Letter from the CCN to the Secretaries of State for Health & Local Government

fullsizeoutput_1cbeLast week I attended the National Children’s and Adult Services Conference in Bournemouth.  On the way down as Leaders from across the Adult Social Care Councils including me, received an email with a letter attached from SoS DH Jeremy Hunt and co-signed by SoS DCLG Sajid Javid about Delayed Transfers of Care, these happen when a person is medically fit for discharge form a Hospital and we are unable to put in place a suitable package of home or residential care quick enough, this is known in Health and Local Government as DTOC.

As winter approaches and with one of the worse Flu epidemic in the Southern Hemisphere seen in recent years (if you have not yet had the flu jab, I would recommend it, I paid £10 at my local chemist and apparently ASDA are doing them for £5) the NHS is extremely worried about the stress on hospital beds over the winter months, as they are expecting significant numbers of admissions for this simple but dangerous virus to vulnerable groups’.  So the need to feed up beds is important and there are two areas where local government is involved preventing people going to A&E in the first place and how quickly we can facilitate those who need a care package when they are ready to leave hospital obviously the more effective the system the more beds the NHS will have free to cope this winter.

The letter were somewhat condescending and effectively suggest we alongside the other 80 or so local councils responsible for DTOC are failing.  However it was a step back from the threats made earlier in the year about fines and direction of budget if the situation did not get sorted out.  Very DoH, not very DCLG but in this repsect DCLG is very much the junior partner to the might DoH.  During the course of last Wednesday at the conference it emerged that there were in fact three different letters issued, and our was the middle one not praising us but not summonsing us to Department of Health (DoH) as about 32 Councils will find themselves having to go before a panel of experts at DoH, and for experts read people who work in Whitehall, or more precisely civil servants who work in DH in Whitehall who will want to see plans for a lower DTOC target in those areas or they will re-direct monies spent of Adult Social Care to hospitals which will not deal with the issues and probably make them worse.  Adult Social Care cannot be fixed by a summons from DoH, it needs careful partnership working on the ground in each area surrounding a hospital. .  At the conference, we referred to these as naughty step letter and which one you were on – a very flippant comment given the seriousness of the issue but given the patronising letters, as if our social work teams are not working hard to provide the care packages, which they are, its the right term to use.

The issues are complex and the impression you get from the letters is that its entirely Local Governments fault and so DoH can swoop in, divert money to hospitals and all will be right with the world, sorry but this is nonsense.   Fundamentally Local Government needs funding to provide the care, it’s as simple as that, and the threat is that if local Government does not improve then it will have funding withdrawn is worrying.  this is not about simply demanding more money for Local Government has stepped up and made the savings the Government has called for but there comes a point.  Across the county grown up discussion with Hospitals and Clinical Commissioning groups are building a long term system to handle discharge and withdrawing money will not improve that one bit, quite the reverse in fact.

So, on behalf of the County Councils Network on Friday I wrote to both Secretaries of State pointing out the position of CCN member Councils and our concerns.  In Suffolk we work closely with our Acute hospitals planning prevention, avoiding having to go to A&E and when people are admitted discharge planning starts straight away, in West Suffolk the hospital’s enlighten CE Stephen Dunn has contracted beds in a Care Home with nursing to provide people a different setting to recover, what used to be called Convalescence.  As our population ages we are going to need to see a return to this sort of step down care, from our hospitals.

Another false dawn?

fullsizeoutput_1bf4Last Wednesday I was in London for the County Councils Network AGM held this year in the main Hall of the Chartered Insurance Institute in the heart of the City of London, which given the discussion I wanted to have with fellow Leaders was quite fitting setting as the sun shone through the Institutes historic stained-glass windows with the logos & formation dates of the various Great British Insurance companies formed since the 1700’s, depicted.

