The scale of the funding challenge in health is colossal and while spending on health is increasing, the service is under unprecedented strain and struggling to keep pace with relentlessly rising demand, and this is also impacting on social care, the Commons Health Select Committee has said.
The Health Committee’s report on the impact of the Spending Review on health and social care noted that last year’s Spending Review announced that the NHS would receive an additional £8.4 billion above inflation by 2020-21. However, the Spending Review only defined health spending in terms of NHS England’s budget, rather than the whole of the Department of Health’s budget, as it had previously. This means it excludes, for example, spending on public health, education and training. Using the original definitions, and taking 2015-16 as the base year, total health spending will increase by £4.5 billion in real terms by 2021.
The Committee’s chair, Dr Sarah Wollaston MP, said: “Whilst the NHS has been treated favourably compared to many other departments, the increase in health funding is less than was promised if assessed by the usual definitions.
“Funding cuts to public health will make it more difficult to address the challenge set out by the Prime Minister to reduce health inequality.
“The cuts to public health undermine the radical upgrade to prevention that is needed to keep people healthy, reduce the gap in life expectancy and years lived in poor health for the most disadvantaged, and reduce demand on the health service. Cutting public health is a false economy, creating avoidable additional costs in the future.”
The Committee also examined the likely impact of the spending review on social care services and the government’s commitment to achieve parity of esteem for mental health. “Historical cuts to social care funding have now exhausted the opportunities for significant further efficiencies in this area,” said Dr Wollaston. “Increasing numbers of people with genuine social care needs are no longer receiving the care they need because of a lack of funding. This not only causes considerable distress to these individuals and their families but results in additional costs to the NHS. We are concerned about the effect of additional funding streams for social care not arriving until later in the Parliament.
“We welcome the plans for additional funding for mental health but there is a danger that this could get sucked into deficits in the acute sector particularly as there is a lack of accurate data on mental health spending. We expect to see clear, verifiable evidence that the additional funding promised for mental health is being delivered to the frontline if we are to make progress towards parity of esteem.”
Shared concerns
The Local Government Association shared the Committee’s concerns. A spokesperson said: “The Health Committee’s findings confirm what councils have been saying all along about the severe impact of the funding cuts on health and social care.
“We have previously warned that reducing the public health budget is a short term approach which could undermine the objectives we all share to improve the public’s health and to keep the pressure off the NHS and social care.
“The government is finding billions of pounds for the NHS over the next four years, but to then take vital money away from the services which can be used to prevent illness and the need for treatment later down the line and ease the pressure on the NHS is extremely counterproductive.
“We are pleased that the committee is adding its voice to the many groups, such as councils, care providers, charities and the NHS, who are all united around the need for government to fully fund adult social care.
“The funding crisis in adult social care is taking its toll on councils’ ability to provide support to older and vulnerable people. It is also leading to providers pulling out of the publically-funded care market and shifting their attention towards people who are able to fully fund their own care.
“The Committee is clear that cuts to social care funding have now exhausted the capacity to make further efficiencies, and shares our concern that additional funding for social care is not available until the end of this Parliament. That is why, as a starting point, government should bring forward £700 million of desperately-needed social care funding earmarked for the end of the decade to allow councils to protect vital social care services essential to easing the pressure on care providers and on the NHS.”
Meanwhile, Dr Rhidian Hughes, chief executive of the Voluntary Organisations Disability Group, which represents not-for-profit disability providers, called for new Prime Minister Theresa May to take a new approach to care.
“Demand for provision is rising whilst government’s policies are leaving fewer disabled people eligible for essential community support,” he said. “The Health Committee have helped bust social care funding myths but the sector remains at a critical state. The spending review settlement was woefully inadequate and, with her new Cabinet in place, we urge the Prime Minister to use the report to lead a progressive and fair approach to care and support in this country.”
