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Giving councils the freedom to spend could help to end the 'integration lottery'

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LGC’s essential daily briefing.

With the social care system in such a well-publicised perilous position, perhaps it was surprising that the Care Quality Commission’s annual assessment of the condition of health and care services brought some welcome good news.

Despite intensifying financial, workforce and demand pressures, plus the strict and contentious direction from government to spend extra funding on delayed transfers of care, the quality of services has been largely maintained.

As the CQC’s outgoing chief inspector of adult social care Andrea Sutcliffe remarked on Twitter, despite significant pressures across the system, the fact that quality has not significantly deteriorated “is a tribute to the commitment & dedication of hundreds of thousands of staff”.

While positivity is always welcome - or perhaps necessary - when facing such huge challenges, the report is packed with clear and worrying evidence of a system hanging on by its nails after reaching the often-quoted “tipping point” the CQC itself memorably warned of in its annual report of 2016.

Safety is identified as a major concern. Despite an increase in the proportion of services rated good or outstanding for safety, from 76.5% in 2016-17 to 79.5% in 2017-18, this is still the second lowest proportion among the CQC’s five ‘key’ questions guiding its performance assessments.

CQC chief executive Ian Trenholm contrasts the welcome news on care quality with the geographical disparities in people being able to access quality care – or any care at all. This, he says, “is not so much postcode lottery as an integration lottery”.

As the report makes clear, the holy grail of integrated health and social care services being the norm rather than the exception remains a long way off.

While in some areas system leaders have found a way of cultivating common ground into fertile collaboration, many others remain in barren lands.

The reasons for this are undoubtedly manifold and complex, often dependent on the quality and resilience of local relationships. But Mr Trenholm references existing structural barriers when he asserts that “there need to be incentives that bring local health and care leaders together, rather than drive them apart”.

Ms Sutcliffe, last year, also raised concerns that the government’s insistence that councils must focus resources on reducing delayed transfers of care from hospital had caused tensions between local government and the NHS which could hinder improvements to services.

At the time, she also told LGC the focus on short-term targets for reducing delayed transfers could put elderly people at risk.

“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’, which would put them at risk potentially,” she said.

The sector is still braced for expected conditions being applied to £240m of extra funding for social care announced by the prime minister this month. Conditions in line with the improved Better Care Fund will hinder rather than encourage integration in areas that need to make the most progress. 

If the government wants to ensure lives can be maintained at a decent quality and emergency admissions reduced, rather than simply insisting the social care system reacts once people experience the trauma of admission to hospital, it must give councils the freedom to spend the new money in the community, where it can be invested in supporting independence and lasting wellbeing.

By Jon Bunn, senior reporter

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