Mean arguments over subtle changes of direction demean the politicians… They should be discussing social care philosophy…. and the real reason for the parlous finances.

Mrs May and the conservatives won some brownie points from NHSreality today. Her acknowledging that there is not enough money, and that we don’t have a plan to provide enough for social care is refreshing. The responses of the Liberals and Labour are pathetic tickertape: word bunting for short term points with a shallow media. What she proposes is fair, and a similar form of overt rationing should arise from a subsequent debate on health.

Mean arguments over subtle changes of direction demean the politicians… They should be discussing social care philosophy and ideology…. At last one political leader is leading by discussing the unpalatable need to ration, and provide. Mrs May has not yet suggested a “mutual” but that may eventually come from a responsible opposition. I hope it’s the Liberals who agree to tell the “hard truths”… but Mr Fallon’s response was unworthy..

Henry Zeffman, & Francis Elliott report in the Times 22nd May 2017: Theresa May announces cap on social care policy as Tories’ lead dwindles

….the insertion of a pledge for “an absolute limit” left the bulk of the policy unchanged.

Under the Conservatives’ plans, property would be counted towards the means-test for domiciliary as well as residential care, but the figure for costs to be capped rises from £23,500 to £100,000.

Initially there was no further limit to liability, meaning that wealthier families risked having to spend a greater proportion of their assets to care costs. After intense pressure Mrs May has now pledged to introduce a cap — with the precise figure to be set after the election.

A cap was the central recommendation of the 2011 Dilnot Report into care funding and was due for introduction at a level of £72,000 in 2020…..

Polly Toynbee has it right when she says: Labour’s failure on the NHS is prolonging this health crisis (Feb 2017) and LIbby Purves continues to make sense today in the Times: Why I’m happy for my house to fund my care – The affluent middle classes live in disgustingly overvalued moneyboxes. It’s high time this wealth was put to better use 

…The idea is to admit that, whether you stay put or move to a care home, it will now be considered that your means-tested wealth includes your house. Only the last £100,000 of the total gets protected for your heirs. Nobody, and no surviving partner, would have to sell that house in their lifetime. But after death the state would do so, to repay the cost of publicly provided care. The protected £100,000 inheritance is four times as much as under present rules, but the clinching difference is that now the house’s value will be counted as if it were cash.

It’s a bold move, and though tweaks and explanations are needed, a necessary one. Those shouting “dementia tax” — often panicking Conservative candidates — are closing their eyes to two things. One is the reality of an ageing population. The other is that the present low, underpaid standard of home care simply will not do. Nor can I sympathise with dementia charities which, unforgivably, in their propaganda try to set sufferers against one another by complaining that if you were in hospital with cancer your care is free on the NHS, but if you are at home with dementia needing social care you have to contribute……

In Case you did not get the message Dennis Campbell reports the truth which government stooges would suppress:  NHS trusts overspend by £770m despite bailout funding – Trusts fail to limit overspending to £580m but make inroads into previous year’s £2.45bn figure…

…“There was a significant improvement in NHS trusts’ finances last year. That was [from] a combination of taking out £750m from the cost of agency staffing and delivering almost another £1bn in efficiency gains,” said Hopson.

New research by his own organisation has found that trusts ended 2016-17 with a combined deficit of £700m-£750m. “That figure would be bigger than that without the £1.8bn sustainability and transformation fund money. That money has clearly been very helpful, too,” Hopson said.

But Sally Gainsbury, a senior policy analyst at the Nuffield Trust health thinktank, said: “The £770m is a very poor measure of how much the NHS is actually overspending by. In reality, the NHS overspent by significantly more than the £770m that HSJ reports because the £770m only comes after a whole series of one-off accountancy adjustments, such as deferring payment of bills from last year into this year and changing the valuation of property [owned by the trust]….

“And there is also the £1.8bn emergency bailout funding from the Treasury. Without it, NHS overspending would probably be in the region of £2.5bn.”

However, Gainsbury added, the NHS’s real deficit at the end of 2015-16 was about £3.7bn, once bailouts were included, so trusts did genuinely improve their finances by £1.2bn during last year.

“The underlying NHS overspend, whatever it turns out to be once NHS Improvement publish their figures, is more a measure of underfunding than of NHS profligacy,” she said.

HSJ’s figures are based on figures contained in board reports for 217 of the 236 trusts and trusts’ responses to its direct requests for information.

Siva Anandaciva, the chief analyst at the King’s Fund health thinktank, said trusts ending the year £770m in the red was an “impressive” performance, given how demanding last winter had been.

But, he added: “Set against the original ambition for lst year’s deficit and given the heavy reliance on sustainabaility and transformation fudning and other financial support, the NHS provider sector clearly remains some way from a balanced financial footing.

“Most worrying is the amount of one-off actions that have been used to improve the 2016-17 position. Delaying payments to suppliers, deferring capital spending and selling land do not address the underlying financial problems facing the NHS each year.”

NHS trusts would only regain control of their finances when “the fundamental imbalance between funding and rising demand is rectified”, he added.

NHS finance experts say that none of the three major political parties’ manifesto pledges of extra money for the NHS during the next parliament will be enough to let it maintain quality of care, meet treatment waiting time targets, improve cancer and mental health services and transform the way it looks after patients.

Key bodies, such as the National Audit Office and the Commons health select committee, have claimed in recent months that the NHS’s finances are unsustainable and need to be put on a stable footing.


This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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