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

EADT Headline: ‘We have a moral imperative to make sure frontline services are protected’.

 

Here’s my column from last week’s EADT and Ipswich Star newspapers:

Debate is good. Debate is healthy. It’s what challenges existing thinking and finds new and often better ways of doing things. Debate is what we need in Suffolk about the future of public services, including local government. And we need it now.

That’s why last week I asked Respublica to conduct a thorough and independent examination of the merits of public service reform in Suffolk. I know, that doesn’t sound hugely exciting on face value.

But, actually, it’s really important and I firmly believe we have a moral imperative to take a long hard look at existing structures to see what savings can be made to free up money for frontline services.

We want Respublica to develop a range of options that would give Suffolk taxpayers a better deal and our county, as a place, more local control over important decisions around health and housing.

They’ll look at current structures, governance and policies and publish proposals in the autumn. We’d like to make a bid to Government to reform the current structure.

The people at Respublica know what they’re talking about. They’re a leading public policy think-tank and were influential in the ground devolution of Government powers and money to Greater Manchester.

In November, they published findings which said £2.9billion could be saved nationally if councils were reorganised. Think what that money could do to improve people’s lives!

As with other areas in England, we want to build the strongest possible case for Government powers and funding to be devolved to Suffolk.

It’s not just about structures – not even close. It’s about how public money is spent.

There are eight councils in Suffolk, collectively spending about £565million each year. Of course, there are other organisations – like health – too.

Across Suffolk, councils have saved over £240m since 2010, becoming more efficient and effective as individual organisations. However, we all continue to face funding gaps in the coming years and the ability to do things more efficiently without affecting frontline services is now very difficult.

As we’re forced to save even more money, can we, morally, cut more when we know we should investigate the benefits of joining up? The mergers in East and West Suffolk are based on the principle that joining up councils saves money and provides better services.

There are many great examples of public sector organisations in Suffolk already working together, sharing buildings and back office functions. Suffolk is known for it nationally. We want to know what more could be done. We think further savings are possible, but restructuring might be necessary to achieve them. Respublica’s work will inform that debate.

I fully accept that it’s controversial – but if you saway from doing things that some people might object to, you’d never do anything at all and change just wouldn’t happen. Leaders must be bold.

Last week, Paul Geater wrote in his column that he could “see the benefits on all sides and I realise there are absolutely no simple answers”. Quite right, Paul. I therefore welcome the debate that’s started from all sides of the political spectrum.

As I said, it’s democracy in action. There will have to be more of it in the coming weeks and months. But it shouldn’t be dismissed just because it threatens the status quo. That’s not leadership.

Some of you may have seen the quite shocking news recently about Northamptonshire County Council having to freeze spending because of the desperate financial position they are in. Thankfully Suffolk isn’t in that situation but, like councils everywhere, money is really tight.

We want to get ahead and secure Suffolk’s future, whilst devolving powers and funding from Government so the public sector leaders in Suffolk can better deliver for residents.

We are Listening

Here’s my first column of the year for the EADT and Ipswich Star last week:

Happy New Year.

In the ‘lull’ between Christmas and New Year I like to reflect on what has taken place in the year behind us, as well as looking forward to the future.

One thing I’ll be hoping for in 2018 is greater participation from you, the public. Since the elections in May, I, along with my colleagues and our officers, have been working hard to give those we serve more chances to have their say and more opportunities to have their voices heard.

These are unprecedented times for local government. Savings have to be made and the way we provide our services will be changing. And we want you to be involved more than before.

Though this isn’t breaking news, our council meetings are open to the public. Members of the media regularly attend and report on them. Recently we’ve had more members of the public come to our meetings, and I’d like to see more people come along to further their understanding of how we make decisions and witness the debate between members first hand.

At our council meetings as well, the public are invited to get involved, in the form of asking a question or making a comment. In order to do this, all you need to do is send a request to www.suffolk.gov.uk/apply-to-speak-at-a-public-meeting/

However, if you can’t make our meetings, why not watch them online? All of our full council meetings are streamed online and we’ve recently upgraded the cameras in the council chamber to present a high definition quality stream to those either watching live or at a later date. You can find out more about watching our meetings online by visiting www.suffolk.gov.uk/webcasting/

We also want you to give us feedback on our services and how we provide them. We value the thoughts of those we serve, as they can help us shape what we provide and how. If you think something needs to be improved, let us know. If you feel you’re not getting the support you should be getting, we want to know. If you believe someone deserves recognition for their work, we’d like to hear about it.

You can do so by visiting www.suffolk.gov.uk/about/give-feedback-or-make-a-complaint/ but by also speaking to us using social media – we regularly respond to queries on our Facebook page, which can be found by searching for @SuffolkCountyCouncil as well as on Twitter @SuffolkCC – if you don’t already ‘like’ follow us I would suggest doing so as there is an array of useful information posted regularly.

