A new Council

As you may have read Forest Heath District Council and St. Edmundsbury Borough Council have held their first few joint shadow meetings as we head towards a merger in May 2019.  I was there to take part in the historic first meeting, and it felt like the next logical step on the reform journey we set out on in 2011 when we decided to share a Chief Executive and cut staffing numbers by merging the officer teams to serve the two councils and save money.

The critical point for me has and will always be the same, organising the councils differently we can save back-office costs to protect frontline services. Regarding Council tax, the merger will mean that it will rise slower than if we did not merge because by merging we can save even more back-office costs. So, on both of my acid-tests, this merger is the right next move.  Lakenheath will still have two Councillors, and we will continue to work hard for our community at the Shadow Council.

One of the differences between the councils has always been that Forest Heath is a District Council with a Chairman who chairs the Full Council meeting and represents the Council at official events and functions.  Whereas, St Edmundsbury is a Borough Council with a Civic Mayor, who does much the same role but there is a more ceremonial aspect to it and thus higher costs associated with the office. What we want to do is get your views on the type of formal role the new Council should have.

The differences and pro’s and con’s of both approaches are explained in far greater detail by having a look at

www.westsuffolk.gov.uk/civicleadership

and then taking part in the survey

www.smartsurvey.co.uk/s/civicleadershipsurvey/

The survey is open until Sunday 2nd September.

Alternativity you are very welcome to contact me to share your views, which we can then feed in. It will be interesting to learn what you think and to have a strong representation from our area would be great.

Postcard from the LGA Conference in Birmingham – BUURTZORG!

BuurtzorgLast week at the Local Government Association’s annual Conference I spoke at an event in the Innovation Zone about the work I have championed, as Chairman of the EELGA Improvement and Efficiency Board looking at the Dutch care system called BUURTZORG which is a successful Dutch model of care at home.

This is being explored in West Suffolk through a “Test and Learn Site”, one of only a handful in the England, in partnership with West Suffolk CCG, St. Edmundsbury Borough Council, Forest Heath District Council West Suffolk Councils and Suffolk County Council, with support from the East of England LGA and the UK Buurtzorg partner, Public World.

I was joined by Paul Jansen of Public World who are delivering the Buurtzorg project work in the UK and Kathryn Caley of SK Nurses who are delivering the pilot work in West Suffolk and for an hour we presented and debated aspects of the work. Afterwards I was approached by NHS England who were at the event to discuss how we might take the work further within the NHS.

The project is a step on a journey about a different way to delivery health and social care in our community.  I opened my words with the starkest fact I have at my disposal, in a Public Health exercise I commissioned in Suffolk last year looking at Suffolk in twenty years’ time if we do nothing Suffolk will need 792 additional acute beds based on current rate of admissions times its ageing population.  Now it’s clear that event with the £20Billion additional funding announced by the Government we are never going to see a doubling of the acute beds in Suffolk or across the country, so we have to find very different ways to support our residents in the future and this lies in improvement in the NHS, better integration across Health and Social Care, better Public Health, all of which will help but they allow will not solve the problem, the missing piece is a our communities and how services are designed and delivered in communities to better support the needs of an increasing cohort of older people who are living longer, which is great, but who’s needs must be dealt with very locally to stop them dipping into and out of acute NHS services.

The BUURTZORG Model of Care at Home
The Buurtzorg model grew from the vision of nurse Jos De Blok to tackle ongoing concerns in the provision of care, such as: the fragmentation of prevention, treatment, and care; the impact of demographic change; a shortage of care providers; lowering quality and increasing costs of care; and a lack information about the quality of outcomes in relation to the cost of care per client. Buurtzorg started in 2006 with a team of four nurses working closely with GPs and delivering community care services. By 2015 it had grown to over 9,000 nurses working in 800 teams working with 70,000 patients. The nurses are supported by around 45 back office staff.

The key to the approach is that the model empowers individuals – in this case nurses – to deliver all the care that patients need.  Nurses work in self-managing teams of up to twelve professionals who provide care for 40-50 clients in a specific locality. The nurses are ‘generalists’ taking care of a wide-range of patients and conditions. They are highly qualified; 70% to bachelors level. Their role includes:

  • Assessment of clients’ needs
  • Care delivery
  • Mapping networks of informal care
  • Coordination of care between providers
  • Promotion of self-care, self-management of conditions, and independence.

