UK government to pool health and social care budgets in England

The UK government on Wednesday published a plan to ensure more seamless working between the NHS and social care sector in England as it seeks to demonstrate value for money from the record sums it is ploughing into the service.

The white paper, which came just a day after the health service revealed that patient waiting lists would grow for another two years, proposed more pooling of budgets between the health and social care services, and designating a single person accountable for joint planning at local level.

Jointly issued by Sajid Javid, health secretary, and Michael Gove, levelling-up secretary, the blueprint claimed to improve the use of resources and prevent people falling into the gaps between the health and social care sectors. It also pledged to “help to create a more agile workforce with care workers and nurses easily moving between roles in the NHS and the care sector”.

However, experts questioned the lack of detail around funding and workforce shortages in the plan. Saffron Cordery, deputy chief executive of NHS Providers, said the proposal for a single accountable person in each place “could further complicate lines of responsibility in already complex, developing system working structures”. She added that pooling NHS and social care budgets was “no substitute for funding both systems appropriately”.

Nigel Edwards, chief executive of the Nuffield Trust, said the white paper risked overestimating the extent to which structural changes would produce results. “We also need to see workforce and funding issues addressed,” he added.

New figures released on Thursday highlighted the struggle the health service is facing in tackling a record backlog of care because of staff shortages. Monthly data from the Recruitment & Employment Confederation and KPMG showed demand for nurses, medics and care staff rose faster than for almost any other sector in January.

Claire Warnes, head of education, skills and productivity at KPMG, said this reflected “the significant workforce and skills challenges which these sectors have faced, and which the pandemic has accelerated”.

Figures from the Health Foundation show the NHS is short about 100,000 staff. Of these, about 40,000 are nurses. International recruitment increased during the pandemic, the charity found, driven mainly by newly registered nurses from non-EEA countries.

Sally Warren, director of policy at The King’s Fund, said staff shortages remained “the biggest issue, the biggest barrier to fast progress on the backlog and improving outcomes”. Yet despite repeated lobbying by health and social care leaders, “the government is just refusing to do a workforce plan which is really odd”, she added.

In the social care sector, industry leaders say that a policy of mandatory Covid-19 vaccination, introduced last November, led to the loss of about 30,000 staff, on top of 120,000 existing vacancies.

Martin Green, chief executive of Care England, said: “Workforce is our biggest challenge.” The government has now signalled it will shortly drop the [vaccine] requirement, in theory allowing the staff to be rehired or redeployed to the frontline.

Mike Padgham, chair of the Independent Care Group, which represents care home operators, said: “We’re sort of running on empty. And until the government does something about pay and terms and conditions, I can’t see how we’re ever going to recruit new people in because they just don’t earn enough.”

He added that the integration paper “stops too far short of the NHS and social care merger needed to provide the best service”.

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