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/

 

 

 

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.

Protecting Vital Funding

health-funding

Last Wednesday at the LGA I presented a paper to the Community Wellbeing Board about Adult Social Care funding, firstly looking at how we take forward our campaign to have the coming new requirements fully funded, how we protect social care funding in the next parliament and how we influence a future Better Care Fund (BCF); so a couple of small subjects then!

What did come out loud and clear were colleagues insights into the pressures facing their adult social care departments locally. Across the country councils are facing really difficult decisions and trying to protect Children and vulnerable adult social services at the same time as absorbing the re-balancing this country has to make in just how much we, as a nation, spend, no easy task. It was a really good discussion where we also considered the principles and features that should underpin a future BCF, which hopefully will inform negotiations into the next spending review which we all know is coming irrespective of who wins the coming election.

Of course the pooling of Health and Social Care Budgets under Health and Wellbeing Boards is to be welcomed and encourages as a step forward in designing a system in which we make sure our A&E department are only having to dealing with real accidents and emergencies not the failure of the system to cope with an ageing population. Equally we need a system where we stop seeing too many older and disabled people left languishing in hospital beds for too long or consigned to residential care because we lack the capacity to help them live independently for longer.
Even with Health and Wellbeing Boards and increased and accelerated pooling, one of the key difficulties still remains. In real terms the NHS budget are being protected but councils are struggling to protect spending on Adult Social Care set against the backdrop op of the 30% reductions in overall Local Government grant funding that will be seen across the past 5 years and what looks from all parties as if it may well be another 20% cut over the course of the next parliament.
All of these figures are quite general but they give a sense of the scale of this issues before Local Government and of the funding gaps councils are having to address.
That’s why last the meeting concluded that we should reinvigorate the ‘Show us you Care’ campaign with a sustainable funding lobby position with that its core, calling on Government to protect adult social care funding to make it sustainable for the future. This is of course not just essential for social care but for all of the other services that will tip into failure if this problem is not tackled. Equally if cuts are leveled across social care as well as the rest of local government funding then to protect this most vital of front line service, other areas of service delivery will struggle. The next government must make the distinction between general grant funding and that spent of social care, not ring fencing as I don’t think that is the right discussion but a way sustainable way forward for NHS and social care funding for without that, the NHS will fail to cope with our ageing population.

Hospital A&E Winter Pressures & Social Care

A&E sign imageYesterday saw the latest figures for A&E waiting times published and Addenbrookes Hospital at Cambridge, our local major trauma centre declared a ‘major incident’ which are early warning light systems that we have a problem, of course all businesses have peaks and troughs but these figures are particularly worrying is that it’s not a harsh winter rather mild actually and we are out of the ‘perfect storm’ period of closed GP Surgeries over the Christmas period. All of us must use the right services at the right time but interestingly records show that predominately those who present at A&E are right to do so, so what’s the problem? Essentially it is our ageing population, that long talked about issue is now starting to ‘bit’, with unplanned admissions of elderly people at the front end and bed blocking at the far end. With bed blocking perhaps being the first signs that the cuts in local government funding to provide social care and an increasing number of people needing services are making discharge of elderly patients ready to go home increasingly problematical. The figures bring into focus the need for the whole system to work better from GP services, to pharmacists, out of hour’s services, intermediate care beds (that’s what used to be called convalescence) to social care.

The debate rages about Health and Social Care which is the single biggest interface and spend area for Local Government (about 40% of most upper tier authorities budgets) and the NHS spends about £1 in every £6 of national total spend. As Portfolio Holder for Health and Social Care integration at the LGA’s Community Wellbeing Board and LGA CWB Health and Wellbeing Board Ambassador for the East Midlands I firmly believe we have the structures in place to tackle an Ageing population but need Westminster’s continued backing for the Health and Wellbeing Boards to be the place this integration is championed by and driven forward from.

The danger is that as the issue starts to impact hospital’s ability to cope with admissions, Government looks towards the NHS to quick fix the problem and I tend to think reading between the various lines out there, not least Simon Steven’s, the new CE of the NHS, 5 year vision speech, the NHS is quietly lobbying to take control of social care.

This would have two fundamental impacts firstly the cost of social care would rise dramatically, as frankly however well the NHS does things it never does them cheaply. Local Government is the most cost effective part of government for a reason, firstly it’s local, and secondly, and far more importantly, Local Government is articulating a different approach to services built around community capacity and how communities and individuals develop care services in part for themselves. This cannot be done centrally or nor by organisations trying to begin to learn what this thing called ‘community’ and ‘capacity’ is all about. Much of Local Government has for some time been cutting costs and at the same time working differently with communities and developing services in communities and to dismiss it as not clinically valid (in the NHS sense of the word) and start again is a serious mistake. Local Government and the health services in their many forms, through the Health and Wellbeing Boards must be the start and finish point for Health and Social Care integration to solve these problems as our population ages.

Continuing Problems, new thinking required!

PrintA few Friday’s ago I had the opportunity to attend a morning at West Suffolk House with David Hall from the Ideas Centre Limited who talked about and then lead a workshop on how to think differently in problem solving. I enjoy these sessions as they are a blue sky thinking opportunity to use different tools and techniques to see problems from different angles and how to then find new ways of thinking about them that are often not apparent when you are right up against the intractable problems on a day to day basis.