Buurtzorg is a non-profit enterprise and is 90% funded through health insurance, which is mandatory in The Netherlands. It has led to:

  • Overhead costs of 8%, compared to a national average of 25%
  • Lower staff turnover, lower sickness rates, high staff satisfaction
  • Lower costs of care per client, 40% less than national average
  • High patient satisfaction
  • 30% fewer A&E visits for clients
  • A € 9 million profit in 2014

 So can the BUURTZORG Model of Care at Home work in an English context?  
This is a key question that the coalition of health, social care and housing partners in West Suffolk are seeking to answer.  As I have said the partners have established a Buurtzorg “test and learn site”, one of only a handful in the country, with the support of ‘the system’ and its primary aim will be to

identify a way to adapt the model to our own context without losing the essential features of the Buurtzorg experience – the focus on mobilising and strengthening the capabilities of the client and the networks around them through self-organised teams of autonomous responsible professionals.  This last element is perhaps the most challenging, not so much to Local Government who over the past 7 years have started to empower its front lien staff more, but more challenging to the command and control elements of the NHS culture.

Website: http://www.eelga.gov.uk/innovation-programme/buurtzorg.aspx

News: http://www.eelga.gov.uk/news/west-suffolk-recruits-its-first-buurtzorg-nurses/

A very interesting week in Birmingham

Last week Councillors and Local Government officers from across the country gathered in Birmingham for the Annual Conference, with some exciting backdrops on the Agenda.

As always it seems the ‘U ‘ question (unitary councils bids such as Buckinghamshire, Oxfordshire and now Leicestershire lead the way) hangs in the air as it has done for a number of years. There was to be the maiden conference speech by a new SoS James Brokenshire MP and last but not least the previous week a key report was published jointly by the Health and Social Care and Housing, Communities and Local Government Committees. It makes for fascinating reading in the coming debate on Health and Social Care and indeed ahead of the much delayed Green Paper on Social Care now due in the Autumn a whole year after it was promised.

You can download it from the http://www.parliment.uk website by clicking the link below.

https://www.parliament.uk/business/committees/committees-a-z/commons-select/communities-and-local-government-committee/inquiries/parliament-2017/long-term-funding-of-adult-social-care-17-19/

Almost as a footnote last week, but no less interesting is an article by Tony Travers for http://www.lgcplus.com. Tony is one of the most respected speakers on Local Government finance and when he rings the warning bell its time to listen. the link to his article which makes for sobering reading is here:

https://www.lgcplus.com/services/health-and-care/tony-travers-nhs-is-on-course-to-consume-all-public-expenditure/7025020.article

On a personal note, I was delighted to get re-elected to the Conservative Executive of the LGA as what is known as an ‘At Large’ Executive Member rather than as the County Council representative for obvious reasons. I am delighted to join a tremendous senior Conservative team as we work to set out the Conservative Agenda at the LGA for the coming year.

Member Peer work in Kensington and Chelsea

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With Council Leader Cllr. Elizabeth Campbell

In the past month, I have had the privilege to be a part of the small team delivering member induction training in the Royal Borough of Kensington and Chelsea for their new and existing Councillors.  One of the roles I do enjoy as an LGA Peer is helping new councillors understand the pressures on them.  I did a series of these last year for Oxford County Council, and it’s interesting to discuss the complex role, its challenges and new ideas and how they impact such as Social Media.

Of course, there is nowhere in the country where councillors come under as close scrutiny after the tragedy of Grenfell Tower disaster which claimed the lives of so many men, women and children, as those recently elected in the Royal Brough of Kensington and Chelsea.  The recently opened Public enquiry will point to the technical and system mistakes that tragically culminated in the fire and we as a country must learn so it never happens again. But for Councillors in their Royal Borough, they have to lead their community forward from this disaster and rebuild residents trust in Local Government.  Not an easy task but one they are certainly and sensitively keen to do.

For my part, I was there alongside Cllr. Jack Hopkins the Deputy Leader Lambeth Council and Graham Elder of Elder Learning Consultants who are highly experienced training provider to Local Government, amongst others.

During my visits, it has been a chance to catch up with Cllr. Elizabeth Campbell The thoughtful new council leader who is under the closest of examination as she leads her council through the process of rebuilding trust in their community.

During the sessions, we have met a great cross-section of experienced councillors and new ones such as Cllr. Marwan Elnaghi who along with his fellow wards Councillors represents Notting Dale ward where Grenfell Tower is located and is all about the needs of his community.  Collectively the Councillors on the council have a unique set of challenges ahead of them, and I hope our experiences and discussions can help them along this important path.