After the formalities of the AGM we moved into a discussion on the coming Green Paper on Social Care and I led a discussion in my capacity as spokesperson for Health and Social Care on our initial ideas by tabling a discussion paper for Leaders to feedback if they agree that the areas we are considering lobbying on are the right ones and what the emphasis should be.  These are senior gatherings from across the Country of those Councils which provide support for some 48% of all older people and those with Learning and Physical Disabilities, so our thoughts  are based on our practical knowledge of delivering a system and thus I would say important to help Government shape the coming bill.

In my opening remarks, I said that what we must lobby for and encourage from across the sector from ADASS to our MPs that this must not another false dawn.  I have been a Councillors since 2006 and in that time, I have seen successive Governments seek to tackle this issue of funding and the nature of the Health and Social Care integration and indeed if I think there has been false dawns on the Local Government side there is perpetual motion on the NHS side.

We have seen with Gordon Brown’s free Social Care at home proposals which ended in disarray as utterly un-costed, but hey there’s a Labour Government for you, to the collapse of the Westminster cross-party discussions when they accused each other of promoting a Death Tax in the run into the 2010 elections.  Next up we had the Andrew Dilnot Report which fizzled out when the then Chancellor decided far too expensive and so set a higher cap and that came to nothing.  To the recent Conservative Manifesto which was accused of being a Dementia Tax by Labour within hours of being unveiled.  On the NHS side, we’ve seen the arrival of the CCG from the old PCTs, the creation of the Health and Wellbeing Boards, some of which genuinely have shifted the notion of how to tackle an Ageing Populations other not so much.  And now the notion that on DTOC DCLG or is that the NHS will start withholding money from Upper Tier Councils if there is an excessive wait for patients once declared medically fit for discharge and too long a wait for a social care package to be found.

If like me you are involved in this issue is an extremely complex once that requires the NHS to work in collaboration with local government.  DTOC fines are not going to help one little bit by taking further funding away from already stretch services and making the relationship not one of collaboration but performance fines.  In 2010 we moved away from this culture and now through the influence of the mighty NHS we seem to be moving backwards.

So, there is a lot riding on the Green paper from solving the ridiculously complex funding grants and taxes currently in place from the BCF to the National Adult Social Care precept, a threshold here and a cap there – all of which seems to me avoids a fundamental question – how do we, as a nation, pay for Social Care often seen through the prism of Free NHS services. To my mind its relatively simple a per head of population funding formula irrespective of BRR and we will to have a contribution from people’s property wealth but given the Russian roulette of Dementia and frailty we should cap this so people can reasonable expect to be able to hand down much of what they have worked hard for over the years. Equally that the NHS must be required to work with Local Government to shape and deliver communities that service our residents not in shiny new hospital buildings but in the communities in which we all live together.  So, can we have a green paper that is more than activity more than another false dawn and genuinely starts to address the issues of our ageing population.

I’ll be presenting a draft lobby paper to the CNN Conference in November for sign off by the County Council Leaders as our contribution to this debate and when completed I will put up a link to it here.

Things have to change

Last Monday in my role as Chairman of the Improvement and Efficiency Panel of the East of England Local Government Association (EELGA) I chaired a conference at the Cambridge Genome Campus Conference Centre, probably the most impressive venue in East Anglia.  The conference was entitled Positive Ageing and co-convened by the Eastern Academic Health Science Network (EAHSN), which is an organisation within the Health system dedicated to new learning and bringing technology to the fore in the Health world, the other co-sponsors were NHS Confederation and Public Health England.

About 200 people from across the region’s Health and Social Care system gathered to hear speakers and life experiences of older age and how we, as a system, can help shape a positive vision and reality for people as they age in our communities.  An ageing population is often talked about but just living to a ripe of age is not enough it has to be a positive experience or what the point and that is the point I made in opening the Conference.

Here is conference brochure summary of what the day entailed:

‘With a significant ageing demographic the East of England is well positioned to be at the leading edge of accelerating the testing and scale up of self-care technology and health services in a way which can help make ageing work better for everyone.

