Looking behind the Dilnot and Hughes-Hallet Reports for CMM

August 1, 2011

Comments on the Dilnot and Hughes-Hallet Reports - Extracts from the August 2011 issue of CMM

"Many more plaudits this time around for the authors compared with the last Royal Commission Report on the same subject some 12 years ago. What the Dilnot Commission brings to the table this time is more practical thoughts on long term funding plus a range of options that will help greater integration between health and social care. Critically, it does not fall into the trap of simply recommending further transfers between the generations.

It is particularly interesting if you read it together with Tom Hughes-Hallet’s report on palliative care, published a few days earlier. Not only do they share thoughts on new forms of assessment that should be applied nationally, but also on the urgent need to relax needs testing rules and widen the number of persons who can access social care without reference to means tests. Both these Reports were clearly written in the context of the NHS Future Forum Report, published in early June. What was clearly paramount to Professor Sir Steve Smith’s team is that if the NHS is to meet the Nicholson Challenge there must be better integration of health and social care, critical redrawing of boundaries between the two services, and significant expansion of the HRG tariff system outside the acute care. They also sign up to more step down care and more people needing to be looked after in the community rather than in institutional settings.

The palliative care Report looks more into the supply side issues rather than simply growing demand. However, perhaps the most intriguing aspect of the Report was its identification of how many people need palliative care and how many are not getting it. Approximately 470,000 die each year in this country. Of course not all these people require palliative care, but based on studies of cause of death, the present service gap is almost 100,000. What is more, an ageing population, longer chronic disease trajectories and greater co-morbidity will increase the gap over the next 15 years to the extent that either another 90,000 hospital beds will be required (which we can ill afford), or alternative services need put in place in the community.

There are three important aspects in the Dilnot Report that need be assessed at this stage: More people in future will be funded by Government Agencies. Access to care will almost universally be through new national assessment procedures. And people will increasingly be incentivised to organise care for relatives at home rather than in institutional settings. The report would have been more rounded if it had consulted with those on the supply side. Cost to Government at this stage is therefore uncertain. If changes made in the proposed Bill were, say, to cut off the current funding subsidy to local authorities, this would clearly have an impact. Setting national rates for hotel services too would generate winners and losers. Will rates also vary for homes built more recently or pre 2002? Inevitably domiciliary care services will expand but will the workforce have to increase in parallel or will there be a greater role for telecare and telehealth? Lots of questions but it is clear what the direction is for the management team at Saga."