A decent home for all

Last Wednesday I attended the first ever County Council Network conference on Housing, sounds surprising doesn’t it that the County Councils have never held one before.  Your surprise level probably depends on your point of view, if you’re not a councillor then maybe a surprise.  But if you are it somewhat depends on what type of council you sit on, if you are in a two-tier area so a District or Borough Councillor, then you might think hey that’s a power grab.

But that, of course, is one of the problems in itself that the issues of housing delivery get distilled into such arguments as soon as Local Government discusses housing.  And its a ‘Red Herring’ of a case, in our country most people will agree with the title of this post that regardless of income and tenure everyone deserves to live in a decent home.  However few would ever accept the new housing proposed near them! So why is this? Some people will of course merely object, afterall they have their home.  But for most, it is the fear of what the new housing not the people who will live in them but the pressures it will place on the infrastructure and services they use in their day to day lives from Highways Junctions to Doctors Surgeries.  NIMBYism is more complicated than just houses in their backyard.

And of course, most of this perceived strain is not provided by the District and Boroughs most of that is about highways, public transport, school place planning and access to GPs and community services which are delivered by upper tier or Clinical Commissioning groups.  And resolved by Strategic plan rather than the specifics about which brownfield site or field they should be built.

Now, this starts to sound like a rag on District and Boroughs, but it’s not its a rag on the system which places vital aspects of community delivery into two different bodies. This demarcation of responsibilities can lead to utter chaos.  Such as the tale I once heard of a County council having to threaten legal action because a District council refused on one site, based on the developer’s viability argument, to seek contributions towards a new school provision as long as the developer delivered Affordable Housing in line with their Local Plan requirements.  And in our system, because the education contribution element is the remit of the County Council who do not have the powers to demand clauses in an S106 agreement, the District was able to contemplate such arrangement, well they did until the County Council’s pre-High Court action letter arrived.

Now there is a duty to co-operate, and sensible councils in two-tier areas are starting to think about the infrastructure delivery across all the partners including health, but each is a fix around for a broken system.

So right at the start of last Wednesday’s Conference, the chairman Cllr. Philip Atkins OBE, Leader of Staffordshire CC who is the CCN Spokesperson for Housing and Infrastructure, said the day ahead is not a conference to grab power it’s a conference to see how the duty to co-operate required by Government under the NPPF can work better and how together councils can increase housing growth in communities.

It also launched two exciting papers about the growing crisis in housing need and affordability and the role of County Councils in future housing delivery planning. If you are connected with the housebuilding industry both are well worth a real.

https://www.countycouncilsnetwork.org.uk/new-reports-back-a-larger-role-for-counties-in-planning-as-councils-warn-over-severe-need-for-affordable-homes/

One of the presenters at the conference and contributors to the above was Kate Henderson who over the past few years has put the TCPA onto the map in the debate on housing.  The following day she was announced as the new CE of the National Housebuilders Federation, an excellent appointment and hopefully, she can use her new role to advance the debate so this county start to deliver the 300,000 homes MHCLG have stated we need.

Only Saturday Sir Oliver Letwin waded into this debate with his article in the Telegraph, rightly talking about the spirit we need to meet the challenge the Government has set of 300,000 homes per year in a system that delivers little more than half that.

https://www.telegraph.co.uk/politics/2018/06/23/greater-variety-homes-needed-solve-housing-crisis-says-oliver/?WT.mc_id=tmg_share_em

Of course in reading this, some will sense that if one council had the responsibility in an area for all the community and planning functions, it would work better but of course, some areas do.  In the recent Respublica report for the CCN they comment on housing start delivery, so whether you think the system of Local Government needs urgent reform or we need to find ways to deliver more housing with the system we have got. But there is a role in the delivery rather than the planning process alone, for Local Government and I shall blog another time about Local Government housing companies.

Suffolk Day 2018

Suffolk Day

Today is Suffolk Day 2018, a great concept thought up by Mark Murphy of BBC Radio Suffolk last year and this years is bigger.  We launched it together on his show in early January as a way for us all, who live and work in our great county to take a moment to enjoy and remember how lucky we are to live in this part of the country.

Looking forward to hearing the Bells of St. Mary the Virgin Church ring out in Lakenheath and then on the Rural Coffee Caravan event at Stansfield Village Hall at 11 am.

http://www.ruralcoffeecaravan.org.uk

If you have never heard of the Rural Coffee Caravan its a great little charity that goes around Suffolk set up on villages greens and people come along and chat and get information about things in their community that they can enjoy and can offer support, you don’t get more Suffolk than that.

