We need to understand that the distinction between health and social care is spurious.

Patients are stuck in hospital because there is insufficient social care. Patients are attending my GP surgery to talk about cuts to incapacity and other benefits. When people are distressed, they stop taking care of themselves. Self-management of chronic diseases is half-way up most poor people's hierarchy of needs; undermine their welfare and their healthcare suffers. I cannot discuss glycaemic control with patients whose benefits have just been unjustly taken away. The recent Marmot report about health inequalities in London, the BMA report on welfare reform and the Glasgow Deep End reports make this abundantly clear. Furthermore, the NHS will be doing social work as those without welfare have nowhere else to go and medical productivity will not stand a chance of improving.

To avoid this catastrophe we need to end the spurious distinction between health and social care and properly understand social determinants of health as co-morbidities. We do not stand a chance without political commitment, and urgent economic analysis is needed to help make the case for this.

Competing interests: None declared