Are radical changes to health and social care paving the way for fewer services and new user charges?BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4279 (Published 27 September 2017) Cite this as: BMJ 2017;358:j4279
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Re: Are radical changes to health and social care paving the way for fewer services and new user charges?
Whilst Pollock and colleagues provide a detailed account of the way in which health and social care expenditure by local authorities has been cut over the years, with huge detriment to those who depend on them, they significantly fail to make the case that sustainability and transformation partnerships will of themselves lead to further cuts in services. It is therefore misleading for you to write in your ‘Editor’s choice’ that ‘Rather than being about integration of health and social care, they (and the linked devolution of services to local authorities) are about reducing services and entitlements, increasing private provision of publicly funded services, and, potentially, introducing charges.’
The bulk of the article tells the sorry story of cuts to local authority funding and services. It is only in the penultimate paragraph that a link is made between that and what may happen with the development of STPs. The authors’ argument amounts simply to the fact that they ‘expect the distinction between them (health and social care services) to blur over time and some health services to fall out of commissioning, and out of NHS funding altogether.’
Most commentators, including the BMJ itself, have over the years called for greater integration of health and social care, so for Pollock and colleagues to decry that puts them very much at variance with most informed views. Their expectation that this will lead to services falling out of NHS funding stems, I suggest, less from rational argument and more from a prior prejudice against any health service re-organisation.
A more plausible analysis sees STPs not as a means to deliver cuts to services, but rather as a sensible way to cope with the significant further shortfall in financing of the NHS that has to be faced. The primary purpose of STPs is to promote collaboration between health care organisations, effectively eliminating the purchaser-provider split and internal market and all its associated costs, and make the most of what we can all agree is an inadequate budget overall. It is likely that without STPs the cuts to health services would be significantly greater than if they are successful.
The introduction of STPs can be seen as reversing as much of the 2012 Health and Social Care Act as is possible without primary legislation. They should surely be welcomed by all of us who argued against that misguided legislation. I am not clear whether the article and your ‘Editors Choice’, arise from misinformation, misunderstanding, or simply the desire to make mischief! How otherwise do Pollock and colleagues propose that £26bn of reduction in health care costs should be found?
Competing interests: I am a non-executive director at Chesterfield Royal Hospital, Consultant Clinical Adviser for NICE, and trustee for the Sheffield Hospitals Charity and Medact. Formerly I was Director of Public Health in Sheffield.