Record £36bn investment to reform NHS and social care - too little, too late?

Industry leaders respond to Prime Minister's announcement of a health and social care shake-up funded by a new levy on working adults

  • Prime Minister pledges to tackle NHS COVID backlog and cut waiting times with new £36billion investment for health and social care
  • ‘Responsible, fair, and necessary action’ taken to provide biggest catch-up programme in the history of the NHS and reform the adult social care system
  • NHS capacity to increase to 110% of planned activity levels by 2023/24, offering more appointments, treatments, and operations
  • Social care reform plan will end catastrophic costs for people across the country, and include extra investment in care sector to improve training and support
  • Move will be funded by a new Health and Social Care Levy on working adults and an equivalent rise in the rates of dividend tax to make sure everyone pays their fair share

This week's announcement of a £36bn investment in health and social care will help to address the backlog caused by COVID. Image, Sasin Tipchai from Pixabay

A ‘large dose of realism’ is needed, warn health experts responding to the Prime Minister’s announcement of a £36billion funding boost to reform health and social care.

While they have welcomed the extra cash, which will controversially be funded through a new, UK-wide 1.25% Health and Social Care Levy, they are warning that it may not be enough to deliver the improvements needed quickly enough.

Richard Murray, chief executive of health thinktank, The King’s Fund, said: “Overall, we welcome the historic levels of investment in both the NHS and social care and the fact the Government has finally grasped the nettle of social care reform.

“However, a large dose of realism is needed in terms of what this money will be able to deliver, and how fast.”

He spoke out following Prime Minister, Boris Johnson’s speech in which he set out ‘responsible, fair, and necessary’ plans to tackle the COVID backlog, reform adult social care, and bring the health and social care system closer together on a long-term, sustainable footing.

He revealed that £36billion will be invested in the health and care system over the next three years to ensure it has the long-term resource it needs.

Playing catch-up

And patients will benefit from the biggest catch-up programme in the NHS’s history, so people no longer face excessive waits for treatment.

To fund the reforms, from April the Government will introduce a new, UK-wide 1.25% Health and Social Care Levy, ringfenced for health and social care. This will be based on National Insurance contributions (NICs) and from 2023 will be legislatively separate.

To ensure everyone contributes fairly, all working adults, including those over the state pension age, will pay the levy and the rates of dividend tax will also increase by 1.25% to help fund the package.

This additional funding is a critical investment in our country’s future - it will give the NHS the extra capacity it needs to get back on its feet and is a vital first step in the reform of our broken care system

And employers, who benefit from a healthy workforce and a taxpayer-funded health service, will be asked to contribute so the costs are more widely shared.

This will raise around £12billion in extra funding per year, to be invested in frontline health and social care across the UK over the next three years.

Beating the backlog

The announcement comes as the number of patients waiting for elective surgery and routine treatment in England is now at a record high of 5.5 million, rising to 13 million by the end of the year if left unchecked.

Before the pandemic, nine out of 10 patients were waiting fewer than 25 weeks in England. This has now risen to 44 weeks.

To fix this, the NHS needs to be able to offer more appointments, operations, and treatments.

And, rather than simply plugging the gaps, new, innovative practices must be pushed forward so patients continue to receive the best-possible care.

The new funding is expected to fund an extra nine million checks, scans, and operations.

Speaking in the House, Johnson said: “You can’t fix the COVID backlogs without giving the NHS the money it needs; you can’t fix the NHS without fixing social care; you can’t fix social care without removing the fear of losing everything to pay for it; and you can’t fix health and social care without long-term reform.

“The plan I am setting out will fix all of these problems together.”

Chancellor of the Exchequer, Rishi Sunak, added: “We’re tackling the NHS backlog and taking decisive action to fix our broken social care system.

“This significant £12billion-a-year long-term increase in public spending will improve people’s lives across the UK, but our health and social care systems cannot be rebuilt without difficult decisions.

“The new Health and Social Care Levy is the necessary and responsible thing to do to protect the NHS, sharing the cost between businesses and individuals and ensuring those earning more pay more.”

Historically, healthcare has been an industry that is data rich and insight poor, and this must change in order to assess challenges, prioritise investments, and deliver greater value to patients in the longer term

And Health and Social Care Secretary, Sajid Javid, said: “Our nurses, doctors and care workers have worked tirelessly throughout the pandemic in our hour of need.

“But the pandemic has taken its toll - waiting times are longer than ever before and social care is under even greater pressure.

“This additional funding is a critical investment in our country’s future - it will give the NHS the extra capacity it needs to get back on its feet and is a vital first step in the reform of our broken care system.”

Social care reforms

Reforms to social care will mean no one in England will now have to pay more than £86,000 in care costs over the course of their lifetime - equivalent to around three years in care.

