Prime Minister

David Cameron has upped the election stakes over NHS funding by guaranteeing to fund the £8 billion deficit the NHS is predicting. Labour are struggling to follow suit. Inevitably, the Liberals have already committed, knowing they will never form a government but may be a small part of a coalition.

If Labour had their wits about them, they would have an answer but it is a hard one.  A lot of NHS money is wasted paying for old people to occupy expensive hospital beds that they do not need. What many old people need is social care in a safe environment, either their home or a residential care home. The problem is that hospital care is funded by the NHS while social care is paid for by local government. While the NHS budget has increased every year, local government funding has been cut horrendously.  This leads to several serious problems.

Firstly, should responsibility for social care be shifted to the NHS, making it a national social care service?  I don’t think so. This is the sort of service that is better run locally and I think local government has generally done it well under adverse financial circumstances.

If social care is to remain local and is to relieve the NHS of unnecessary costs of so-called bed-blockers, it will need more cash – and quite a lot more – because social care funding is already at crisis point. Clearly and in the long-term, this should come from the NHS budget but life is never easy in the short-term!

Shifting large numbers of old people from hospital to social care will not happen overnight but, when it is achieved, will have a significant impact on the capacity needs of many hospitals.  This creates two further problems.

There will need to be transitional funding during what will be a fundamental service shift. However and much more challenging, the process may question the need for hospital  capacity in the longer term. I cannot think of a MP of any party who has ever been able to support a hospital closure in their constituency.

I am quite sure the issue of health and social care lies firmly in the hands of Members of Parliament but I am not convinced any of them have the courage to face up to reality and support the necessary resource shift that is the only solution in the long-term.