Writing in The Times , Nial Dickson identifies that the biggest omission in the budget was any reference to the crisis in social care.
He postulates that the government may feel it did enough in the March budget and the recent offer of a green paper next summer.
He feels that in reality, the £2 billion for social care spread over two years in the spring budget was never going to be enough to sort out the much-neglected social care service.
The NHS Confederation welcomes the prospect of reform but the lack of urgency is deeply regrettable.
A vast number of older people are being denied the help they need now, and the knock-on effect on the NHS is severe and growing.
For such people the future is not so much about being in the slow lane as in no lane, without support in their own home or stuck in a hospital bed.
The NHS Confederation is clear that the budget was a missed opportunity to tackle the immediate challenges of health and social care.
Surely the time has now come for a national debate about what as a society we are prepared to pay for? Or the alternative remains to lurch from one crisis to the next.
We are pretty sure the IHM memebership agrees, but the question is how will that debate be structures as there is no mechanism.
CEO, NHS Confederation