Joint vision for a high-quality and sustainable health and care system

Long-term solutions to make the health and care system resilient, preventative and promoting independence.

18 January 2023

Joint vision from the NHS Confederation, Association of Directors of Adult Social Services and Local Government Association. 

High-quality, responsive, preventative and personalised health and care services contribute so much to our lives and society by:

  • enabling people to live their best lives and be active in their local communities
  • supporting unpaid carers to continue caring while working and living their own lives  
  • offering rewarding, skilled employment and long-term careers to over three million people
  • bringing together the best of the NHS, local authorities, adult social care providers, public health, and the community and voluntary sector to support people to live good lives, meet growing needs and expectations of those who draw on care and health services
  • boosting local, regional and national economies by contributing to economic outputs (gross domestic product) as major employers and contracting with local businesses. Recent analysis shows that every pound invested in the NHS results in around £4 back to the economy through increased gross valued added (GVA), including through gains in productivity and workforce participation; and that the estimated adult social care sector GVA was £23.6 billion in 2016.

However, all of the evidence points to a stark truth: our health and social care services are struggling to meet their statutory requirements to provide people with timely, safe, high-quality and effective care and support. And despite the heroic efforts of all those working in social care and health, without immediate and long-term action from national government, they will fail to improve, leading to worse health, wellbeing and economic outcomes for all of us.  

We are pleased that the government has gone some way to addressing the financial challenges on social care and health in the Autumn Statement by providing more resources over the medium-term to meet inflationary pressures. But this funding will not address the underlying gaps, market fragility and workforce pressures across health and social care. Neither does it provide sufficient long-term certainty for social care and health organisations to invest in different models of care which prevent ill health and promote wellbeing, resilience and independence.

We acknowledge and support the government’s ambition to invest more in prevention and early intervention but, as a nation, we have often struggled to shift from ambition to reality. Attention is too often focused on acute hospitals, rather than on working to maximise our health and wellbeing and to keep people well and independent for as long as possible. 

The focus of this statement and the supporting paper is on the long-term solutions required to make this shift a reality. We need a major reset of our social care and health services and supports, to prioritise prevention and promote independence. It is only by doing so that we will turn the growing tide of ill health and dependence on acute and hospital services, so that when people need treatment, care and support, our responses are built around what matters most to the individual and enables them to live meaningful and independent lives.

Our three national organisations agree that our vision for all partners in the health and care system must focus first and foremost on promoting the health, wellbeing and prosperity of our citizens. This vision is relevant to all of us, whether we need care, support or treatment now or in the future, provide unpaid care for family members, work in social care or health, or run businesses that contribute to health and wellbeing outcomes. It focuses on:

  • maximising health and wellbeing and preventing or delaying people from developing health and social care needs
  • redirecting resources so that when people need treatment and short-term support they are assisted to make as full a recovery as possible, restoring their health, wellbeing and independence
  • maximising independence and wellbeing for people with ongoing heath and/or social care needs by working with them to put in place the care and support that works for them.

We call on the government to work with us and to put in place concrete measures to ensure that local leaders can achieve this culture shift, now and in the future. To this end, we have three key asks – that the government:

  • invest in prevention and early intervention
  • create the ability to plan for the long term
  • deliver a long-term, fully funded workforce plan that covers health and social care – including the public health workforce.

Invest in prevention and early intervention

We call on the government to invest in prevention and early intervention by:

  • reinstating real-terms increases to the public health grant at the level seen before the pandemic
  • incentivising integrated care systems (ICSs) to allocate resources according to deprivation in order to address health inequalities
  • investing to realise the benefits of social care as a service in its own right, rather than as an adjunct to the NHS – every day, adult social care enables millions of us to live independent lives in our communities, avoiding the need for hospital care
  • investing in care and support at home and community to avoid the need for institutional care, including promoting a full range of housing options to enable people to live in safe and appropriate accommodation.

Create the ability to plan for the long term

We call on the government to create the ability to plan for the long term (prevention takes time but is much better for people and delivers much better value for money in the medium to long term). This means investing in fully funded workforce plans, in paid leave entitlements for carers, and in increasing prevention and support at home and in recovery focused services and funding sustainability. Commissioners and providers need a medium-term funding settlement to contract for and invest in new prevention and recovery models.   

Deliver a long-term, fully funded workforce plan that covers health and social care

We call on the government to deliver a long-term, fully funded workforce plan that covers health and social care – including the public health workforce. We also need to enhance the contribution of the community and voluntary sector and of unpaid carers, without whom the care and support system would collapse.