The morning was most timely as that afternoon I travelled to Cambridge for a meeting of the EELAG’s (East of England Local Government Association) Improvement and Development Panel of which I am a member and we pondered the coming Autumn Statement from the Chancellor of the Exchequer George Osborne and how, over the next few years, it will be those Councils who look at their issues from new and different perspectives that will flourish. Those who do not innovate and simply salami their way thought the cuts Agenda that will prevail until at least until the 2020s will have missed a considerable opportunity to have an open and honest debate with resident as to which services they value and wish to keep and which can simply slip away as being of a different era.

If the last few council elections have been about council tax track records and future pledges, as important as such things are to the vast majority of residents, cuts in services are inevitable however well organised, stream line and cost efficient a council is. So how you go about cuts in one service whilst protecting another is vital, not only to make the right decisions and be proportionate but to take residents with you. Those councils that simply plough on cutting services as they go with the fig leaf of ‘Statutory Public Consultation’ will see the ruling parties sweep aside and lose control as people become more dissatisfied with their councils. Seems to me those in control now who survive will be those that actually co-produce changes with their residents, someone one said ‘culture eats strategy for breakfast’ and of course co-production is a cultural thing not a strategy.

Looking at things differently.

Public Health DiagramLast Wednesday evening I drove to Birmingham for what’s now my forth time working with the Leadership Centre for Local Government as it delivers its programme with Public Health England for Public Health professional working in Local Government entitled: ‘Public Health, Politics & People – Perspectives & Power in the System’. Facilitating the workshop sessions were Chris Lawrence-Pietroni who has co-designed the course and Liz Goold who I was working with for the first time. Also for the first time Cllr. Jonathan McShane from Hackney who is Cabinet member for Adult Care joined, myself and Cllr. Roz Gladden, Cabinet Member for Health and Adult Care at Liverpool Council, whom I have worked with on each of the previous days we have delivered the workshop as a team of Councillors from different backgrounds and political Parties.

Whilst Chris and his team refine the programme a little each time and change it around a bit based on the positions and experience of the participants, doing something for the 4th time is quite unusual for Councillors. Usually a paper or policy percolates through the system and you work out how to present it and you do to once, occasionally twice, at say a Cabinet meeting and then Full Council but mostly it’s a one off speech/round of media interviews etc. Thus it presents an opportunity to refine what you say and reflect on the differences of each cohort.

In the few months the programme has been up and running whilst every group is different both in terms of where they are in the hierarchy of public health teams now a part of local government there has in that time been an interesting shift in the conversations and I suspect thinking as the place of Public Health in local Government is rapidly maturing. Equally as you become more skilled at the delivery of the programme you start to develop what you are trying to stress in the sessions and the differences and similarities of Councillors from across the political divide that you are trying to explore. For me one of the mantra’s I’ve tried to stress is that if you meet one politician you’ve met one politician – for we are all different. In some ways defined by our political party allegiances and in others most defiantly not.

The great thing about this work is that I personally get as much out of it as the participants for it really stretches your own thinking about the Council you belong to and not so much the Public Health teams, more the mind set of officers and how they view their roles and the careers they have chosen.

National Children’s and Adult Services conference

NCASC14 LogoVery early on Wednesday I left the house in darkness and caught a train bound for Manchester to go to the annual National Adults and Children’s conference #ncasc14

The day started with a thoughtful speech from David Pearson this year’s President of ADASS with whom I sit on the TLAP Board with. At the conference ADSS and the LGA launched the Adult care funding: 2014 state of the nation report which you can find at http://www.local.gov.uk/publications This report is a really good summary of the state of adult social care after a period of Local Government funding cuts, the funding crisis that is looming, readiness for the coming Care Act and the current state of play with regards the great ‘undiscovered country’ of Health and Social Care integration. In short if you never read another thing about this subject, probably the biggest domestic challenge this county faces, then read this, it makes for a sobering read. Not full of doom and gloom but a realistic assessment of where we are at.

It also neatly summed up the day and the various plenary and fringe events I attended. In one we heard from from a reinvented Shadow Secretary of State Andy Burnham MP, who surely can’t be the same chap who I knew of in the last Labour Government. But as usual in his session with the Shadow Children’s Minister Tristan Hunt lots of announcements that if they win in May 2015 they promised to implement but as usual with Labour nice ideas, but back in the real world how are you going to pay for it, always the flaw in their argument.

The conference covers both Children’s Services and Adults Services, but a read of the programme rather highlighted the impression I usually form each year that it is a programme that leans towards adult rather than children services. Of course the current funding cuts and demographic pressure rather demands the attention in local government as does the undiscovered (well for most councils and local Health economies) country of real health and social care integration.

The following morning I had a meeting with colleagues from the LGA and then with the TLAP team about the upcoming TLAP conference where I am speaking and co-chairing a session about Building Community Capacity. And then my conference was over, all too quickly for the 89 hours I spent travelling to and from it.

As I said to one colleague, most jealous I could not stay for the rest of the conference as so many important sessions and discussions to hear on this most difficult of subjects facing local government for the foreseeable future.

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