End of Year 2016

2016 New YearSo, as 2016 draws to a close, it’s a bizzare year to sum up.

On the personal front, it’s been a terrible one as we lost Dad in far too sudden circumstances.  We all miss him a lot.  It a strange thing to say when you ‘painted’ as this old hard-nosed individual but it’s a moment in life when both your parents have gone, of course we all must go through it, but it still a sobering moment for each of us.  Over Christmas, Lisa and I visited an Aunt of hers who is learning to live with Dementia, a dear lady I have known for 19 years who is struggling and in contrast before we left we travelled further north to visit my Auntie who is older but as sharp as a pin and in top form!  Old age is a strange journey and there is no play-book but what I do know is that this country has to wake up to the needs of an ageing population or we will sleep walk into an unpleasant society where old age is not celebrated but seen as a burden.  There are many things on the horizon but how we change our health and social care system and start building homes that address the needs of older people is right up there.

The highlight of the year for me as a Councillor, was being introduced to Her Majesty the Queen at the Home of Horse-Racing Museum official opening.  As we awaited her arrival I chatted with David Burnip the former CE of FHDC and asked him if he remembered my stance on the Palace House purchase and rescue, by the council, all those years ago.  He did, I was against it!  And we reminisced about the then District Council Leader Geoffrey Jaggard and his vision.  The day was all about the Racing Community and how Newmarket can capitalise more on being the world headquarters of Racing but without the decision taken by these two chaps all those year ago to rescue a tumbled down spooky old house and semi delicate yard, none of it would have been possible.  If you ever find yourself in Newmarket do go along as it’s a world class museum and the way it helps you understand of the science of Horse-racing is impressive. Not to mention the heritage and art which is just stunning.

On the national and international political front, it’s been a staggering year where the rule book has been ripped up.  You can see that Brexit is going to be the most complex, time consuming thing for our Government to get right and make sure our economy does not suffer more that it has too.  I suspect the history books will have a somewhat mixed view on David Cameron’s time as Prime Minister but I briefly met him at Felixstowe Docks 100 days from the Referendum and he spoke with passion and conviction that strangely was not the hallmark of the remain campaign which seemed to me to fail to make the points about access to the single market being vital to our economy and that the vast majority of those working in Britain from Europe where either here ‘Auf Wiedersehen Pet’ style contributing to our industry or here raising their families and paying their taxes, i.e. contributing not taking British jobs.  The government and our new Prime Minister must find a way to get the best possible exit we can and that won’t be easy.

Internationally we will shortly watch the inauguration of a new American President and I recall the hope and expectation that hung in the air at President Obamas’, I suspect the world will watch with different feelings at President Trumps’.

Here in Suffolk I have had the pleasure to lead the County Council and the frustration of Devolution.  I say pleasure to lead the County Council because it is.  There is lots more to do and we are doing it but I am proud of the staff, the Cabinet and my group and how they have all risen to the challenge of significantly less Government funding and our demand that the Council lives within its means and maintains a sensible level of reserves.  As I look about the sector our cautious, prudent approach puts us in a place that is very different from some councils beyond Suffolk, there begins to be real concern that some councils may start to run out of money and fail to deliver front line services, I have often said that unlike the NHS, if councils run out of money the cheques don’t just carry on being honoured, staff will not get paid and services will fail, not here in Suffolk.  As a political party, we pledged and have delivered 7 years of 0% base Council Tax rises only putting up the Council tax to pay for the National Living Wage which everyone agrees is the right thing to do for the lowest paid workers in our society.  However I say a frustrating year in terms of Devolution because across Suffolk we can see how it can help us reshape Public Services and be a part of how we create a community that addresses the needs of our ageing population at the same time as investing in new infrastructure to accelerate growth and housing, which is vital for the quality of life we will want to see.  Yet at the end of the year Suffolk has no deal.  Cambridgeshire does but not Suffolk. The Public surveys, the business leaders and their respective trade bodies and all councils agree we want a Suffolk based Devolution deal, will we get one, it certainly won’t be for the want of trying and or effort.

Looking ahead… well that’s another blog!

If you have been kind enough to read this, may I take the opportunity to wish you and your family a very Happy, Healthy and Successful New Year.

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.

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.

LGA CWB TLAP BCC – how’s that for Local Gov speak!

TLAP LogoToday I reach a small milestone in my blogging as this is my 300th blog, probably does not mean much to you but it seems a long way from when I first logged into word press, set up an account and well had a go. If you’re one of those kind people who follow it, thanks for reading. I do try to be as brief as possible, sometimes I succeed and sometimes I don’t. Hopefully it gives a bit of an insight into the things I get involved in and am passionate about.

Speaking of which, last Wednesday I was in London representing the LGA Community Wellbeing Board at two meetings firstly the Building Community Capacity steering group and later at the TLAP Board Meeting. I wanted to be a part of the Building Community Capacity work as it is very much what I started in Suffolk as we came up with the Supporting Lives Connecting Communities Programme (SLCC) about how the Council can develop services that communities truly need that compliment rather than crush the work that existing in Communities now and to help build community based services where there are none. In short how to delivery more services to an ever growing number of people who need care services but with less money with which to do so.

In the afternoon, the main Board meeting took place, where I am able to give the programme a sense of what Local Government and Councillors need from the various work streams and how the reports and initiatives its provides and funds can help Local Government can make its services more relevant and personal to those who need them.

