Health and Social Care Green Paper

Over the past couple of weeks in anticipation of the much-delayed Health and Social Care Green Paper from Government, the Local Government Association and the County Council Network have published papers setting out the sectors aspirations and make many practical, sensible suggestions as the government considered the final version of the Health and Social Care Green Paper.  Mind you I would say that as up until recently I was the CCN Spokesperson for Health and Social Care and much of what is in the document is that which the team and I worked on during the past year with County Councils across the country, so it is quite dear to my heart.

In the CCN and the subsequent LGA paper, both make the point about an ageing population, and how their healthcare needs not only are best-served in the communities where they live, in doing so you can lower the cost to the system.  Many more services both Health and Social Care should be designed and commissioned in communities.  This hyper-local solutions will deliver three things, a Healthcare service better suited to the actual needs of our populations where there will be an exponential increase in low-level medical care for an increasingly older cohort of people who don’t need to go to A&E but do need help managing their conditions and possibly some social support as well.

Tony Travers, one of this country’s’ leading economists, recently said that based on current trajectory the NHS was on course to consume all of the governments non-statutory spending.  The NHS on its current model for funding is unstainable.  And so future changes must reflect that inescapable fact not pander to the vested interests, the compelling vested interests, the currently dominant vested interest groups?

If you’re interested in Local Government they are both to be commended as essential local government reading, here are a few links.

From the CCN:

and the hashtag: #socialcare

And from the LGA comes a dedicated web site:

And the hashtag #FutureofASC

So both are well worth a read and in respect of the LGA website you can also submit your comments.

Next month I re-join the LGA Community Wellbeing Board, and it will be interesting to see the responses, which of course will be high on the Agenda of the Board for the coming year.

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’

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

An additional cost but an opportunity

The draft Care and Support Bill

The draft Care and Support Bill

According to the DH, when the Social Care and Support Bill is passed in 2015, they estimate an extra 50,000 people will present to have an assessment to set up a ‘care account’ which will effectively tally how much they spent post 2015. Added to this we will also have the additional work load on the universal deferred payments scheme.

I understand the DH has allocated a £335M budget, and that a consultation is now open between now and Oct 25th, to the Joint Committee on the draft Bill.

Suffolk is working up our impact assessment on the figures for Suffolk and the impact of the many complex aspects of the bill and there is no doubt that it will present yet another significant impact on Local Government.

To my mind one of the key things is that as people switch on to the need to clock on and we grapple with how to do that, we must not lose the opportunity that this process presents, effectively if people become known to the Local Authority ways need to be found to use this process and permission to start a relationship and use this opportunity to offer advice to help people stay independent and healthy.

In Suffolk this accords with our Supporting people, connecting Communities programme and needs to build on that.

As to the costs apparently Hertfordshire has estimated that they expect an extra 6,000 initial requests in 2016 and they think there will be an additional 2,000 people presenting annually, thereafter requiring an extra 140 staff in the longer term and cost about £5.2M per annum; along with how to staff up the initial surge.

This is clearly something the LGA Community Wellbeing Board will want to lobby on as I suspect the funding will be woefully short if the Herts estimates are anything to go by, hopefully I’ll get appointed to it, all my fingers crossed.

NHS Learning set day

Yesterday I attended the 3rd plenary day of the NHS Learning set as we design products, that’s briefing papers to you and me on emerging best practice and what each group thinks about the Health and Well Being Boards.

The first session was with my Learning set B2 – Collaborative Leadership to discuss the day and who would be doing what, I agreed to man the stand for a stint, where I talked to cohorts members about the products we are developing around top tips for people from the former PCT s, for Doctors about Councillors and for Councillors about Doctors; sounds simply but a lot so hard work went into the design of what to say and what not to say from each side of the fence.

The opening plenary session was opened by Cllr. Gareth Bernard to give t that LGA link, I know Gareth from my early days as a Councillor when we were both on the Leadership Centre Next Generation Year 1 programme together. He was joined by John Wilderspin National Director of HWB Boards Implementation who I had a long chat with a couple of weeks previous at the Kinds Fund event looking at a self-assessment tool for HWB Boards. Next up was David Behan, Director General of Social Care, Local Government and Care Partnerships – Department of Health, what a title. I have met with David a couple of times when a group of us meet with him and Paul Burstow MP to lobby about the vital nature of the Dilnot proposals. It can be quite a small world somestimes!

David spoke about the learning that was emerging and one of the things that truly stuck in my mind was his comment that it would be easy for the HWB Boards to slip into a comfortable scrutiny place rather than the place where true reform and change is driven; It struck me  how very true this is and I have spoken of the need for Healthwatch and upper tier authority Health Scrutiny function to fulfil those roles and for the HWB Board to ban anything that looks remotely like it from their agenda’s!

The rest of the day was a string of workshop sessions about the learning across the county and it struck me that on each subject area there was a genuine desire to succeed and a common thread to effect real change. Not to just become another committee of the upper tier authority, this is the real challenge before us to actually redesign the most sensitive eco system in this country!, no small order at all.

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