How much of the rising pressure on the NHS could be relieved by proper funding and organisation of public health and social care? We are far from achieving either: cuts to public health are making people ill; failures of social care are keeping people in hospital when they could be at home.
Pressure on the NHS is nothing new. “Disseminating hyporesourcitis” was The BMJ’s diagnosis back in the Thatcher 1980s (www.bmj.com/content/bmj/292/6529/1212.full.pdf). But the looming crisis is now big enough to be seen if not from space then at least from the United States (https://www.nytimes.com/2018/01/16/opinion/nhs-britain-crisis.html). On BMJ Opinion (blogs.bmj.com/bmj) this week the independently minded politician Sarah Wollaston calls for a whole system approach, encompassing public health and social care. These systems cannot be considered in isolation, she says.
So what difference can we expect now that health and social care are both the responsibility of a newly dubbed secretary of state for health and social care (doi:10.1136/bmj.k208)? Not much, says David Oliver (doi:10.1136/bmj.k136). For one thing, the group advising Jeremy Hunt on social care includes people long associated with the current muddle. “The problems facing the social care system are just the kind of thorny issue we elect governments to solve,” he says. But he’s not holding his breath.
Jon Glasby is similarly cautious (doi:10.1136/bmj.k201). Hunt’s new title feels like progress, he says. But our health and social care services are fundamentally different and not designed for integration: one is national, universal, and largely free at the point of delivery; the other is local, targeted, and means tested. A single department changes nothing, Glasby says.
Wollaston now wants to see all options for funding and integration clearly set out for the public to consider. These should include ways of achieving intergenerational fairness, she says, perhaps through a hypothecated tax borne by wealthier over 40s. Hypothecation is gaining popularity. It was, however, roundly dismissed by John Appleby (doi:10.1136/bmj.j471). Also dismissed, by Nigel Crisp, was the idea of a royal commission (doi:10.1136/bmj.j1621).
But while Brexit continues to steal the political oxygen (doi:10.1136/bmj.k189), it’s hard to see what else will lift this precious public service out of the mire of short term party politics and give it the long term visionary thinking it urgently needs.
Follow Fiona Godlee on Twitter @fgodlee

中文翻译：

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卫生和社会保健，最后在一起吗？

通过适当的资金以及公共卫生和社会护理的组织，可以减轻多少NHS上的上升压力？我们离实现这两个目标还很遥远：削减公共卫生正在使人们患病；社会关怀的失败使人们在可能在家时仍留在医院。
NHS面临的压力并不新鲜。BMJ “传播低资源性神经炎”早在Thatcher 1980年代（www.bmj.com/content/bmj/292/6529/1212.full.pdf）的诊断。但是，迫在眉睫的危机现在已经足够巨大，即使不是从太空，也至少从美国都可以看到（https://www.nytimes.com/2018/01/16/opinion/nhs-britain-crisis.html）。在本周的BMJ Opinion（blogs.bmj.com/bmj）上，独立思考的政治家Sarah Wollaston呼吁采用包括公共卫生和社会护理在内的整个系统方法。她说，不能孤立地考虑这些系统。
那么，现在我们可以期望卫生和社会照料同时由新任命的卫生和社会照护国务卿负责吗？（doi：10.1136 / bmj.k208）？大卫·奥利弗（David Oliver）说（doi：10.1136 / bmj.k136）并不多。一方面，为杰里米·亨特（Jeremy Hunt）提供社会护理服务的小组包括长期与当前混乱有关的人们。他说：“社会护理体系面临的问题只是我们选举政府要解决的那种棘手问题。” 但是他没有屏住呼吸。
乔恩·格拉斯比（Jon Glasby）同样谨慎（doi：10.1136 / bmj.k201）。他说，亨特的新头衔感觉就像是进步。但是我们的卫生和社会护理服务根本不同，并非为整合而设计：一种是全国性的，普及的，在提供服务时基本上是免费的。另一个是本地的，针对性的，经过测试的。格拉斯比说，一个部门什么也不会改变。
沃拉斯顿现在希望看到所有明确列出的供资金和整合的方案，供公众考虑。她说，这些应该包括实现代际公平的方式，也许是通过40多岁的富人承担的假设税来实现的。假说越来越流行。但是，约翰·阿普尔比（John Appleby）（doi：10.1136 / bmj.j471）将其全部驳回。奈杰尔·克里斯普（Nigel Crisp）也驳斥了一个皇家委员会的想法（doi：10.1136 / bmj.j1621）。
但是，尽管英国退欧继续窃取政治氧气（doi：10.1136 / bmj.k189），但很难看到还有什么其他办法可以将这种宝贵的公共服务从短期党派政治的泥潭中解脱出来，并对其进行长期的有远见的思考，从而使其刻不容缓。需求。
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