We have seen headline news this week of an extra £150m being made available for Adult Social Care at a national level to help address budget shortfalls. It is interesting that with 151 Councils in the country that have disclosed ASCOF returns in relation to social care expenditure, that you can see that the headline figures, when broken down at a local level, do not actually go very far. Whilst each Council will not receive an equal share, if an average was given it would be below £1m to each Council.
The following is in relation to a blog I wrote in the summer of 2017 which I am now reposting.
Back in July 2017, Jeremy Hunt released a statement discussing his plans to “redress the historic imbalance” between physical and mental health by 2021. Theresa May planned to “scrap the flawed Mental Health Act” as part of a plan to revolutionise the health and social care sector.
The plans were greeted with mixed reviews and I thought it would be interesting to summarise some of the opinions of the press, and then give my own views of them, with thirty years’ experience of working in the sector behind me.
- 2,000 new staff including nurses, consultants and therapists
- 3,000 posts are being created for adult talking treatments such as CBT for people with depression, 21,000 new posts promised in the next 4 years
- £1.3 billion package for mental health up to 2020
- More GPs will be encouraged to undergo psychiatric training
- 570 extra consultants had been promised in the plan and Professor Wendy Burn, president of the Royal College of Psychiatrists stated she “was supportive of this strategy which starts to tackle a problem”. The problem being that it can be rare in mental health services to see the same consultant twice in a row.
- Professor Ian Cumming, Chief Executive of Health Education England said “I am confident that the NHS can rise to this challenge and that this plan is a significant step to make the improvements to care we all know are needed a reality.
Some of the negative points surrounding Hunt’s plans were as follows:
- Janet Davies, Chief Executive of the RCN said: “The Government’s policies appear not to add up”. The promise of more nurses was not reflected in the decision to withdraw funding and grants that are available for study. The withdrawal of such funds had in fact led to a sharp decline in the number of University applications.
- The plan did not provide any real answers as to how these new posts were going to be funded, or where in fact recruitment was going to happen.
- Some feel that the plans are ‘too little too late’ with the Tories being warned in the past that severe staffing shortages were affecting patient care.
- People have a lack of belief in Hunt, due to a failure to deliver on pledges in the past that could have improved services. Having had ample time to address the issue of chronic underfunding, people feel that perhaps this again could be all mouth and no action.
- There is a general feeling that the plans are not sustainable, the plans for extra cash are not backed in any way with a realistic strategy.
On the face of it, It is always great, when we hear that extra money is being put into Health and Social Care. The headlines are great, £1.3bn and up to 21,000 new posts. However, without not being able to analyse the full detail of the proposals, the headlines actually ask more questions than what they answer.
But once you start breaking this down, let us say an average post costs £30k including on costs, that only gives £650m to support existing services. We know service budgets are already facing increased pressure with changes to national living wage, increases in inflation and the effect of pension changes. This coupled with the increased demand for prevention services and the general increase for services, suddenly makes a big dent in any additional funding.
What we do not know at this stage, is where the additional funding is going to be found from and if it will be to the detriment of other key frontline services. We already know that Social Care commissioners are struggling to deliver services with limited resources but also being asked at the same time to deliver ongoing savings plans. If suddenly commissioners are expected to contribute to existing budgets then the headlines are not so encouraging.
If we are encouraging GPs to carry out more psychiatric training, what effect will this have on the shortage of GPs already being experienced across many GP surgeries across the country? This then starts opening up the debate about looking at services in isolation opposed to the bigger wider issue of Health and Social Care.
Budgets can be used to win political arguments at both a local and a national level so we need to understand the overall funding for Health and Social Care in its entirety and not a specific service level. There was a recent report showing that residential care budgets had reduced year on year which indicates funding is reducing. What it failed to show was that whilst, the budgets had reduced, fewer people were being funded in residential care, so in effect, the spend per client had actually increased.
From experience, headline news also encourages people’s expectations to grow which then in turn, have to be managed. We need to understand the detail behind the proposed additional money, how much is ringfenced for new posts in order to be able to deliver additional services.