The end of the line?

David Cameron has come out fighting in defence of the much-maligned Health and Social Care Bill today, ahead of its return to the Lords with more than 1000 amendments. There is a veritable blizzard of competing viewpoints over the potential affects of the Bill with the role of the private sector within a revamped NHS attracting most debate. Proponents of the bill say that the additional income raised by allowing the NHS to undertake more private work can be beneficial, as 53 NHS Directors argue in an open letter this morning. Earlier in the week Ed Milliband put an opportunity cost on the Government’s NHS reforms at 6000 nurses, saying that the changes were unnecessary and would promote a market free for all.

Away from the political manoeuvrings and the government’s patent failure to sell the benefits of the reforms to any of the vested interest groups, it is, as usual, the patients that have the most to lose. A report from the health select committee warned yesterday of an impending crisis for social care in the UK, caused by the ‘salami slicing’ of services by underfunding and a failure to properly integrate health and social care. It said that elderly people are deeply reliant on public services, accounting for 50% of those in social housing, 70% of hospital beds and 91% of those needing nursing care, but that there was no ”joined-up approach” to dealing with elderly people. Indeed it seems that the Care Trust experiments, where Health and Social Care budgets were brought together and managed to decrease hospital admissions by 30% by focusing on more community-based care, are not being rolled out.

The consensus seems to be that the NHS would certainly benefit from reform and better integration, but enshrining such changes in law was probably not the best way of doing that. Alan Milburn, writing in the Times today, argues persuasively that integration of services is key, moving from a healthcare system to a whole care system that properly addresses the issues the country will face in the coming years.

Churchill’s observation that ‘If you’re going through hell, keep going’, could have almost been written for the Coalition’s attempt to get the Health and Social Care Bill onto the statute books, but it could yet prove a hollow victory if they are successful. The focus will remain on the cost of the NHS re-organisation itself and what it has achieved, whilst every slip up or problem will be laid firmly at the Government’s door from now on. The real questions though – the importance of competition within the NHS and the aforementioned integration of services, seemed to have been drowned out for now.

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