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

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.

A chance to reflect

Shropshire shire hallA couple of weeks ago I spent most of it in Shrewsbury as a part of LGA Peer Challenge team looking at Shropshire Council’s Health and Wellbeing Board’s effectiveness and it’s relationships across the Health sector in the area.

Sometime people question why councillors and officers spend time away from their council undertaking these Peer Challenges and for me it is really simply, the process of reviewing all a Councils printed materials, their reviews, flow charts, agendas, minutes and papers from various meetings. Alongside some 33 interview sessions with over 100 people across their systems and partnerships with acute hospitals, CCGs, patients, carers and voluntary groups not only do you come to an opinion about that system and then play that back in the final presentation and ultimately a report; you can’t but help reflect on what your system in your area looks like and its strengths and weaknesses, which helps your local system gain as well.

Also in my case as I am one of Local Government Association’s Health and Wellbeing Board Ambassadors in my case for the East Midland, hopefully you can help others develop their board to be as effective as possible. All political parties are starting to publish their policies if elected and across the political divide it is clear how important Health and Wellbeing boards are and will be to the delivery of better services without spending more tax payers money and anyone who’s kind enough to read this blog will know that’s my thing.

These challenges are not inspection and are something councils across the county ask the LGA to undertake so they can get an external prospective on how either the whole council or some aspect of what the council is delivering. I worked with a great team which was ably lead by Anne Binkhoff, LGA Peer Challenge Manager and Phil Norrey, Chief Executive of Devon County Council along with Anna Lynch, Director of Public Health at Durham County Council, Sharon Liggins, Chief Officer for Partnerships Sandwell and West Birmingham CCG, James Cawley Associate Director – Adult Care Commissioning, Safeguarding and Housing, Wiltshire County Council, Rory Deighton, Chief Executive of Healthwatch, Kirklees and me. Hard intense work but the group I worked with helped make it fun as well.

 

The coming Storm or Gold rush depending how you see it

englandA couple of Friday’s ago I attended the East of England Assembly of Council Leaders representing both Forest Heath District Council and St. Edmundsbury Borough Council as neither Leader was able to be there due to prior commitments, held at South Cambridgeshire’s District Councils offices in Camborne, I always go for a little drive around Camborne because as a new entirely village it is interesting to see its development from the site boards & sales Portacabin of a few years ago, into the thriving community it is today.

Attending for the first time was the new Chairman of the LGA Cllr. David Sparks who took over from the Conservative Sir Merrick Cockell, it was interesting how he spoke about Devolution being as heavily involved as he is in a City Region Bid for new powers. It was clear from all in the room that whoever wins the next election that we need to come up with an ask based on some form of East Anglian, the trouble is I think we’ll struggle to agree what this looks like before the great political ‘gold rush’ that many of us think is coming. I say gold rush because un-doubtable those regions with a defined view will secure the ability to have a greater sense of devolution of power than those areas that do not.

The day before the meeting Ed Balls was speaking in Norwich and spoke of a region based around Norfolk, Suffolk and Cambridgeshire and it was interesting to hear what people thought of that!, not least because he does not make off the cuff remarks and clearly Labour have a regional agenda and probably plan. As usual grand schemes whereas the Conservatives are quietly allowing Local Government to reorganise itself to best suit local circumstances, grand plans v pragmatic approaches, oh hum nothing changes!

Next up was Phillip Colligan the Deputy Chief Executive and Executive Director of NESTA who went through some of the fascinating initiatives his organisation is leading on, Suffolk got a mention about the mutuals it created around Adult care services and I was quietly chuffed at those as I politically lead on them. I have followed with interest the work of NESTA since its inception and some of the pilot initiatives he talked about relating to volunteering in Hospitals and how to reduce unplanned admissions into hospitals for elderly people were things I shall be following up on to seem how we might replicate those across the wider system.

A fascinating morning to represent West Suffolk at.

Digital Leadership in Local Government Masterclass

Channel_Shift_Accelerators_handLast Thursday I travelled to Warwick University to deliver a session on Digital Leadership for Local Government drawing on things like this blog and other forms of social media I have used in my role as a Councillor, reflecting on what has worked well, the challenges of using social media and of the whole subject of what is a Digital Council form a Councillors point of view.

