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Big debate: Do we need a review into the future of the NHS and social care?

Benenden examines the debate by speaking to Norman Lamb MP, former care and support minister and health spokesperson for the Liberal Democrats.

What’s the news?

With the backing of two former health ministers – Stephen Dorrell (Conservative) and Alan Milburn (Labour) – Norman Lamb recently introduced a bill to parliament to propose an independent commission to examine the future of the NHS and social care.

Why is a review needed?

Lamb suggests that the future of the NHS needs to be decided by a cross-party commission that could “[engage] the public in a big national conversation about how much we are prepared to spend as a society on our health and care system”. He says the review is urgent as health and care costs are rising at a rate of 4% to 5% a year due to better medical treatments and an ageing population and current funding arrangements don’t cover this.

What’s the answer?

“The system is under impossible pressure and it results in cutting corners and crisis management where you just try and prop up institutions that are failing financially, rather than actually doing the smart thing, which is to invest more in preventive care,” says Lamb. He adds: “I think most people take the view that we need to … shift much more emphasis onto preventing ill health, that not only involves social care but also public health. Shifting away from repairing the damage once it’s done, which is usually very expensive, to stopping it happening in the first place.”

Stephen Dorrell, now chair of the NHS Confederation, has supported this position by writing to Lamb saying: “[There is a] need to develop new funding and management structures that deliver more joined-up and supportive care, reflecting the needs of individuals.”

“The bottom line,” says Lamb, “is that it’s very important that we have a health and care system that provides for people when they are in need of help and my fear is that we are drifting to a situation where that won’t be the case.”

How could funding arrangements change?

“I would end the divide between health and social care,” says Lamb. “We need a health and care budget with everybody within that system all with their interests aligned in preventing ill health and preventing a deterioration of health. At the moment that’s not the case. And so we have to get the incentives right in the system, which at the moment are chaotic, often contradictory and conflict with what we are trying to achieve. Particularly Payment by Results as it’s called, or Payment for Activity, which completely conflicts with the idea of stopping deterioration of health.”

He adds: “I also think we’ve got a real problem with funding the NHS out of general taxation. My view is there is a very strong case for carving it out and having a health and care tax.”

What could Benenden’s role be in a review of the NHS and social care?

“If you had an NHS and Care Commission, then organisations like Benenden could come forward and put their case,” says Lamb. “And I think that enables ideas to be considered in the mix in reaching conclusions about what will work best.”

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