If it’s something in your town or village that you have comments on, it may also be worth speaking to the councillor in your division, who may be able to assist. As councillors we are here to serve our residents and we are regularly working hard on local issues. If you don’t know who your councillor is, you can find them on our website here – www.suffolk.gov.uk/find-your-councillor/

We also consult residents and service users when changes are being made. In the past year we have consulted on a number of things, such as the Lake Lothing Third Crossing in Lowestoft, roadworks in Bury St Edmunds and roadworks in Ipswich. We currently have two consultations live at the moment – high needs funding and school and post-16 travel. We want your views – the better the response, the better informed we are moving forward on any potential decisions.

Last year I was joined by councillors and officers at five ‘we are listening’ events across the county – in Bury St Edmunds, Felixstowe, Haverhill, Ipswich and Lowestoft. These events are something I enjoy doing as it gives me, and others at the council, the chance to speak to the electorate about issues affecting them. It also gives a personal touch and the fact we are actively seeking views may make it easier for people to share their views.

At those events we received a number of comments which have since been acted on with the help of officers, giving positive outcomes for many.

These events are something I’m wanting to continue this year, and I hope to see as many of you as possible as and when they are held, across the county.

So why not make a new year’s resolution to get involved where you can at Suffolk County Council?

A very Merry Christmas

It’s that wonderful time of year were we all pause, relax and spend times with our loved one and family to celebrate Christmas and then the year just past and look forward to the year ahead.  However, for some it’s also a time of reflection of loved ones gone and sadly missed.  So, as you rush about maybe drop a card off to an elderly neighbour or pop round for a cup of tea and a chat about their Christmas, no one should be alone at Christmas.  It does not have to take much time but can make all the world of difference to them at this time of year.

My I wish you and your family a very Merry Christmas and a happy, healthy, and successful New Year.

Social Care article for The Guardian

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Week before last I wrote an article for the Guardian Newspaper about the future of social care and things our Government needs to consider as they ponder the way forward:

When you consider the plethora of social care papers that have come and gone down the years, irrespective of governments, you’d be forgiven for taking next summer’s review with a pinch of salt.

Yet, there is a feeling that this cannot go on for much longer. County areas are withstanding some of the greatest pressures in delivering and procuring social care services, coupled with the deepest reductions in core government grants.

If there was an easy answer, we would not be arriving at social care paper number 13.

Any solution must be long-term in its vision, but early noises suggest that next summer’s review could narrowly focus on funding options for older people.

Exploring a wide-range of options to ensure long-term sustainable funding, firstly to meet the £1bn funding gap that counties face in delivering social care, and for the individual to protect them from facing huge care costs, is paramount.

Whilst this is clearly crucial, the County Councils Network (CCN) argues for a more holistic approach, which brings together prevention, housing, workforce, and integration as well as sustainable way to fund social care.

We argue for a culture shift; turning the existing system on its head. It is currently too focused on the end result, or dealing with issues as they arise, rather than exploring ways to mitigate a person’s health troubles. From the individual’s point of view, who wouldn’t want to live healthier and independent longer?

This is best illustrated by how much media airtime delayed discharges get; an example of the reactionary nature of the system. We must shift thinking towards stopping people from entering hospital unnecessarily in the first place instead of institutionalised care; enabling them to be in control of decisions about the type and location of care they receive.

Housing reform will play a big part in this shift of mindset. The ability for people to stay at home and receive care – or at least to choose to do so – is hampered by the lack of adaptable housing, whilst for those exiting hospital, there are not enough reablement and rehabilitation services in England.

Another issue that often slips under the radar is the dearth of retirement property development: with 7,000 built yearly, whilst analysis suggests 30,000 are needed. The need to keep pace with England’s rising elderly population is obvious, but an increased prevalence of care housing and adapted properties will allow people to live independently longer. In turn, this means less demand on social care services and fewer delays in exiting hospital.

The green paper should seek to create the conditions to encourage more development of supported and retirement homes, including reforms to the planning process to better incentivise the building of these properties.

Integration of health and social care has been labelled a solution, especially in reducing demand. Yet for a variety of reasons, the agenda has not had lift-off. Considering that full integration by 2020 as originally planned is unlikely to happen, we should consider reforms to the way the current system works.

Instead of gunning for wholesale change in a short timeframe, government should be considering pooling its NHS and social care budgets as a precursor to full integration. Some counties already are; with councils and local NHS providers making joint decisions based around the individual; with the aim of keeping people out of hospital for longer.

At the same time, the NHS Tariff, which rewards acute trusts for patient contacts rather than outcomes should be reviewed; to reward providers for preventing people from entering crisis care unnecessarily.