This conference, led by Eastern AHSN, the East of England LGA, Public Health England and the NHS Confederation, will bring together NHS, local government, industry and academia stakeholders and aims to strengthen emerging solutions, new ways of working and shared plans for achieving healthier and happier ageing across the region.

In particular it will look to:

  • support the STPs to meet their ambitions on this agenda
  • identify opportunities to work collaboratively to further positive ageing agenda
  • position the region at the forefront of the UKs research and innovation communities.

The conference will be structured around six themes which include:

  • Defining successful ageing – What are the real demographics of ageing?
  • Sowing health habits – What can we do to ensure our own health and increase the chance of both a long life and a healthy life?
  • Rethinking work – How can society ensure the health and economic benefits of work for more people into older life?
  • Breakthroughs in technology – How can new research and innovations radically change our concepts of what old age means?
  • Connecting with others – How can we develop caring communities and multi-generational social networks?
  • Preserving purpose – How can health and social care systems focus on maintaining quality and purpose of life above the drive for extending life?’

And here is the link to the presentations from the day and if you have a look please look out for the Buurtzorg Health Care Model as that is a programme I am championing here in Suffolk and is a part of our contribution to the national debate about how we re-shape the healthcare system to better serve the changing age profile of our communities.

http://www.eelga.gov.uk/events/east_of_england_positive_ageing/

 

 

 

The battle for Row Heath

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Over the past 11 year years I have had the honour of representing my community on Suffolk County Council and as elections approach I start my campaign full of beans.  After 11 years on a council it might seem that you might have done everything but far from it, Local Government is changing and resident’s expectation of the services they want and need is also changing. On the one hand, there is considerable less money in Local Government that there used to be, in the past 7 years Suffolk County Council has saved over £200M yet delivers more services that ever before. We done this by being business like in our approach to the way the council runs.

People want faster better services such as road repairs and want to know that Children are protected, we have prioritised Children Services and protected the budgets with which hard working teams go about their business, and this is recognised by OFSTED who rate our Children services as good.  For older residents who can’t afford their own care, we make sure they are looked after with love and dignity, and quite right to, we do this by making sure we have a robust relationship with providers of services, holding them to account, ever mindful we are the holders of the public purse.

Locally, housing for our younger people so they can start to get on the housing ladder is vital, as is new schools and school places. As the housing arrives we want better facilities in our communities and we also want to know that if we reach a stage in life that we can’t use a car that our lovely rural villages do not become traps.  On all these fronts, I try to be a strong voice for Row Heath advocating locally, in Ipswich and nationally for our area. Today for instances I am in Cambridge meeting senior officials about the future of RAF Mildenhall a set of decisions that will affect the economic prospect of Row Heath for years to come.

We have a number of plans we will be putting forwards in our manifesto, all careful costed out.  Labour Finance Spokesperson on the county council Len Jacklyn is on record as saying ‘It is predicted that finances should improve over the next four years and spending now on statutory costs will begin to pay off in 2020’. A truly scary comment as they have been to all the same conferences I have been and at not one of them did it predicted that the finances will improve much.  Their Financially Dangerous Manifesto makes promises they could not hope or maybe even be allowed to fulfil or maybe Labour have some Corbinista moneytree nightmare where he takes power and removes the Council Tax cap and they can go back to the good of days of treating your hard-earned money as their personal piggy bank.  It’s well worth having a look at their bizarrely already published Manifesto it is truly Financially Dangerous.

So, what a contrast we have spent the past year working on our manifesto, carefully costing it every step of the way. And I can’t wait to get it launched and be out their explaining to residents how we are going to take Suffolk forward.

In the meantime, as I am out and about I am asking residents to fill in my survey or do it on line.  The one for my Division Row Heath is http://www.surveymonkey.com/r/RowHeath please do click through and take the survey, as I am very keen to hear your views.

 

Budget Day

Budget

This Thursday is Suffolk County Council’s Budget Day. It’s important for two reasons, it’s when we set the bulk of your, and my, Council Tax bill and we set the money each service will get to provide frontline services for the year ahead.

