May 21, 2020

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We have to talk about the money

By Dr Gabrielle Silver, CEO

Earlier this week, Chancellor Rishi Sunak gave an update to the House of Lords Treasury Committee on the financial impact of COVID-19.

Debt has been used strategically to support the country through this crisis, whether that has been a debt write off for trusts, an open cheque book for the NHS, funding for CCGs and local authorities to support COVID-19 preparedness, or the furlough scheme.

We all know that in the long run this debt will need to be tackled and that further borrowing will need scrutiny and debate – when is it right to use debt and when do we need to look at other ways of managing costs through measures such as tax increases? The defining line for these decisions is starting to become clearer.  It is around borrowing where additional funds are needed to deliver against urgent pandemic requirements versus funding ongoing public services which are needed regardless of COVID-19.

At the moment, older people discharged into the community to create capacity for COVID-19 are funded via the NHS under COVID-19 provision. This funding was made available to support the pandemic emergency and facilitated the rapid discharge in March of around 15,000 people. In the pre-COVID-19 world these older people would have been assessed and allocated either as self-payers, funded via LAs or funded via the NHS (Continuing Healthcare).

As we move out of the peak of the crisis the urgent need for this emergency funding gives way to individuals’ ongoing care and therefore the system must revert to the traditional funding routes supported through taxation rather than borrowing.

The Treasury estimates that borrowing this year could reach £337bn vs £158bn at the height of the global financial crisis. Sunak said yesterday that the impact of the pandemic will cause a “severe recession, the likes of which we haven’t seen”. We all know there is a real focus at the moment on getting the economy moving again with employers working hard to design solutions for social distancing in workplaces, and we’re seeing the challenge facing public transport and schools. We’re seeing independent hospitals begin to go back to BAU, and we’re starting to see the NHS prepare for elective surgery with around 8m people waiting for operations.

It may be tough to talk about funding when social care providers and older people have been through so much and are still experiencing such a difficult time. The drive to move back into some semblance of normality in terms of funding of care is the right thing to do. The debate around social care reform will continue, and should receive priority, but in the meantime, we need to move out of emergency measures so we can understand the financial reality facing the sector as well as ensure older people are getting the right care in the right place.

And we don’t have to reinvent the wheel. We can make our lives easier by utilising existing frameworks and processes which give CCGs access to support, additional workforce and dedicated expertise to implement processes to bring the system back online.  Doing this does not negate the need for social reform – in fact it will make that reform easier to grasp and therefore more possible.

As originally seen on LinkedIn

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