In essence, we should try to build a preventative ecosystem that allows people to maintain their health for longer. This means widening the debate, to tightening the links between adult and children’s social care, and crucially, public health services.

It should also aim to ensure those currently ‘in the system’ live as independently as possible. Here, having consistency in carers is vital. Yet Brexit could impact on workforce projections, not least in areas such as Essex where one-third of its care home workforce are EU nationals. CCN is calling for flexibility in immigration rules to allow providers to recruit from Europe should they be unable to internally.

These solutions are only a cog in a much larger machine; there is no silver bullet to making social care sustainable. No-one is under any illusions of how difficult a task this is for a government, least of all an administration that does not have Parliamentary arithmetic on its side.

But without thinking long-term, and a culture shift that brings prevention into focus, next summer’s green paper could ultimately go the same way as its precursors.

Cllr Colin Noble, County Councils Network Spokesman for Health & Social Care and Leader of Suffolk County Council

The link to the article is:

https://www.theguardian.com/social-care-network/2017/dec/07/there-is-no-silver-bullet-for-social-care-but-ministers-must-not-dodge-the-issue?CMP=share_btn_link

 

 

 

At what age do we become ‘old’?

Here’s the column I wrote for the EADT and the Ipswich Star newspapers last week:

 I’d like to begin this week’s column with a question.

At what age do we become ‘old’?

As language changes and adapts, we as a society are good at filtering out certain anachronisms. The use of the word “elderly”, for example, is less common now. But we frequently use such catch-all terms as “older people” which, after all, is so general as to be almost meaningless.

We are all ageing and I would claim with some confidence that we all want to age well. So, if we are not “older people” now, we will all fall within this category one day.

We know that more of us in Suffolk will be aged 65 years or over in the coming years as a proportion of the population. We’re also living longer, with the gap between male and female life expectancy closing.

In addition, Suffolk is a fantastic county, with incredible assets, so it is no surprise that many people enjoy living here, retiring here and ageing here.

Unlike many other parts of the UK, we are a county without a city. Many of our greatest strengths centre around rural, country living with the benefits this provides as we support one another and look out for our neighbours. We enjoy significant formal and informal networks of support that see old and young living and working together, bringing out the best attributes of supportive communities.

I would argue our rapidly ageing population can be viewed in one of two ways: as an insurmountable, growing threat to our health and social care services, or as a great opportunity to adapt, innovate and prosper as a county.

I see this as an opportunity to be a forward-thinking county that values and welcomes its growing older population.

No single authority, organisation or sector can create this environment alone. We must work together and engage our communities if we want to see meaningful, sustainable change.

The last 10 years have seen major change. We have seen a move from centralised control to more personalised support and care delivered in the community. The coming years will bring about increasing change to our health and care services.

Inevitably, we will be working later into life which means the nature and shape of the county’s workforce will change.

Our predominantly rural setting also provides a challenge to the way  we reach potentially isolated communities. But we are already seeing examples of this in abundance, from well established schemes such as the Debenham Project to emerging opportunities created by social prescribing.

Thanks to the foresight of our health and care teams, we are already seeing the benefits of  learning what works well elsewhere. In the west of the county, we are testing out the Buurtzorg model of integrated health and personal care delivered by small teams of self-managed nurses working in the community, based on an approach developed in the Netherlands.

One issue that is perennially in the headlines is housing; more specifically, the need for more housing that caters for the changing needs of the UK population. If we are to curb the trend of 30-40 year olds living at home because they cannot afford to join the property ladder at one end of the spectrum, and 80 year olds living on their own in a five-bedroom home at the other, we all have to act now.

But the need is wider than this: as we build and adapt our homes, we must ask ourselves if they are they hardwired for the needs of an entire population. Is the surrounding transport network responsive to the needs of an ageing society? Above all, are we providing affordable, shared space that encourages an active lifestyle at every stage of an individual’s life?

Ultimately, we need to provide support for those with more complex needs, while enabling others to remain active and independent, without the risks of becoming isolated.

When it comes to being connected, the myth of an older generation out of touch with modern technology is not borne out by the facts. Nationally, more than three quarters of 65-74 year olds and over 40% of those aged 74 and over used the internet in the last three months.

From open access at our libraries and other information points, to the investment in countywide broadband, our older population is more switched on to new media than ever. This is clearly not the case for all, but the many advantages this brings – from online shopping to connecting with family – are often a valuable antidote to social isolation.

Which brings me back to my question: what we mean by “old”? There’s the old cliché that you are only as old as you feel, and that age is just a state of mind; with people living and working longer, and the cultural changes that this entails, we may be moving  closer to a society in which we need to reconsider and redefine every aspect of what we mean by ageing.

Most of us enjoy better life chances, and a higher life expectancy, than previous generations. Though not without exceptions, this affords us the opportunity to think about ageing differently.

 

 

 

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.

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