Budgets are important to Councils because until like the La, La, Land of the NHS finances where massive deficits mean little, in Local Government if you run out of money, wages are not paid and services shut down.

Every year the Conservative administration pour over the figures in the £500M budget starting almost as soon as the last budget is set. And whilst the figures are huge and services are vital such as protecting vulnerable children from abuse, the process is little different from how we budget at home.  We save money for big projects like a house extension or in the council’s case the two new Bridge projects. We have some money set aside for emergencies and the unexpected (reserves) and we plan for renewing smaller items like the computer, (major IT system changes) all of which is based on assumptions of our income in the coming years.

That may sound a bit simplistic but it’s essentially it’s the same process we go through at home.  For Local Government, as to future prospects all the future income indicators are poor as we face less money over the next few years’ from Government. So we maintain reserves to ensure we can sustain services and deal with the unexpected. It may at times be a little bit boring but we are prudent and careful with your money.

Just as in life then there are the neighbours or in our case the opposition Labour and Lib Dems.  Like the neighbour’s flash new car, always out there promising the world, spend, spend, spend for tomorrow never comes, we’ll get more money from somewhere, why have reserves, live for today. The Jeremy Corbin view of the world, it all look like fun and of course the sun will come out tomorrow, Happy Days.  But then again the last time they were allowed to be in control in Suffolk we all know how that ended, budgets not keep to, failing services and finally booted out of power, for raising the Council tax by 11.9% in one year and 18.5% in the next trying to keep the show on the road – ‘What rubbish’ I am told that was then this is now, but you see I don’t think it is rubbish, I think it’s a mind-set that has not changed one bit.

So we may be a bit cautious, we may be a bit tough in how we negotiate but, we have delivered 7 years of 0% raises in the base Council Tax and carefully applied the National Adult Social Care Precept to give our lowest paid, mainly care workers, a welcome pay increase and rightly so.  I hope in May people will allow us to carry on running the council, we will be innovative in our approaches and have lots of new ideas about how we go about things over the next 4 years building on the work these past 4 years but we will always, always be prudent and carefully with the budget and our reserves, ever mindful of the need to protect the most vulnerable in our communities and ever mindful it’s your hard earned money.

But remember those flash neighbours (and apologies to my neighbours who are all lovely people and not part of this reference!), if Labour and the Liberal were in power when they run out of the council’s money, guess who’s money they’ll come after, yours!

Thursday’s meeting is web cast so please log-in and have a watch.

3% National Adult Social Care Precept rise

 

health-funding

Last year the Government surprised many with the very welcome change from Minimum Wage to National Living Wage, a pay boost for the lowest paid in our society, which has been universally welcomed.  But it also must be paid for and the LGA and the CCN spoke for the entire Care industry in saying we have to, have more money to pay for this, so the Government introduced a new Tax, the National Adult Social Care Precept set at 2% of the Council Tax or in places such as Suffolk 2% of the County Council element of the Council Tax.

You can argue the merits of local v national, property or income based taxation as much as you like but the 2% did not quite cover what we paid to our providers to fund this increase in pay.  We are, this year, asking for the additional 1% Government has allowed, taking this tax to 3% and every penny raised with be spent on Adult Social Care for our most vulnerable residents.

In Suffolk, we carefully negotiate both the rates we pay for residential and home care, ever conscious that we are the holders of your hard-earned money you pay in Council Tax and balancing that, with the need to make sure that employers pay the higher National Living Wage and can attract the staff they need to provide the vital quality of care we would want for our own families.

This year we will not be putting up the base Council Tax for the 7th year running fulfilled our manifesto commitment when we were elected in 2013.  As a Conservative administration, we are philosophically opposed to increasing Council Tax and only do so to pay for those things that we rightly must provide to the most vulnerable in our society.

