Health spending has always been a public priority: PwC recently found that 67 per cent of people support protecting the NHS - up from 58 per cent in 2010.

Sarah Bickerstaffe is associate fellow at IPPR

Health spending has always been a public priority: PwC recently found that 67 per cent of people support protecting the NHS – up from 58 per cent in 2010.

The problem with the ringfence is that it doesn’t protect the health service – with demand rising astonishingly fast the only way to protect the NHS is to shift investment towards services that can help prevent, delay or manage illness.

These are services traditionally funded out of the far smaller social care and public health budgets – which sit within squeezed local government.

While a further transfer from the NHS to social care is expected tomorrow (at least £1bn according to care minister Norman Lamb), there are reports that the public health ringfence could be under threat.

Spending on leisure, transport, housing and employment support all has an impact on health. Cuts in these areas feed through to the NHS as the public service of last resort.

Coping with flat budgets is a huge challenge for the NHS, and while the system is more or less on track to achieve £20bn efficiency savings by 2015, progress so far is down to national actions to hold down pay and prices.

Finding further savings will depend on service transformation and investment in preventative, community-based services and technologies to support people to manage their own health and reduce demand for costly hospital care.

If we fail, we will see more calls such as this from the BMA’s consultants’ committee for patients to be charged for treatments outside of a core list of services.

Our population is getting older, people are living for decades with long-term conditions like diabetes or heart disease, but our health and care system is built for a different age, when people suffered discrete bouts of acute illness and died far younger.

High quality care for chronic conditions is characterised by helping people to manage their health themselves and coordinating the medical and non-medical support they need.

Older people end up in hospital because we do not have the right health and social care support available in the community. An emergency admission is a distressing and dangerous event for an older person with a chronic condition, and nursing staff in hospitals struggle to cope with the levels of care that such frail patients require.

Making the shift from reactive hospital care when a person is in crisis to preventative, community-based care that helps people to manage their health is not only better care – it is cheaper care.

But it requires a long-term mindset and local commissioners struggle to make these investments because they don’t know if they will be able to maintain the funding long enough to see real benefits and release savings.

The chancellor could help by providing a longer term funding settlement for the NHS and social care. A ten-year settlement would provide the stability and certainty to make the changes needed.

Without productivity gains the funding shortfall for the NHS is predicted to be £54bn by 2021 as a result of rising demand driven by ageing, innovations in drugs and treatments and lifestyle factors like rising obesity – this is not a problem that will go away when the deficit is reduced.

Ultimately, reducing demand will depend on preventing or delaying the onset of chronic disease; a long-term project that begins in early childhood. In the short to medium term, everyone is hoping that better management of chronic conditions through integration can improve care, reduce use of hospitals and save money.

The only way to protect the NHS is for it to stop being a sickness service and to start keeping people well – and it can only do that with the help of social care and public health.

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