Latest from CIPFA Health and Social Care Panels

21-03-2016

The main CIPFA/ADASS Social Care & Welfare Reform and Health panels which met on 11 March 2016 concentrated on how the government might better facilitate the delivery of the integrated health and social care agenda to which all are committed. There were two main discussions:

What might the Department of Health do to help the position of social care authorities?

The Social Care & Welfare Reform Panel were in favour of three general approaches which it was felt could be better delivered:

  1. More certainty in the frameworks on which to plan for the future.
  2. Early notification of changes proposed ahead of the relevant year (examples of delay: BCF technical guidance, capital limits for charging).
  3. Harmonisation of rules (eg on funding, capital, transfers of responsibilities) across social care and health, which would make integration easier.

More specific potential requests were that:

  • The £1.5bn BCF increase should be brought forward to an earlier year.
  • In the context of slow progress in implementing welfare reform (eg 170,000 people are now on Universal Credit, implying a considerable speeding up to reach the target of 7,000,000 by 2018), it would be timely for DH to consider and report on the wider implications of how welfare reform affects social care.
  • It would also be helpful to see consideration of how the recent changes in how the Government categorises and handles debt will affect social care debt (with the aim of ensuring that the chances of collecting social care debt are not reduced).
  • More guidance / research / support might be made available on the development of alternatives to residential provision for social care, eg extra care housing.
  • Guidance might also be helpful on the evidence requirements for fraud in the area of Direct Payments.

These suggestions will be forwarded to the Department of Health to inform further discussion.

What actions are needed to improve the chances of delivering the NHS’s Five Year Forward View?

The Health Panel discussed an early draft of an update to CIPFA’s August 2015 publication ‘The Health of Health Finances’. They agreed with the general conclusion reached – that pressures would be more than the £30bn identified in the Five Year Forward View, and savings likely to be less than the £22bn being assumed, and so the current plans were unlikely to prove financially deliverable. That is emerging as something of a consensus across commentators, so the Panel concentrated on what flows from such a position:

  • It is a leadership challenge as much as a financial challenge – the Panel emphasised the need to seek out radical but sustainable solutions to controlling costs, securing value, and perhaps seek novel funding solutions.
  • New methods of prioritisation will be needed if the necessary savings are to be made without affecting services unacceptably. In particular members wondered what the health system can learn from local government which seems to be maintaining services successfully with reduced resources within a framework that does not allow for deficits.
  • There is also a potential case for extra funding, especially to generate projects with longer term preventative benefits.
  • More analysis is needed to update the £30bn assessment of pressures on which the Five Year Forward View is predicated, and an assessment should also be made of the comparative phasing of pressures and planned savings.
  • The frontloading of NHS support in the 2015 CSR has not changed the underlying position: it will be necessary either to add further to the NHS budget, charge users more, or reduce services. To choose none of those is not a realistic option, and so the Government need to assess its options radically and seriously.
  • The plan is to develop ‘More Medicine Needed? The Health of Health Finances Revisited’ for publication this spring.

The panels also considered various other workstreams, including a study (for the Department of Health) on the factors driving the cost of residential and domiciliary social care services, and how best to procure them; a potential tool for assessing longer term investments such as public health; and the health and social care aspects of a general guide to contract management practice.