The Commons is half way through its closing debates on the Health and Care Bill.
I have concerns about both main elements of the legislation. The first concern the extensive reorganisation of NHS England. This gives legislative force to the creation of Integrated Care Boards and Integrated Care Partnerships. These bodies are being set up to change the landscape of purchasing services from the NHS trusts, GP partnerships and other providers. They bring together various budgets, decide on what they need to provide for their area and divide up the budget to seek to procure what is needed.
I am not clear as to how they will be better than the Clinical Commissioning Groups they replace nor see why their boundaries have been configured as they are. There are big variations in geographical area and populations covered by these bodies. They need to hit the ground running now, as they have a big job to supervise the expenditures of large and increasing sums of money with a view to providing high quality care throughout England, and to bring waiting lists and times down to more acceptable levels. My concern is too much time and resource might go into reorganisation when we need it to be pushed to the front line to provide the extra treatments and care needed by the large influx of patients.
The second concern is about the social care reform. I have written and spoken before about the need to put raising the quality of care and supplying enough of it to the fore of the consideration, rather than the vexed issue of how much people need to pay for themselves where they have assets. For many years there has been cross party support for the proposition that all frail elderly people should get their health care free as part of the NHS pledge, but should pay for their own board and lodging where they can afford to do so. It has meant that where someone moves into a Care home leaving their old home empty it is usual for it to be sold and for them to pay for their hotel costs at the Care Home from their own resources.
There have been some who suggest that placing a cap on care costs will free many people from having to sell their homes to pay the bills, but this does not cover the costs of board and lodging which can be considerable. There is a danger that some will think this new system and legislation will free their families from the need to sell a home and spend the proceeds, when in many cases there will still be substantial bills that people need to self fund. There is also the danger that the introduction of a Care Tax , starting at around 1.25% on National Insurance, will make people think social care is cheap. In practice this tax will pay for around one fifth of the total state costs of social care.
There needs to be more discussion and more consideration of what social care will look like in five years time, and how we will all help pay for it.