The potential catastrophe which was feared could be included in the September 23 mini-budget and in Therese Coffey’s first policy statement as Health and Social Care Secretary has not materialised … yet.
The NHS Confederation and NHS Providers had both warned of the consequences if the Truss government implemented her proposal to “raid” NHS finances and take up to £10bn a year from the most recent extra cash allocated – to hand it to social care.
Others also feared that such a rapid, near 50% increase in social care spending would simply allow the chaotic array of private providers of domiciliary care and care homes to jack up their prices and profits.
There is no national coordinating body in charge of social care: no body able to ensure extra spending leads to any increase in provision of care or even improved pay to help fill the 160,000 vacant posts in social care (almost all of which offer pay scales that compare poorly with less stressful jobs in supermarkets and elsewhere).
Nor is there any means to ensure that the largest care home chains, controlling one in nine social care beds, but owned by profit-hungry private equity investors, don’t just siphon off any extra funds to benefit shareholders.
However the fears, while not misplaced, have been slightly premature. Coffey’s sketchy, short term policy paper “Our Plan for Patients” proposes only to launch a “£500 million Adult Social Care Discharge Fund” (not new money, but a reallocation of funds already in the DHSC budget).
This temporary fund is supposed to take the place of the ‘Discharge to Assess’ funding, brought in to speed discharge of patients from hospital during the pandemic, that was scrapped from April this year.
But as winter approaches, the continued pressure on acute beds from a new rise in numbers of Covid patients (back up to more than 5,100 on September 21) and an average of over 12,000 patients each day occupying hospital beds for lack of social care support, mean over 17% of beds are unavailable for ‘normal’ work.
That’s why NHS front-line capacity is nowhere near sufficient to treat emergencies and elective cases – leading to a continuing rise in waiting lists to 6.8m.
Nevertheless, ministers are still threatening far-reaching and damaging changes, vaguely described by Coffey as: “further action from next year to rebalance funding across health and care.”
Coffey argues this is needed to establish “a strong and sustainable social care sector with greater accountability for use of taxpayers’ money.” But it’s certain that the damage that would be done to the NHS by any substantial outright cut in funding would massively outweigh any possible benefit from improved social care.
Cutting the full £10bn of extra funding per year would amount to a 7 percent reduction – far and away the biggest-ever actual cut in NHS funding, dwarfing the cutbacks imposed under Margaret Thatcher in the 1980s.
And while Chancellor Kwasi Kwarteng’s tax-cutting “mini-budget” promised that the extra funds promised to health and social care from the now scrapped “health and care levy” would still be paid, there has been no announcement of additional funding for the NHS.
The Lowdown and SOSNHS have explained that, after 12 years of real terms cuts, billions more are needed to enable the NHS to weather the massive rise in inflation. SOSNHS has argued for a down-payment of £20bn, to be followed by further increases.
These are needed to cover the substantial increase in pay needed to stop the exodus of demoralised, under-paid staff from the NHS, fill 132,000 vacant posts, repair crumbling hospitals and expand capacity to meet demand and tackle backlogs and waiting lists in acute services, mental health community services and primary care.
Any claim that such funding is not affordable has been shot down by Kwarteng’s massive spree of tax-cutting that benefits only the top 1% of tax payers and big business, and the hand-outs to the energy companies. These add up to £161bn of reduced tax income and increased government borrowing over the next 4 years.
Kwarteng’s measures also mean energy companies will preserve windfall profits of up to £170bn, while leaving millions of households and small businesses with unpayable inflated energy bills, as the general cost of living increases at rapid pace.
The market reaction to Kwarteng’s profligate and reckless squandering of cash on the wealthiest few suggests that few are convinced leaving millions in poverty, and unable even to pay for necessities, is a realistic way to grow the economy.
Instead it runs the risk of worsening physical and mental ill health among the poorest and piling more pressure on the NHS.
Already the money markets are demanding big cuts in public spending to reduce the level of increased borrowing.
To make matters worse, the ‘mini-budget’ has already further collapsed the value of the pound, giving another boost to already rocketing inflation.
The ultimate danger of all this is that when it all goes wrong any panic package to rescue the economy (as happened back in 1976 in the aftermath of similar tax cuts by Tory Chancellor Anthony Barber in 1972) is almost certain to again include a fresh crackdown on public spending and prolonged, even deeper, austerity.
Meanwhile Rishi Sunak’s three-year plan to claw back much of the “extra” spending on the NHS during the peak of the Covid pandemic remains in place. It is at the core of huge financial pressures on the 42 Integrated Care Boards that have taken charge of England’s NHS since the Health and Care Act was implemented in July. This puts every ICB under pressure to generate ‘savings’ totalling £5.5bn – and plans will need to be in place this autumn.
The worst scenario has not yet taken place – but the present reality is bad enough.
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