Health and social care changes 'paving way for fewer services' warn experts
Current reforms to health and social care services, and radical redesign of the local government finance system, may signal the end of the NHS and local government in England as we know them, warn experts in The BMJ today.
Allyson Pollock and colleagues at Newcastle University and Queen Mary University of London, say changes introduced by the Health and Social Care Act 2012 and further reform planned under the Cities and Local Government Devolution Act 2016 and Sustainability and Transformation Partnerships (STPs) are being presented to the public and health professionals as a way of integrating health and local authority social care, but "are likely to lead to reduced services and entitlements, more private provision of publicly funded services, and potentially more user charges."
The issue lies in the fundamentally different funding bases for health (free at the point of delivery) and social care (means tested) services, which they say has been ignored.
How will these changes and reductions in funding affect access to care, equity, and already widening inequalities, they ask?
As funding decreases, and with single contracts for both health and social care, the authors warn that the distinction between them will blur over time and that some health services may fall out of NHS funding altogether. "Private providers and local authorities - both accustomed to charging and privatisation - may also lobby for concessions to charge for services that were once free at the point of delivery and delivered through the NHS," they write.
Furthermore, they warn that under the radical and regressive changes to local authority funding people in poorer areas "are likely to lose out as will depend more on the wealth of local areas and less on the principles of redistribution and need."
"The zeitgeist of integration and devolution obscures the fundamentally different funding bases for health and social care," they argue.
It is therefore essential that the public is given access to all the tender documents for joint commissioning and local authority commissioning of health services, they say "so that we can see how the distinction between NHS funded care and social care is made, what services are being tendered, how services are being defined, and how charging is dealt with.
Most importantly, the evidence for and the effects of these seismic changes on access to care, equity, and widening inequalities must be disclosed and understood," they conclude.