This will apply regardless of where they live, how old they are, what their condition is, or how much they earn.

At the same time, the Government will support those without savings – with the state covering all care costs for anyone with assets under £20,000.

Anyone with assets between £20,000-£100,000 will be expected to contribute to the cost of their care, but will also receive state support, which will be means tested.

Sajid Javid

The new £100,000 limit is over four times higher than the current limit of £23,250, meaning many more people will be eligible for support than under the current system.

And the social care workforce will receive new training and qualification opportunities, so they have an opportunity to progress and improve, while providing an even better standard of care.

Javid said: “An ageing population with increasingly-complex needs is putting ever more pressure on the social care system.

“So, alongside providing a path to long-term financial sustainability, additional support for the care system is also needed.

“The Government will set out a detailed plan later in the autumn to enable local authorities and other providers to invest in technology, innovative methods of care, and in their workforce.”

Commenting on the investment in social care, Murray warned that the three-year settlement may not be enough to ‘fix’ adult services in the longer term.

He said: “Social care will see only £5.4billion over three years, with no guarantees of sustainable funding beyond this.

While we have yet to see the finer detail of the settlement, putting this funding to best use will critically depend on developing a plan to address chronic workforce shortages

“The cap on care costs – which will consume nearly half the funding – will protect people from the very-high costs of long stays in residential care, but setting it at £86,000 means it will help relatively few people.

“And the changes to the means test are very welcome and will bring thousands more people into the publicly-funded system. However, there is a real risk this will leave inadequate funding to bring about meaningful change in areas such as workforce, access, and quality.

No quick fix

“While this plan certainly does not 'fix' adult social care, as the PM had promised, it is the most-significant step forward for a generation.”

And on the plans to address the COVID backlog, he said recruitment was key, adding: “Today’s three-year funding settlement represents very-significant investment in the NHS, but it is important to be realistic about how quickly the service can clear the waiting list.

“While we have yet to see the finer detail of the settlement, putting this funding to best use will critically depend on developing a plan to address chronic workforce shortages.

“Public expectations will rise with their taxes and the Government must be honest about how long it will take to recruit and train enough staff to provide the tangible improvements to NHS care the public will expect.”

Javid has made it clear that technology will play a key role in delivering these reforms, a direction which is being welcomed by industry.

On the back of this week's announcement, an Elective Recovery Technology Fund will provide access to cutting-edge technologies.

And a further £250m will be provided to increase operating theatre capacity and improve productivity in hospitals.

Technology, and data collection, will have a key role to play in delivering the improvements outlined. Image, Pexels from Pixabay

But, speaking to BBH, Steve Morgan, partnership director at Agilisys, said data would also play a major role. He commented: “It is positive that the Government is committing to this investment into the UK’s social care system. However, despite this additional funding, the growing demand and cost of social care is not going to reduce without long-term structural change.

“With social care making up most of local authority spend, local authorities need to think about flattening the curve to ensure that excess demand is being mitigated by concerted efforts to lessen dependency and reduce institutionalisation.

“The most-effective way forward for the social care ecosystem is building on its technology capabilities and infrastructure - analysing and engaging with local authority data to make informed decisions around social care resources.

“Technology, like social care cost and demand models, can support by showing local authorities and key decision makers the demand for, and delivery of, social care and its costs, and ability to plan more sustainably.

Capturing the data

“Taking all the disparate data captured by a given local authority and applying it to potential scenarios will help to illustrate what services are being delivered and at what cost per person.

“Once local authorities have this ability to see what the cost per person is in a particular category or cohort, for instance, they can play out potential investments, approaches, and models that can make savings and reduce demand.

The most-effective way forward for the social care ecosystem is building on its technology capabilities and infrastructure - analysing and engaging with local authority data to make informed decisions around social care resources

“Having this information from the outset will remove some of the veil of financial uncertainty for local authorities when it comes to social care delivery and cost management.”

And Mark Frankish, data scientist at SAS UK & Ireland, adds: “Historically, healthcare has been an industry that is data rich and insight poor, and this must change in order to assess challenges, prioritise investments, and deliver greater value to patients in the longer term.

“To deliver value today, all relevant patient data must be at the centre of all the NHS’s performance analysis.

“With artificial intelligence, machine learning, and analytics, data from past case notes, biomedical imaging, and health monitors can be quickly combined and used to ease these difficulties.

“Using AI to score donated kidneys against whether they are suitable to be transplanted by doctors, decreasing the chance of rejection, is a perfect example of how the technology can work symbiotically with humans to streamline healthcare provision.

“This should enable the NHS to derive maximum value from its data and, ultimately, save more lives.

“AI and automation exists to help people make better decisions, not replace them. It’s vital that we don’t lose sight of this.”

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