It was quite timely as just before I left my office, I received a Facebook message asking about my locality funding and if a community group could access funding for a project they were working on. Of course they probably could have contacted me in some other way but they chose Facebook because that is what they used to talk with other people in the community and this sort of accessibility and networking that lay at the heart of being a Networked Local Councillor and should be encouraged and supported by Councils.

The brief for the session I was speaking at was called: Councillor Perspective – a panel discussion focusing on real examples of digital Leadership, key Challenges, and opportunities, and the panel’s view of what are the top three ingredients needed to ensure ‘digital’ can flourish in an organisation.

I was joined for the session by Cllr. Theo Blackwell of Camden Council. We had both been given the exact same brief but we came at the subject from completely different prospective.

I very much focused on what I think are the cultural challenges to making digital happen and Theo spoke of the opportunities Digital brings to Councils and communities.

In my bit, I hypnotized as to the behavioural patterns of those at the cutting edge of being digital and those who lagged. From the various discussions and research I have looked at, those Councils who are embracing and thus benefiting from the digital revolution display some common characteristics which can be distilled into one word, culture. Those Councils who have enabled their Councillors with tablets and have provided extensive social media training are the very same councils who are web casting their meetings, are the very same councils who are redesigning their web sites to be better interfaces for people to access on-line the services and information they need, and have genuinely embraced the fact that most people access the internet not through laptops by via tablets and smart phones and thus are becoming digital Councils faster than others. And as to the culture it’s those Councils who’s leadership is focused on being in broadcast mode, where the control of the message is viewed as more important and less dangerous than debate, for to enable Councillors to engage and share opinion, for Council meetings and Councillors to have the full glare of web casting often can mean people can be off message and get embroiled in genuine debate that might be contra to the delivery of the message. The correlation of the two is quite striking in Councils across England.

Only one theory as to why some embrace the opportunities of being a Digital Council and some do not, but in short, same session title totally different approaches which everyone on the course thought gave a really good variety, almost planned, set of responses to the question posed and what followed was a really interesting Q&A session.

I also got the change to meet with Emer Coleman who’s had a remarkable career working with a variety of politicians and Leaders. And who’s extensive knowledge on Digital and Social Media I was lucky enough to hear as I arrived in time to hear her session before ours, titled ‘Managing your online reputation’.

Digital to save money through channel shifting is one important thing but digital and how it is used by communities to support themselves and ultimately how to better engage communities and groups in the decision making processes is the really interesting thing ahead.

Public Health: Post 2015 Challenge Conference

2014_11_05 Public Health Conference Plenary Group PictureLast Wednesday I travelled to London to meet with officers from the LGA to discuss aspect of my new portfolio responsibilities on The LGA Community Wellbeing Board and then it was off to the Mermaid Theatre for a Public Health Conference where we had been asked to provide a speaker for a closing plenary Question Time session about Public Health the local Government prospective going forward.

On the platform with me were Natalie Bennett, Leader of the Green Party, Cllr. Mike Roberts, a senior Labour Local Government figure in the LGA and the session was moderated by Tam Fry.

For my part in my opening few words I spoke about the role of Public Health and the landscape in which it operates and my opinion that the greatest single challenge ahead was their role in an evidence based approach to how we cope with an Ageing Population. The House of Lords Committee on Public Services and Demographic change warned in March 2013 in its report ‘Ready for Ageing? That the UK was ‘woefully underprepared’ for the social and economic challenges presented by an ageing society. For example, with the number of people living with long-term medical conditions is set to rise sharply, so a ‘radically different model’ of care will be needed to support people in their homes and to prevent pressure on the NHS. I think this can currently be seen manifesting itself at the sharp end with the debates about pressure on A&E frankly the tip of the Ageing Population and these debates will gather in strength and urgency as the realities of an Ageing Population and a lack of systemic planning hit home, we are simply not keeping up with the rising demand.

It was an interesting question time session and it is strange how you find yourself slipping into a sort political party mode at times. One of the reoccurring themes used by both Natalie Bennett and Cllr. Roberts was that this country is the 6th wealthiest in the world and so we should be able to do this and that. And so in response I had to do what Conservatives always seem to have to do! Both seemed to be determined to ignore the fundamentals of our underlying economic challenge, promising the earth with a default position of how we pay for it, lots more taxes. I hoped I interjected a sense of realism that Local Government and Public Health better look to itself for the solutions to the challenges ahead because there was not likely to be additional monies from Central government for many years to come. A really excellent Q&A session and well worth the trip form my point of view and I hoped the audience agreed.

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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