social care should remain separate from the NHS, and does not encourage additional private funds.
In practical terms, the Government should bring forward its review of the budget ringfences, and bring forward its review of the Dilnot proposals to reform social care funding. It should do so at the same time as it drives real pooling of health and social care via STPs. More than that, it should see the problems of social care as having structural causes which needs structural solutions, not a sticking plaster.
Andrew Haldenby, Director, Reform