CREDIT: This story was first seen in OnMedica
The current “seismic changes” in the organisation, delivery, and funding of health and social care services, and radical redesign of the local government finance system, could signal the end of the NHS and local government in England as we know them, experts have warned.
OnMedica reports that the analysis* in The BMJ predicts that as the distinction blurs between health and social care services, and funding falls, some health services will fall out of commissioning, and out of NHS funding altogether.
Responsibility for public health transferred from the health secretary to local authorities as a result of the Health and Social Care Act 2012; and under the Cities and Local Government Devolution Act 2016, further health functions will be devolved to local authorities. At the same time, the authors noted, NHS England is implementing sustainability and transformation plans (STPs) covering 44 geographical ‘footprints’ in England, that have been reported to be required to cut £26 billion from health and social care costs over five years. They examined how these changes and reductions in funding will affect access to care, equity, and already widening inequalities.
They argued that although STPs are being presented to the public and health professionals as a way of integrating health and local authority social care, in fact missing from this picture is their fundamentally different funding bases: social care is a local authority responsibility, and subject to means testing and user charges, whereas NHS services are free at the point of delivery.
They found that reductions in expenditure and the removal of ring fencing have already affected social care services and entitlements, and been closely followed by reductions in services, often achieved by tightening eligibility criteria. The effects of reduced expenditure and services are now also being seen in public health services. And inadequate funding is affecting clinical commissioning groups (CCGs), with reports of rationing of fertility treatment and elective hip and knee replacements, and restrictions on prescribing over-the-counter medication.
They warned: “A major concern with the reduction of NHS services is that people will be able to obtain them only if they can pay or have insurance. Financially strapped trusts, particularly in wealthier areas, are well placed to charge … Well positioned trusts have already seen large increases in income generated through charging. The greater involvement of local authorities in health service provision also increases the risk of new charges for what were previously free NHS services.”
They wrote that the fundamentally different funding bases for health and social care are obscured by “the zeitgeist of integration and devolution”. They predicted that as funding decreases, and with single contracts for both services, the distinction between them will blur over time and some health services will fall out of commissioning, and out of NHS funding altogether.
They concluded: “It is essential that the public is given access to all the tender documents for joint commissioning and local authority commissioning of health services so that we can see how the distinction between NHS funded care and social care is made, what services are being tendered, how services are being defined, and how charging is dealt with. Most importantly, the evidence for and the effects of these seismic changes on access to care, equity, and widening inequalities must be disclosed and understood.”