The NHS and a social care commission

On 6 January 2016 Rt Hon Norman Lamb, the former Minister for Community and Social Care, presented a 10-minute rule Bill to establish an independent commission to examine the future of the NHS and the social care system.

He went on to set out the need for what he described as “a new Beveridge Commission for the 21st century”:

The NHS and social care face an existential crisis. In the post-war period, demand has risen by about 4% every year. We all understand the reasons for that. We are all living longer. The number of people surviving cancer has increased dramatically. According to Cancer Research UK, half those diagnosed with cancer now survive their disease for 10 years or more, compared with only a quarter 40 years ago. The number of people living with three or more chronic conditions is expected to have risen by more than 50% during the 10-year period up to 2019. New medicines are invented that enable the underlying cause of some genetic diseases to be tackled for the first time, and we are seeing remarkable advances in surgical procedures. All that is a triumph of modern medicine and of our NHS, and it is something that we should celebrate.

For the last five years, the coalition Government ensured that spending on the NHS was protected, but real-terms increases have been marginal. With demand continuing to rise, this has been the toughest financial settlement in the history of the NHS. Meanwhile, social care has been cut in real terms, despite significant increases in demand. A widely accepted assessment is that there will be a gap of £30 billion in the NHS by 2020. The Government have committed to finding £10 billion, including the increase in this financial year, but few experts in the NHS believe that that will be enough. The Health Foundation has estimated a gap of £2 billion in 2020 on top of the £10 billion commitment and many others believe that the gap will be much larger.

A reflection of the rapidly deteriorating financial position is shown in the accounts of NHS and foundation trusts. They are facing a projected £2.2 billion deficit by the end of this financial year. Pension changes announced by the Chancellor of the Exchequer are likely to add another £1 billion to costs. Pressures across the system are very evident. Today’s news that at least 100 GP surgeries applied to stop accepting patients because of shortages of doctors is the latest example.

The position in social care is perhaps more serious. The respected Health Foundation has estimated that there will be a £6 billion funding gap by 2020, without taking into account the increase in the minimum wage; the Local Government Association has estimated that that alone will add £1 billion to costs by 2020. It also does not take into account the planned introduction of the cap on care costs, which the Government have said they are committed to introducing in 2020.

The spending review provision for councils to increase council tax by 2% will narrow that gap by an estimated £1.7 billion by 2020 according to the LGA, but only if every council takes advantage of the new power. The plan for an increase in the better care fund will add £1.5 billion, but only in 2019-20. So a substantial shortfall remains. That means that further cuts to social care are inevitable.[1]

[1] HC Deb 6 January 2016 c287