CIPFA Health and Social Care Conference 2016

By Paul Carey-Kent, Policy Manager, CIPFA

The annual conference was well attended, and covered a wide range of issues relevant to health, social care, their integration, and the wider system. Read below for an overview of the topics discussed by our speakers and download their presentation slides.

The future of social care and the consequences for health

Surveying the state of social care and its implications for the NHS, keynote speaker Richard Humphries (Senior Fellow, Social Care, the King’s Fund) warned against the tendency in some quarters to present social care as a supportive adjunct to the NHS – Simon Stevens is the first national NHS Chief Executive to say that social care should be the priority – and attribute NHS problems to social care’s funding challenges. Social care is also a critical service in its own right, he said, and "the NHS is quite capable of getting into trouble without any help". The question could equally be put the other way round, to look at the effect of health changes on social care; for example, there were 40,000 long-term beds in the NHS 25 years ago which are now in the social care sector, and domiciliary carers now do tasks which nurses undertook 25 years ago.

Looking at the spend on older people, which is dominated by the NHS, he suggested a designed system would end up with the split we have between keeping people in good health and dealing with them when they’re ill. The CQC Report on the State of Health and Social Care, issued on the day of the conference, points out pressures, as does the King’s Fund’s recent Home Truths report on all dimensions of care for older people. Even allowing for the Better Care Fund, he said, there has been a 9% real terms cut in social care spend since 2009 – against the flow of demography. Likewise key NHS services for older people have reduced, and there is considerable concern for the viability of local authority reliant residential care, and especially home care, where market exits are occurring.

Delayed transfers of care due to awaiting a social care package are up 165% in the last five years, though there are still more delays. But there are fewer delays than those involving other reasons, primarily awaiting further NHS care. Austerity has focused the mind, but savings actions can’t fully explain the reductions: 26% fewer people in receipt of social care now than five years ago; carers are feeling less satisfied; and there are more complaints to the ombudsman. The last five years have seen social care funding cut by 2% per year in real terms, and even if 100% use of the precept is assumed, the average real terms increase will be 0.6% annually when probably 4% is needed to maintain the service offer. The King’s Fund believes the current £1.2bn social care shortfall will rise to £3.5bn by 2020. Naturally, Richard Humphries said social care needs to carry on trying to get more with less, but the government may also need to revisit the Care Act’s ambitions, and take notice of the rising crescendo for fundamental change.

Download the presentation (PDF, 969 KB) 

Social care in a time of budget risks

John Jackson, who has been ADASS’s Resource Policy lead since 2009, backed up the picture of social care finances painted by Richard, stressing how hard it was proving to carry on generating £1bn a year of savings in social care – the more so when it was no longer feasible to hold provider prices down further: rather, what local authorities have to remember now is that if the market falls over it will cost massively more than at present. The starkest fact is that there are 1.6 million people over 85 now, but by 2035 there will be 3.5 million.  

Would sustainability and transformation plans (STPs) solve the problem? It is unlikely that they will deliver the savings plans required by the Five Year Forward View, for two reasons. First, political deliverability is likely to be a big issue. Second, the NHS doesn’t have a history of long-term planning, and had never had less than 4% growth per year prior to 2010, so this is new territory and a struggle is likely – the more so when lack of coterminosity between local authorities and STPs is problematic, and A&E performance is at its worst since 2003. 

Download the presentation (PDF, 448 KB)

Brexit: implications and next steps

Elizabetta Zannon (Director of the NHS European Office, NHS Confederation) explained that, as the first full member to leave the EU, Britain couldn’t really tell what to expect from Brexit, but that there are two main models:

• ‘Soft’ Brexit would be to arrive at something like Norway’s position. This would be as close as possible to full membership, ie remain in the European Economic Area, must comply with legislation, contribute to EU budget, allow free movement of people. Norway’s contribution is very similar in net terms to what it would pay as a member and Elizabetta pointed out that if we adopt this position we might pay more in net terms than we did as a member given the loss of our rebate.
• ‘Hard’ Brexit could be characterised as no compliance with EU rules, control of migration, no payments, no market membership. This position is generally held to be economically risky, but Canada can be seen a possible model.

What options lie between these extremes? Hard to say, but EU leaders say Britain can’t separate movement of people from movement of goods, services and capital – no ‘cherry picking’. Trade deals are very complex, she warned, and tend to take a long time to settle.

Turning to health specifically, 10% of doctors, 5% of nurses and 6% of social carers are from the EU, but the distribution is uneven, so there could be particular problems in some regions. ‘Brexit’ can be used as an acronym of the areas of potential impact on the NHS: