Upturn in suicides due to recession not reversed now unemployment levels have fallen. Carl Walker

10 March 2017

TAP healthy equalities campaign Blog 5.

Is social care really “not about the money”?

Carl Walker – University of Brighton – Psychologists Against Austerity

SUMMARY

“Sustainability and Transformation Footprints”  STPs

The most recent of the many mass infrastructure changes visited upon the NHS will see the development of 44 ‘Sustainability and Transformation Footprints’ (STP). A key element of the STP programme is the premise that the movement of care out of hospital will save money. As a result councils and clinical commissioning groups are hurriedly trying to put into practice greater integration while having to make unprecedented cuts to services which are already struggling to cope with years of sustained underfunding.  A Nuffield Trust analysis suggests that the falls in hospital activity projected in many STPs will be extremely difficult to realise. Moreover, significant financial investment will be required for additional supporting facilities in the community and an appropriate workforce. In this context to £2bn for STPs in the budget looks like little more than meat thrown to under-pressure backbenchers than a meaningful way to address the social care crisis. 

Largest fall in real wages for 50 years – increase in mental health problems.

Recent research has shown that the onset of the recession in 2008, and subsequent rises in unemployment,  were associated with an upturn in suicides and an increase in other adverse mental health outcomes. Unlike many recessions however, these trends have not reversed once unemployment levels have fallen. In England in recent years, a number of mental health indicators have continued to deteriorate, even after the economy began to recover. For people in work, wages started to deteriorate from 2010 and this continued into 2013 –the largest continuous fall in real wages for at least 50 years (5). Here we have one example of potential demands on the health and social care services that are very much about the money.

 

Is social care really “not about the money”?

Carl Walker – University of Brighton – Psychologists Against Austerity

“Sustainability and Transformation Footprints”  STPs

My intention for this blog series was to focus on exploring three core myths related to how we understand the relationship between social policy and health inequalities.  This week I was aided somewhat by the reporting of the spring budget. In this budget Chancellor Phillip Hammond allotted £2bn over the following three years to social care, with £1bn available in the next year. On the news that evening I heard the phrase ‘It’s not about the money’ used on three separate news programmes regarding the problem of health and social care in the NHS. The underlying message appeared to be that our aging population and anachronistic health and social care infrastructure needed such radical reorganisation that money alone cannot realise.

While £2bn given to social care may look on the surface like a significant contribution to health and social care funding, a cursory glance at the broader picture suggests otherwise. I have written elsewhere (1) about how the most recent of the many mass infrastructure changes visited upon the NHS will see the development of 44 ‘Sustainability and Transformation Footprints’. (STP). Ostensibly designed to ensure a greater integration between health and social care services, the plans are being driven by £22bn of cuts into already financially besieged localities by 2020. As I write, councils and clinical commissioning groups are hurriedly trying to put into practice greater integration while having to make unprecedented cuts to services which are already struggling to cope with years of sustained underfunding. Indeed recent research (2) has suggested that “excess deaths” in England and Wales could be linked to underfunding in the NHS and social care system. Here, cuts to the health service were positioned as one possibility to explain the 30,000 excess deaths in 2015.

A key element of the STP programme is the premise that the movement of care out of hospital will save money. A recent report (3) from the Nuffield Trust draws on an extensive literature to assess the realism of this idea. The report documents the hope – both within the NHS and amongst national policy-makers – that moving care out of hospital will improve population health and patient care, while reducing costs.

The Nuffield Trust’s analysis suggests that some STPs are targeting up to 30 per cent reductions in some areas of hospital activity, including outpatient care, A&E attendances and emergency inpatient care over the next four years. This is the case despite steady growth in all areas of hospital activity. This analysis suggests that the falls in hospital activity projected in many STPs will be extremely difficult to realise. Moreover, significant financial investment will be required for additional supporting facilities in the community and an appropriate workforce. Unfortunately this heavy investment is required at a time when the STP’s are implementing severe cuts.  Out-of-hospital care is not likely to be cheaper for the NHS and not under the breakneck speed of change expected by the STP programme.  In this context £2bn looks like little more than meat thrown to under-pressure backbenchers than a meaningful way to address the social care crisis. 

Largest fall in real wages for 50 years – increase in mental health problems.

Moving from recent changes to the supply of health and social care services to the demand on such services. While I could have chosen a number of potential areas, space restricts me to an account of one group of patients who will find themselves confronted by these new care landscapes- people experiencing mental health problems. Recent research has shown (4) that the onset of the recession in 2008, and subsequent rises in unemployment, were associated with an upturn in suicides and an increase in other adverse mental health outcomes. Unlike many recessions however, these trends have not reversed once unemployment levels have fallen. In England in recent years, a number of mental health indicators have continued to deteriorate, even after the economy began to recover.

For people in work, wages started to deteriorate from 2010 and this continued into 2013 –the largest continuous fall in real wages for at least 50 years (5). Barr and colleagues, in research published in 2015, found that the increase in reported mental health problems since 2008 have been greatest for those people out of work and suggested that the patterns of increases in mental health problems that they observed in their study, with increases highest among those out of work and with low levels of education, was consistent with the groups most adversely affected by recent welfare reforms. While such research cannot be interpreted as ‘smoking gun’ evidence, it does undermine the notion that ‘it’s not about the money’. Here we have one example of potential demands on the health and social care services that are very much about the money.

In order for us to move to conversations about meaningful health and social care innovation, and its potential impact on the challenges of the future, we first have to establish welfare regimes, living incomes and health and social funding baselines that match our European partners. From that point on we can have sensible conversations about what health and social care innovation can look like. 

Conclusion

In an excellent previous blog in this series Angela Donkin suggested that a ‘health in all policies’ approach whereby the health impacts across society of any policy are considered with tools such as health equity impact assessments. Indeed had the current budget proposals been subject to such scrutiny it would have revealed a range of health impacts that were unlikely to be ameliorated by the £2bn given to social care.

In an era when his predecessor George Osborne has declared a salary of £650,000 a year for working four days a month at BlackRock, the world’s biggest fund management firm (6) and where social care around England faces unprecedented cuts, Mr Hammond and his supporters may find it increasingly difficult to make the case that ‘it’s not about the money’.



1. http://www.cost-ofliving.net/the-real-crisis-in-the-nhs-is-democratic/

2. http://journals.sagepub.com/doi/full/10.1177/0141076817693600

3.https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-summary-web-final.pdf

4.http://www.sciencedirect.com/science/article/pii/S0277953615302173
5. http://www.sciencedirect.com/science/article/pii/S0277953615302173%20-%20bib36

6. https://www.theguardian.com/politics/2017/mar/08/george-osborne-to-be-paid-650000-for-working-one-day-a-week-blackrock-salary


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