Meaningful reform on the horizon in this Budget or Armageddon€?

Ninety MPs signed a letter this month calling on the prime minister to set up a cross-party convention on the future of the NHS and social care in England.

One-third of the MPs who have signed the letter to Theresa May and Chancellor Philip Hammond are Conservative and said patients were being €œfailed€ by the system.

The letter said that a non-partisan debate is needed to deliver a €œsustainable settlement€ and €œthe need for action is greater now than ever.€

A Government spokesperson insisted a cross-party convention was not needed, because MPs would be consulted on social care next year. €œWe have announced a cross-government green paper on care and support for older people with input from a group of independent experts.€

The green paper was announced by First Secretary of State and Minister for the Cabinet Office, Damian Green. He said that the government recognises the need to reach a long-term, sustainable solution to providing the care older people need. As part of this work the government has begun a process of engagement in advance of the green paper to ensure it reflects a wide range of views and requirements. Government will work with independent experts, stakeholders and users to shape the long-term reforms that will be proposed in the green paper.1

He added: €œAn ageing population needs a long-term solution for care, but building a sustainable support system will require some big decisions. In developing the green paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, to build consensus around reforms which can succeed.€

Jeremy Hughes, chief executive of the Alzheimer’s Society, said it was €œreassured€ that the government was €œsetting out its commitment to address the social care crisis so that real action can begin.€

However, according to Simon Bottery, Senior Fellow for Social Care at The King’s Fund, the green paper will only be meaningful if it results in a fundamental reform to the social care system. €œThis is a challenge that previous governments have ducked and it is vital this government has the courage to deliver real change. Given that the government has decided to focus on older people, it is critical that it ensures the unique issues around working age adults are fully understood in a separate but linked process.€

He added that government must not use the green paper as an excuse for failing to address the immediate needs of the publicly funded social care sector, which faces a £2.5 billion funding gap by 2020.

Both the announcement and letter from MPs comes in the same month as three leading charities warned that the government must find at least £4 billion more for the NHS in the Budget to stop patient care deteriorating next year.2

The Health Foundation, The King’s Fund and the Nuffield Trust said that NHS funding growth had fallen to the lowest rate in this parliament and one of the lowest in NHS history.

It said that minimum requirements for the government to meet its manifesto commitments are to: deliver on its pledge to increase NHS spending in real terms for every year of the parliament; make an immediate, substantial down-payment on its promise to increase NHS funding by £8 billion by the end of the parliament and ensure that any increase in pay for NHS staff is fully funded, rather than being met from within the existing NHS funding settlement.

It should also outline a plan for meeting its election commitment to provide an extra £10 billion in capital investment to carry out essential repairs and improve deteriorating facilities.

This concern was echoed by Simon Stevens, chief executive of NHS England, in a recent speech at the NHS Providers conference. He said that after seven years of unprecedented constraint, €œthe NHS can no longer do everything that is being asked of it.€ With NHS funding increases in 2018-19 set to fall close to zero, he warned of services retrenching and retreating, waiting lists growing, and staffing levels falling.

The Government points out that it recently injected £2 billion into social care and the chancellor Philip Hammond dismissed calls for an emergency cash injection of £4 billion, as he said people running public services always predict €œArmageddon€ before a budget.

As worries about the NHS continue to grow, it seems many in parliament are unwilling to stand by anymore to wait to see if Armageddon materialises.

References1. https://www.gov.uk/government/news/government-to-set-out-proposals-to-reform-care-and-support2. https://www.kingsfund.org.uk/publications/autumn-budget-2017 (accessed 20/11/17)