Health & care
are confident their budgets are sufficient to meet their statutory duties. Last year it was 35 per cent. It is therefore unsurprising that many councils are struggling to balance their books. If local authorities do not receive adequate funding from government, they may be forced to retender critical community and public health services at a time when those very services are critical for a robust health response. The ability of our health and care systems to respond in crisis is also thwarted by a lack of investment in preventative services. Countries that have experienced similar public health crises have performed better where there were preventative measures already in place. Such measures across all services could help safeguard organisations from the impact of another crisis. Even in the absence of a crisis, investment in prevention can reduce both cost and demand, increasing the resilience and sustainability of our public services. Addressing these issues will be key not only to the health outcomes of citizens across the UK, but to our ability to cope with the expected economic downturn. Evidence shows that economic depressions and unemployment are inversely correlated with chronic health conditions. To put it simply, as money in people’s pockets goes down, demand on health and care services go up. Without a sustainable health and care system with strategies in place to cope with this increase in demand, the vicious cycle of unemployment and poor health will only spiral further, leading to reduced growth and increases in welfare spending – further widening the health inequalities that already exist.
The crisis has gone some way to breaking down institutional silos that had inhibited integration – necessitating a move away from focusing on the barriers of process and encouraging shared goals and outcomes Lessons to be learnt There are clear lessons to be learned from the present crisis. At CIPFA, we want to see the positive examples of joined up working in parts of the health and social care system become business as usual across the country. We want to see prevention viewed as a true investment – money paid in now to improve outcomes and reap future benefits. But most of all, we want to see leadership from the top that enables these lessons to be applied consistently. Government needs to view health and social care as parts of a cradle-to-grave system, where weaknesses in one will lead to failure in the other, and fund both services accordingly. This does not mean more centralisation – it means joined-up, coherent policy, adequate funding to meet demand and ensure sustainability of vital services, and recognition that localities are best placed to determine what works in their area. But as we begin to return to some sense of normality, potential tensions are already beginning to emerge. The Community Network, part of the NHS Confederation, have called for a pause on the retendering
of community and public health contracts to give providers more stability. While this would indeed provide certainty for the healthcare sector, it also limits the ability of local authorities to deliver savings that could enable them to balance their books. While a pledge from government to fully fund the additional costs that Covid has created for local government could help overcome this, MHCLG has moved away from such commitments, instead promising future funding in the context of ‘burden sharing’. Covid-19 has created a huge amount of debate around the issues facing health and social care. The upcoming spending review will offer an opportunity to reflect on what the future shape of these vital sectors should be. However only time will tell whether we will let the crisis go to waste, or use the momentum gained over the last few months to build meaningful reform that puts both the NHS and social care on a sustainable footing. L FURTHER INFORMATION www.cipfa.org
Issue 27.5 | GOVERNMENT BUSINESS MAGAZINE
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