Storing up problems for the future.

The chancellor of the exchequer’s announcement of more funds for social care in England is welcome. The money falls short of what’s needed, but it will help stabilise social care, says Chris Ham (doi:10.1136/bmj.j1281), and will free up 2000-3000 hospital beds for casualty admissions or for elective surgery. But the overall picture is very far from rosy. The prolonged underfunding of the NHS is now biting hard, says a King’s Fund report published this week (doi:10.1136/bmj.j1328). After more than five years of austerity, patient care is suffering, along with (and linked to) staff morale and wellbeing (doi:10.1136/bmj. j1313). This should come as no surprise, but the King’s Fund authors say that it’s hard to track the effect of underfunding on quality of care, especially outside hospital, where metrics are poorly developed. They conclude that acute care and specialist services have been relatively protected, though waiting times for elective procedures are now creeping up. Less visible has been the corrosion of community services and public health. Their findings present a fundamental challenge to the direction of travel set out in the NHS Five Year Forward View. “The NHS is moving further away from its goal of strengthening community-based services and focusing on prevention, rather than making progress towards it,” they say. Patients’ experiences of mental health crisis care sadly bear this out. As Jacqui Wise reports (doi:10.1136/bmj.j1141), growing numbers of people are being detained under the Mental Health Act, sometimes feeling criminalised in the process as GPs are forced to call the police if they are concerned about someone’s safety. The erosion of support in the community is a contributory factor. As one patient says, “I used to have support from a community psychiatrist who knew me well and could identify when things were starting to go wrong. Now, because of cuts to teams and an increase in case load, this help is just not there.” Another says, “I wish that my GP had other options than calling the police to check on my safety.” The RCGP and Mind are calling for an additional year of training for GPs to increase their knowledge and skills in mental healthcare (doi:10.1136/bmj.j1311). This sounds like a good idea, but it can be only part of the solution. As the King’s Fund report concludes, the government’s failure to invest properly in community care and public health is merely storing up problems for the future. As the sixth richest world economy, the United Kingdom can and should spend more on the health of its population.