Professor of Health and Social Care and Director of Health Services Management Centre
The coming year could be make or break for the Coalition’s shake-up of health and social care services. After all the furore surrounding the 2012 Health and Social Care Act, 2013 will witness the full implementation of one of the biggest reorganisations of the National Health Service and the continuation of some of the most substantial financial pressures in its history. One of these by itself would be significant enough – but both together feel unprecedented. At the same time, the leader of Birmingham City Council – the largest local authority in Europe - has warned of “the end of local government as we know it” and adult social care is creaking at the seams.
Alongside this, we will also see substantial activity around the publication of the Francis Report into failings at Mid-Staffordshire NHS Foundation Trust, further changes in response to the collapse of care home operator Southern Cross and the abuse uncovered at Winterbourne View, and ongoing debates about how best to reform long-term care for older people.
Interestingly, one of the key challenges for the health and social care system will be to know how best to respond. Under such pressure, the temptation is to carry on trying to do more of the same (just slicing X% of the top). Alternatively, we could recognise that we are genuinely “all in it together” and look for more fundamental change. While this is hard to predict, this could lead to a series of hospital services shifting into the community (with some hospitals closing altogether), greater integration between health and social care and a much greater focus on collaboration rather than on the use of market-based reforms. However, all these would have political consequences – and a tough winter either now or in twelve months time could really stretch some of the current reforms to breaking point.