The latest papers to shortly be available from their web site and being launched at this week’s National Adult and Children’s Conference in Manchester are called ‘Shaping the future- information, advice and brokerage in the context of the Care Act’  – essentially 3 reports co-badged with ADASS, DH and LGA to support the Care Act implementation.

I’ll pop the links to those papers up when they are on the TLAP website, the other recent ones that I think are useful reading are:

‘Getting Serious about personalisation in the NHS’ – Partner publication to the IPC (integrated Personal Commissioning) with ADASS LGA and NHS England http://bit.ly/1rxvKeD

‘No Assumption: a narrative for personalisation, co-ordinated care and support in Mental Health’ – with National Voices and NHS England http://bit.ly/1ywCMoU

‘A Wealth of information: your questions on personal health budgets answered’ – NHS Confederation briefing produced in partnership with TLPA http://bit.ly/1mG7gPW

Policy to Reality

On Monday I blogged about my Mum’s passing and how ‘far too close to home’, I saw the system of health and social care, policy, commissioning and providers work, in our case, rather well. But as the various systems kicked in I thought to myself you know what, this is precisely why we must get the policies, funding and the way we set up the system, right. This stuff does actually matter for those vital moments in our lives when we need the system to take good care of us.

Last Wednesday I attended the Local Government Association’s Community Wellbeing Board meeting in London and in amongst a packed agenda was a discussion on Better Health and Social Care integration. One of those think tank pieces put together before the next parliament to give the Westminster politicians food for thought as the return after the general election, about the policies they need to enact to hopefully improve the system rather than hinder it.

Geoff Alltimes and Richard Humphries from the King’s fund were in attendance to discuss with us the Barker Report, as it will be known after Kate Barker who is heading it up, as they go about the evidence gathering stage. Here is a link to a short video explaining the commission and its remit http://www.kingsfund.org.uk/audio-video/kate-barker-commission-future-health-and-social-care-England

The report certainly pitches a wide variety of ideas about the future funding of the NHS and what is the role of social care in amongst its mix. Amongst them is such headline grabbers as charging to see your GP or attend A&E alongside the less sensational but more fundamental about the notion of a free NHS and how it sits so uncomfortably with the financial assessment and charging for Social Care. It was quite bizarre as the NHS element of Mums’ care was delivered and you could ‘watch before your very eyes’ the money being spent and yet when it came time for a small element of social care to be planned, out came the forms for this assessment and who is going to pay and the charging mechanism. This is not a criticism of those who very involved as they handled it very well but for such a small element of Mum’s care suddenly the system changed and it was jarring.

At the Board meeting we also discussed the governance and accountability of the NHS and I made the point hat there are so many, many structures in the NHS with vast armies of friends, governors and structures to delivery such things that in reality does it really work or it just a maze where no one, including those who designed it, quite knows who is responsible for what and when it goes wrong across an array of services, well!!. Because in my experience whenever you ask a question of any aspect of the NHS someone seems to point at someone else, just look at the Francis report on ‘Mid Staffs’ Hospital.

In an earlier blog I explored this with new Directors of Adult Social Services, how in local government, Councillors are the first point of call for residents because they elect them. The line to Directors to respond, is one email not a vast system of accountability. In making my point I was stressing to both Geoff Alltimes and Richard Humphries how I saw the future of an NHS delivering services but local government being far more involved with elected representatives being the key local way in which the NHS is provided with accountability and governance. It will be interesting to see their final report and I’ll blog it when it’s published in the autumn.

Back in Manchester

Chairing Supporting People or Social Care? session at NHF Conference

Chairing Supporting People or Social Care? session at NHF Conference

Listening to a response from the platform

Listening to a response from the platform

Wednesday I was back in Manchester at the National Housing Federation (NHF) conference called ‘Rethink Refocus’- Care and Support representing the LGA’s Community Wellbeing Board speaking and chairing a session entitled ‘Do we need to spend more time expanding our role in social care, and less time talking about supporting people?’.

I was joined on the platform by Patricia Kearney, Director of Innovation and Development, Social Care Institute for Excellence (SCIE) and Mike Lawlor Regional Manager, Riverside. Clearly from the questions from the floor after our presentations there was a concern that in all the cuts and removal of ring-fencing firstly the monies will be diverted to other services and that whilst the big issue group, an ageing population, will get focus other vital more specialist but hidden supporting people work around supporting those with mental health or drug and alcohol issues.

I said that “clearly the prime concern of our government was the rising cost of the NHS as it consumed a 6th of the national spend. The primary cause of this is our ageing population and so I think from the conference speech last week across the road at the Manchester Central by Jeremy Hunt, the £3.4billion announced by the Chancellor couple of weeks back to be ring-fenced for social care and in a more private meeting with Norman Lamb they collectively grasped the need to put money into preventative services to keep older people from going to hospital in the first place and to then get then out quicker which is good for the older person and for the NHS budgets, but yes if the focus is on this area there is a danger other services will suffer, so you have to be advocates for those other services.”

The rest of the conference was a really interest mix of social care, health and housing. The reason I agreed to travel so far and attend and speak was that this triangle of Housing the NHS and Social Care support are the cornerstone of how we delivery better outcomes for our communities. Get it right and in this area we should be able to provide better, more person focused support and health care along with better life enhancing housing.

All for less money, it is achievable? – Debatable but it’s certainly challenging.

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