Reflections on health and social care – 4 key milestones of 2014

Femi Ogunbiyi

2014 has been a momentous year for the health and social care sector. Ground-breaking pieces of legislation, major commissions and important debates on the future of health and social care in England have all featured on the agenda.

As we reach the end of the year, and with only months to go before the 2015 General Election, it seems like a pertinent moment to reflect and take stock of the key milestones over the last 12 months.

1. The Care Act 2014

Passed in May, the act is a seminal piece of legislation, which introduced the most important reforms to care and support in 60 years.

The act stipulates a requirement for local authorities to deliver care which meets the individual needs, rather than the ‘one size fits all’ provision that previously existed. This person-centred approach will be much more beneficial to the individuals in question.

It also promotes further health and social care integration and places responsibility on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS and other health related services. It is hoped such integration will provide the best and most cost-effective care for people based on their individual needs.

Finally, it demands that local councils arrange care for both council- and self-funded users. Crucially, local authorities will be able to charge for this service, meaning they will be incentivised to do so. This could result in local authorities having greater market control and more power over price setting. In these conditions some providers in
the independent sector may come under increasing pressure.

2. Demos Commission on Residential Care

This was one of two major commissions launched this year. A joint project between think tank Demos and former Care Minister Paul Burstow MP, the commission set about a root and branch examination of the future of the residential care sector.

Its proposals were published in September and included increasing co-location in the sector – i.e. combining care properties with educational or community centres. The other central recommendation was that surplus land should be sold so that care homes and supported living apartments can be built to meet the increasing demand.

The recommendations proposed aim to make the health and social care sector fit for today’s fast growing ageing population and higher numbers of younger people with complex health needs.

3. Kings Fund-Barker Commission on Future of Health and Social Care in England

The second commission, chaired by Business Economist Kate Barker and supported by the King’s Fund looked into the sustainability of the existing funding models of the NHS and social care in relation to the needs of today’s patients and service users.

It recommended sweeping away the existing model and giving patients a single, comprehensive and multidisciplinary assessment for all their needs instead. To maximise clarity and ease, one local commissioner with one care budget would provide ‘critical’ social care free at the point of use. As the nation’s economy improves, free provision for less serious needs could be added to this framework later on. If ‘substantial’ and ‘critical’ social care needs were provided free at the point of use, the costs of this care (approximately £5bn annually) would be shifted from patients to taxpayers by 2025.

The Commission believes that the simpler pathways created from their recommendations will increase the opportunities for many more integrated health and social care services to be rolled out providing a clear, simple and high quality service to people across the country.

Both commissions set out radical reform for the care sector. However, what matters now is if and how these recommendations are taken forward, and if and when they will be implemented. It is only at that stage that the health and social care sector see these changes come to fruition.

4. NHS England’s Five Year Forward View

The Five Year Forward View was the first NHS had set out a clear sense of direction for the way services need to change and improve. It includes an upfront request for increased funding, asking for an additional £8bn by 2020.

This has received broad support from politicians. While there is a strong monetary implication (namely £8bn) which none of the parties have committed to thus far, the Five Year Forward View will certainly play a role in the debate about how health and social care should be providing, particularly in the run up to the General Election.

Looking to the future

There is no doubt that health and social care integration and funding will be the fixations of all interested parties moving forward. What is unclear is who will be responsible for the delivery of care. The Conservatives, if re-elected, would like to see increasing delivery from providers across the private, public and third sectors based on a set of qualifications, whilst Labour would repeal the Health and Social Care Act and make the NHS the main provider. Whatever the result in 2015, we should expect the transformation of health and social care grip the political and national consciousness even tighter.

This article was first featured in the January print edition of Healthcare Business News.

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