NHS and social care must share a budget, says former health secretary

Health and social care should become one joined-up system with a single budget, former health secretary Stephen Dorrell has said.

Dorrell, who was named this month as chair of the NHS Confederation, said it made “no sense” to ringfence the NHS budget while cutting social care funding. He added: “If we mean what we say about joined-up health and social care, that has to be around one budget and one budget-planning process.”

Dorrell said the argument needed to be made “very forcibly” to the government that any additional funding given to the NHS – such as the £8bn promised by 2020 – was in reality not an increase in funding if at the same time money was taken from social care budgets.

Speaking at a Guardian event at the National Children and Adult Services conference in Bournemouth, Dorrell said politicians often talk about the necessity of integrated care in speeches – but that during the same speech they go on to talk about healthcare or social care as though they were separate organisations in different silos.

Dorrell said he was in favour of devolution, partly as it makes it more possible for joining up health and social care services in practice. He argued that it would be impossible for local government-owned social care, the national health service and the social housing sector to deliver integrated services if they remained centralised. He added: “The only way you can do it [join up health and social care] is by empowering local decision-making.”

When asked about George Osborne’s devolution plans, which include the requirement of a directly elected mayor in order to devolve power to a city or region, Dorrell said he thought it was a “slightly odd mix”. But he said he was Heseltinian in his support for elected mayors, as it “focuses responsibility and debate in a way that in the traditional local government context has been more difficult very often to achieve … if you’ve got an elected mayor it’s clear who’s responsible for success and it’s equally clear who’s responsible for failure.”

Joanna Killian, who leads KPMG’s local government team, asked how appetising it was to be the mayor of a city “when actually in a health and social care situation you are going to be the one that will lead the really difficult discussions about which hospital has to close or which medical institute has to close”. But Killian added that “local government is much, much better at talking to the public about really really difficult things”.

The event, held in partnership with KPMG, where Dorrell is a senior adviser, invited him to look back on 20 years in social care. In 1995, Dorrell addressed what was then called the social services conference, also held in Bournemouth that year. At the time, he had just been appointed health secretary in John Major’s government. He went on to reform social care, and championed the commissioning model of service, which has become central to how local government services are delivered today.

When asked to compare social care in 1995 with the sector today, Dorrell said that health and social care services still had to “get comfortable” with change. He added that there remained a need for services to accept the concept “that health and social care services need to change in order to respond to change”.

Asked if social care services were better today than in 1995, Dorrell replied that they were. But he said: “I would pose a different question to the system, which is whether it’s as good as we want it to be. And to which my answer is no.”