Solace Blog

The seven tests of health and social care funding and reform

By Paul Najsarek, Chief Executive, London Borough of Ealing and Solace Spokesperson for Community Wellbeing

The general election result and the continuing focus on Brexit would suggest that reform of public services will not be centre stage for a while in government. 


However, the salience for the public of health and care, and the stresses that the system is under, mean that it will be impossible to ignore the issues we are facing in this area.

At first glance there is still plenty happening:

- A promise of a consultation (green paper?) on social care in the Autumn.
- New time-limited funding being channelled through the BCF with three goals in mind.
- New reporting requirements to go with the new money.
- A programme of area reviews looking at how local systems are operating.
- A new performance framework looking at flows of patients in and out of acute settings with a particular focus on delayed discharge.
- Overspending in most adult care departments and in many health settings as a result of growing population demand.

Given the risk that attention will be focused on partial solutions and short-term fixes, it is especially important to keep an eye on the principles that should be guiding our long term thinking. Here are seven tests we should apply to any reform and funding proposals that we consider locally or nationally:

1. Resident engagement and communication - A sustainable system needs resident support and will need residents to make lifestyle changes. This can only be achieved with open engagement.

2. Outcomes and community focus - It is very easy for us to become preoccupied with the technicalities of reform and institutions. We need to keep our attention directed on resident impact, well-being and inequalities. Our health and care funding should be viewed as an investment in the social and economic outcomes of our communities.

3. Subsidiarity and devolution - The assumption should be that improvement should be led as close to the patient/user as possible with national and regional reform and funding enabling change.

4. Credible business cases - The users of our services are often extremely vulnerable and at very sensitive points in their lives. This reality demands careful and credible plans and reassurance. When services are struggling to meet current demand and money is tight, it is easy for the plans to lose credibility.

5. Articulation of benefits - Right now, what we most need are investment and improvement in community services and prevention. Focusing on the benefits of those changes for staff and residents should be the immediate concern.

6. Whole systems - Any proposed solution should be judged on its ability to bring us closer to making the whole system work - rather than successfully competing for resources in order to make just one part of the system work.

7. Sustainable funding - Reform and improvement are crucial but reform alone will not produce the high quality outcome our residents expect without a short and long term funding solution to go with it.

We need to keep the tests in mind as the current changes in health and care are implemented and use them to guide and judge the work on future reform – and the Chancellor’s autumn budget.