Word on the street: Brexit an excuse to neglect issues
PUBLISHED: 12:30 31 January 2019
One of the many malign effects of Brexit has been that life has been sucked out of government and so many serious issues have been badly neglected.
Homelessness, education, regeneration, global warming, Universal Credit, poverty, prisons, crime... all have been sidelined, starved of money, and only the occasional policy statement has got anywhere near implementation.
However, one area that has received the chancellor’s largess is the NHS.
Last summer Philip Hammond announced an extra £20.5bn over five years (caution: would anyone care to guess what this will buy in 2024 prices after five years of Brexflation?).
This is an extraordinarily large sum – until you consider the challenges: many acute hospitals running big deficits; the increasing costs of drugs and kit; the relentless increase in demand from a growing, aging population with more co-morbidities; 100,000 vacancies; and a decade’s worth of austerity crash-diets as prescribed by Dr Osborne.
So it was with some eagerness that, three weeks ago, we turned to [NHS England’s chief exec] Simon Stevens’ 10-year plan to see how the dosh would be spent. There was no shortage of suggestions from clinicians, NHS bean counters, patient groups and lobbyists: but £20bn will not pay for everything, so would Simon be able to show the Wisdom of Solomon?
There is a lot of good stuff in the plan and several nettles have been grasped – personalised care for patients, emphasis on preventative work (despite cuts to local government public health budgets), tele-medicine and a commitment to integrated and place-based care, which requires improving facilities and standards of care provided outside hospitals.
But fundamental to integrated care is a properly funded social care sector.
It allows people to leave expensive hospital beds and return home for convalescence, rehabilitation and continuing treatment provided locally.
For many people, social care is crucial for hygiene, hydration, nutrition, and drug compliance. Failure of any of these can mean a blue-light trip to A&E and a return to the bed recently vacated. Bad for the patient and costly for the NHS.
If Dr Osborne’s NHS ministrations were severe, his funding cuts to local government (the prime source of social care) were sadistic.
For example, in 2009/10 Haringey’s revenue budget was £405m, with £67m spent on adult social care.
Following a string of funding cuts, by 2018/19 the budget was £250m, but Haringey prioritised and now spends £80m on adults. The increase is basically a decade of inflation and takes no account of increases in demand.
So, is the NHS 10-year plan really deliverable without a significant reboot of the resources available to social care? If we agree that more funding is needed, where will it come from?
A clue comes from the Equality Trust: when austerity began, the combined wealth of the wealthiest 1,000 people in Britain was £256 billion: the same cohort in 2018 sat on some £724 billion.
If we have the collective will, we can properly find an integrated and balanced health and social care system.