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Editorial Thursday 15 December 2016: The three deals to be done | Health Policy Insight
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Editorial Thursday 15 December 2016: The three deals to be done

Publish Date/Time: 
12/15/2016 - 10:25

Connoisseurs of U-turns are going to have some fun with Prime Minister Theresa May’s administration. The Teflon determination on absolute control that served Mrs May well at the chaotic Home Office is a poor approach to running the whole of government.

Today's U-turn isn't surprising. Following the Autumn Statement, I wrote on Twitter ”there will be quite a few Conservative MPs who are surprised and uncomfortable that nothing new was done for social care today”.

So it rapidly proved. Just call me Nostradamus.

As Paul Johnson of the Institute for Fiscal Studies said in his Autumn Statement analysis, "strikingly, the Chancellor responded not at all to calls for more money for either the NHS or social care. I’m going to stick my neck out and suggest he won’t be able to do that for much longer".

Following the refusal to address social care funding in the autumn statement, it is now the country’s worst-kept political secret that communities and local government secretary Sajid Javid will later today announce increases in the council tax precept for social care – thought to be 3% in each of the next two years.

This is the wrong way to raise money. Council tax is limitedly progressive, inequitable (it consumes a high proportion of the poorest people’s disposable income) and worst of all, raises less in poorer areas, which have the biggest funding burden.

It seems from Mrs May’s remarks at PMQs that that we may even be heading towards a heated debate on health and care funding. I confidently predict that it will find – as the Guillebaud report, the Wanless, Barker and Dilnot reviews and everything in between – that funding via income tax is the fairest and most efficient means of paying for these things.

We don't need a commission on health and care funding. We need politicians who will level with us that living longer (A Good Thing) is expensive, that social care need is unpredictable and uninsurable, and so we are going to have to pay more tax.

Income tax is progressive, equitable and straightforward. Unless you are very rich, it's almost impossible to avoid.

Farting about with the social care precept is literally and metaphorically impertinent at a time when all the data reveal a serious crisis brewing in health and social care.

A half-way competent opposition would be twenty points ahead in the opinion polls on the back of this.

Instead, we have the shark sandwich that is Jeremy Corbyn's Labour Party. Heading towards the 2020 general election with the Momentum and aerodynamism of Humpty-Dumpty, the opposition seems invisible on this, as on many other issues.

Perhaps one of the reasons for this is that the Dear Leader's office is not releasing Short Money funding for its health team to employ researchers. (Curiously, the Dear Leader's office is just recruiting a former member of staff of Sinn Fein. It is as if the leadership is deliberately trolling voters who are not ideologically tied into any major political party.)

The three deals
Currently, for health and social care, there are three deals to be done.

The first is a deal with all health and care staff. Well-run organisations are already doing their best here, but an extra effort is needed to tell these staff a few things.

The first is 'thank you, and we're sorry it's this hard right now'. This needs engaged and authentic leaders. It needs to be accompanied by asking 'how could we make things work better round here?' There is still waste in the NHS - and the staff know where it is.

I'm sensing that the erosion of staff goodwill and going the extra mile is nearing a tipping point. Most NHS staff need thanks, a hug and to get the genuine sense that their effort is appreciated.

The NHS culture issue is huge: I don't know about social care. It's hugely heartening to see an organisation publicly commit itself to the hard, long slog of improving its culture as Mersey Care have done.

The second is a deal on capital. This isn't impossible, though there will be ownership complexities around the blend with public dividend capital accounting. But without capital, STPs are guaranteed to move too slowly and slightly.

The third deal is the real deal: a deal with the voting, taxpaying public.

This deal says 'look, you know that you don't want worse health and care services. You know the smart way to fund them is communal risk-pooling across the whole population. And you know income tax is the best way.

'We're been pulling your leg that you can always have better services on lower funding, as social care is definitively demonstrating right now. This is going to cost you a bit more money. But it's worth it.'