Can’t wait to see the first of the new signs I designed with Suffolk County Council Highways team for the entry points to our great county being unveiled – a fitting set of new signs for our great county.

There’s so much to do across Suffolk today and everyday, we are so lucky to live here in Suffolk.

http://www.suffolkday.co.uk

Have a wonderful Suffolk Day 2018.

Adult social care – a national or local Service

Just before I stepped down as Health and Social Care Spokesperson for the County Council Network I wrote the following for the Local Government Association which forms part of a think piece series ‘Towards a sustainable adult social care and support system’

https://www.local.gov.uk/about/campaigns/towards-sustainable-adult-social-care-and-support-system/2-adult-social-care-2

Adult social care has and continues to face significant challenges as a result of the current financial context, rising demand and evolving public expectations.

However, despite this, the notion of a national adult social care service is one that makes me break out in a cold sweat. I’ve read and heard from some people out there that adult social care is in the too difficult box for local government, with the easy option being that it be delivered on a similar size and scale to the NHS.

I would vehemently oppose such a notion. Local authority councillors and staff have worked hard to protect adult social care in the face of austerity and the significant reduction in public sector expenditure. For example, adult social care expenditure in counties accounted for 45 per cent of all service expenditure in 2017/18, excluding education, increasing from 42 per cent in 2015/16. Despite this, service user satisfaction levels remain high with social care in general, with 64.7 per cent being either extremely or very satisfied with the care and support services they received.

There is also an inherent risk in removing social care from local authorities that are legally bound to deliver a balanced budget year on year. Counties, and upper-tier authorities alike, have not shied away from making the difficult decisions required and re-routing money from the likes of transport, central services, and culture towards protecting these life-critical, people-focused, services. We have proven our ability to be prudent in a period of unpreceded financial cuts, often delivering more with less money. Following a similar model to the NHS, which continues to report regular and significant deficits on an annual basis, would most likely place additional and significant strain on the public purse.

As a councillor, I pride myself on the fact that I am democratically elected and the decisions that are made by me and my colleagues are accountable to the public we serve. I would be concerned for the future of democratic accountability if social care were to be delivered on a national basis, which would likely see it become subject to a similar democratic deficit as the NHS, something which was previously recognised by the Coalition Government through the creation of Health and Wellbeing Boards.

The Care Act made the promotion of individual wellbeing the organising principle of adult social care. Therefore, it would seem inconceivable to remove social care from local decision making on services that directly impact upon the health and wellbeing of every individual, such as public health, transport, education, plus housing and leisure in unitary areas.

What also seems clear to me is that a national adult social care service is incompatible with the ongoing impetus at both a national and local level to deliver care and support closer to communities and where possible away from acute settings.

For example, local knowledge will be essential to the Secretary of State for Health’s vision for reform that includes whole-person integrated care.

The personalisation agenda, including personal budgets and joint health and care plans, is built upon providing individuals with greater choice and control over the services and support that they can access locally. A ‘strength based’ or ‘asset based’ approach are used interchangeably. However, regardless of the label, a local social care service is ideally placed to work with adults, individuals, families and communities to deliver this agenda.

If we are to reduce the pressure on the hospital front and back doors a local approach is also essential. Ensuring that people are well informed of the best place to go to address their health and social care issues helps prevent attendances at A&E. The focus must be on maximising people’s independence, examining what outcomes a person wants to achieve and what is available locally to help them achieve that. Collaboration and coproduction with social workers who know the local area are at the heart of this approach.

This must be underpinned by the work of local authorities, councillors, community leaders and others to help build community resilience and capacity to support the most vulnerable in times of need. A prime example is the recent cold weather, which saw local people and groups supporting their communities by ensuring that vulnerable people could access medical appointments and also basic provisions.

It must also not be forgotten that care markets are unique, with differing needs and complexities existing not only in all four corners of England, but also within regions and local authority boundaries. A significant proportion of residential, nursing and domiciliary care is provided by small and independent providers. Would a national care service be able to interact with the swathe of providers that are either very local or regionally based? Or would they be able to respond at the pace that local authorities do if/when a provider falls into financial difficulty?

Many of the issues outlined above are recognisable across the country, but local solutions that are flexible and utilise the unique strengths of each and every community are, in my opinion, the best way to improve outcomes for local people.

Cllr Colin Noble
Health and Social Care Spokesman, County Councils Network

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