End of Year 2016

2016 New YearSo, as 2016 draws to a close, it’s a bizzare year to sum up.

On the personal front, it’s been a terrible one as we lost Dad in far too sudden circumstances.  We all miss him a lot.  It a strange thing to say when you ‘painted’ as this old hard-nosed individual but it’s a moment in life when both your parents have gone, of course we all must go through it, but it still a sobering moment for each of us.  Over Christmas, Lisa and I visited an Aunt of hers who is learning to live with Dementia, a dear lady I have known for 19 years who is struggling and in contrast before we left we travelled further north to visit my Auntie who is older but as sharp as a pin and in top form!  Old age is a strange journey and there is no play-book but what I do know is that this country has to wake up to the needs of an ageing population or we will sleep walk into an unpleasant society where old age is not celebrated but seen as a burden.  There are many things on the horizon but how we change our health and social care system and start building homes that address the needs of older people is right up there.

The highlight of the year for me as a Councillor, was being introduced to Her Majesty the Queen at the Home of Horse-Racing Museum official opening.  As we awaited her arrival I chatted with David Burnip the former CE of FHDC and asked him if he remembered my stance on the Palace House purchase and rescue, by the council, all those years ago.  He did, I was against it!  And we reminisced about the then District Council Leader Geoffrey Jaggard and his vision.  The day was all about the Racing Community and how Newmarket can capitalise more on being the world headquarters of Racing but without the decision taken by these two chaps all those year ago to rescue a tumbled down spooky old house and semi delicate yard, none of it would have been possible.  If you ever find yourself in Newmarket do go along as it’s a world class museum and the way it helps you understand of the science of Horse-racing is impressive. Not to mention the heritage and art which is just stunning.

On the national and international political front, it’s been a staggering year where the rule book has been ripped up.  You can see that Brexit is going to be the most complex, time consuming thing for our Government to get right and make sure our economy does not suffer more that it has too.  I suspect the history books will have a somewhat mixed view on David Cameron’s time as Prime Minister but I briefly met him at Felixstowe Docks 100 days from the Referendum and he spoke with passion and conviction that strangely was not the hallmark of the remain campaign which seemed to me to fail to make the points about access to the single market being vital to our economy and that the vast majority of those working in Britain from Europe where either here ‘Auf Wiedersehen Pet’ style contributing to our industry or here raising their families and paying their taxes, i.e. contributing not taking British jobs.  The government and our new Prime Minister must find a way to get the best possible exit we can and that won’t be easy.

Internationally we will shortly watch the inauguration of a new American President and I recall the hope and expectation that hung in the air at President Obamas’, I suspect the world will watch with different feelings at President Trumps’.

Here in Suffolk I have had the pleasure to lead the County Council and the frustration of Devolution.  I say pleasure to lead the County Council because it is.  There is lots more to do and we are doing it but I am proud of the staff, the Cabinet and my group and how they have all risen to the challenge of significantly less Government funding and our demand that the Council lives within its means and maintains a sensible level of reserves.  As I look about the sector our cautious, prudent approach puts us in a place that is very different from some councils beyond Suffolk, there begins to be real concern that some councils may start to run out of money and fail to deliver front line services, I have often said that unlike the NHS, if councils run out of money the cheques don’t just carry on being honoured, staff will not get paid and services will fail, not here in Suffolk.  As a political party, we pledged and have delivered 7 years of 0% base Council Tax rises only putting up the Council tax to pay for the National Living Wage which everyone agrees is the right thing to do for the lowest paid workers in our society.  However I say a frustrating year in terms of Devolution because across Suffolk we can see how it can help us reshape Public Services and be a part of how we create a community that addresses the needs of our ageing population at the same time as investing in new infrastructure to accelerate growth and housing, which is vital for the quality of life we will want to see.  Yet at the end of the year Suffolk has no deal.  Cambridgeshire does but not Suffolk. The Public surveys, the business leaders and their respective trade bodies and all councils agree we want a Suffolk based Devolution deal, will we get one, it certainly won’t be for the want of trying and or effort.

Looking ahead… well that’s another blog!

If you have been kind enough to read this, may I take the opportunity to wish you and your family a very Happy, Healthy and Successful New Year.

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