Outlining its five key priorities for the NHS for 2017, The King's Fund says the government faces a choice between finding additional resources for health and care or being honest with the public about the consequences of continuing austerity for patients and users of publicly funded social care.
In April, the NHS will enter the eighth year of unprecedented constraints on funding, which has reduced adult social care to "little more than a threadbare safety net for the poorest and most needy older and disabled people."
Finding additional resources for the NHS will mean either being willing to raise taxation or reallocate funds from elsewhere. "Being honest about the consequences of continuing austerity requires acknowledgement that current performance standards and new commitments like seven-day working cannot be delivered within available funding," says The King's Fund.
Furthermore, the more important challenge, it says, is to initiate a debate about a new settlement for health and social care, which would build on the work of the Barker Commission and go beyond what it terms the "short-term interventions that have sought to shore up the current creaking system" in favour of fundamental reform around the funding of health and care.
"An equitable and sustainable system would be one in which public funding is increased and entitlements to social care are aligned more closely with those in health care, paid for by increases in taxes and National Insurance and changes to some existing benefits."
The other priorities identified by The King's Fund are:
Supporting new care models centred on the needs of patients - plans to integrate care should be accelerated and more emphasis is needed on public health and prevention.
Strengthening and implementing Sustainability and Transformation Plans (STPs) - used wisely STPs could be the means by which new care models are supported and spread across England and they should now be stress tested to ensure the service changes they envisage and the financial plans that underpin them are credible.
Improving productivity and delivering better value - supporting clinical teams to reduce unwarranted variations in care and to improve care should be the priority for every NHS organisation.
Developing and strengthening leadership at all levels - the ability to engage and support staff to improve care is essential, and more needs to be done to support the compassionate and inclusive style of leadership advocated in the national framework for action on improvement and leadership development and to tackle the cycle of fear and bullying behaviour that is evident in some parts of the NHS.
Throughout 2017, The King's Fund will continue to analyse the impact of government policies on health and care and to support leaders to make the changes needed to sustain and transform services.
"We will make the case for changes in policy and practice that hold out the possibility of improving the outcome and experience of patients and service users based on evidence drawn from our research. This includes highlighting innovations in care that are possible within the constraints of current arrangements. We will also use our expertise to speak truth to power where we believe politicians are avoiding difficult but necessary choices about taxation and spending."
