Councils could lose some control of their multibillion-pound social care budgets to the NHS as part of the changes to the Government's health reforms.
At present, the NHS is only responsible for funding hospitals and GPs and does not control the budget for long-term care – particularly for the elderly. But yesterday, in a speech to healthcare professionals, David Cameron signalled that this divide could end as part of the Government health reforms. The Prime Minister said the changes "must tackle the longstanding and damaging divide between health and social care, including the bed blocking that still afflicts so many of our hospitals".
At the same time, Stephen Dorrell, the former Conservative Health Secretary and Chairman of the Health Select Committee, suggested that such a change could be included in a reform Health Bill.
"Such a commitment would allow large-scale efficiency savings as we break down traditional structures as we abandon the pretence there is a difference between a healthcare nurse and a social care nurse," he said.
Mr Cameron said he was particularly concerned about "bed blocking" – where patients are forced to stay in expensive hospital beds because local councils want to avoid paying for care in the community.
If GP Commissioning Boards controlled the budgets for both health and social care they would be able to allocate resources for patients both in hospital and at the point of discharge.
A similar idea is likely to be proposed by the Dilnot Commission on the future funding for social care when it reports to the Government next month. If accepted, it could form part of the package of changes expected to be included in the Health Bill before it returns to the Commons.
However, it is likely to be fought by councils who will not want to cede control of large parts of their budgets. In return, they might be offered a greater say in the new GP Commissioning Boards.
In his speech, Mr Cameron said he would not concede ground on the central parts of his NHS reforms. "If we don't modernise now, we face a crisis tomorrow. Sticking with the status quo and hoping we can get by with a bit more money is simply not an option."
Mr Cameron referred to "loving" the NHS five times in the speech but mentioned his Health Secretary only once in passing. He said: "Let me be clear – there will be no privatisation, there will be no cherry-picking from private providers, there will be no new upfront costs people have to pay to get care. Absolutely not. These are red lines we will not cross."
But Dr Hamish Meldrum, Chairman of Council at the BMA, said there were still widespread concerns in the medical community about the changes. "We would certainly not like to see these new commissioning boards become too unwieldy," he said.
Labour health spokesman John Healey said Mr Cameron had done nothing to clear up the confusion and chaos around the reorganisation.