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Minister's focus on failure points to ongoing struggle to influence care crisis debate

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LGC’s essential daily briefing.

Newly appointed social care minister Caroline Dinenage’s flying visit to the Local Government Association’s councillors forum last week was a welcome, if merely symbolic, gesture.

With the arrival of the Saudi crown prince Mohammed bin Salman taking place, Ms Dinenage could only spare 15 minutes as members of the kingdom’s delegation were said to include officials who were keen to talk about the country’s “excellent” adult social care system.

Whether these discussions will somehow feed into work on the green paper is anyone’s guess, but they gave the minister an opportunity to avoid a potentially awkward Q&A on the current state, and potential changes to, a social care system in urgent need of political and practical attention.

The minister’s short and cordial address was, as to be expected, short on detail.

But it was surprising that, just days after the latest figures for delayed transfers of care showed councils continued to improve performance while the NHS struggled at a time of unprecedented demand on hospitals, she chose to highlight “failings” in social care “driving people to hospital and stopping them leaving when they are ready”.

Ms Dinenage trotted out the familiar line that, while funding is important and “very much a live debate in government”, changes to the wider system would be necessary “even if we did have all the money in the world”.

Following the minister’s departure, LGA chair Lord Porter (Con) was keen to seize on the figures as evidence of stretched councils’ ongoing ability to deliver when it matters and use extra resources more productively than the “national unwell service” to relieve pressure on the system.

He insisted the LGA would now be able to stand up to NHS England chief executive Simon Stevens, widely regarded as the driving force for imposing targets and the threat of potentially losing control of vital resources on councils, when discussions resume on how best to deal with inevitable winter pressures.

Sarah Atkinson, lead health director at Impower, whose analysis of delayed transfers was shared with LGC, concurred.

She said councils’ role in preventing a winter crisis from escalating further had secured local government a “seat at the table”, whereas previous engagement had been “tokenistic”.

But the role of the deeply unpopular targets remains a point of significant contention.

The Care Quality Commission’s chief inspector of social care Andrea Sutcliffe told LGC back in October that tensions between local government and the NHS on a local level could hinder improvements to services.

The setting for the interview, the National Conference of Children and Adult Services, was defined by angst among delegates over heavy-handed control from the centre adding to pressures to maintain vital but fragile support services.

The disruptive targets were unlikely to undermine relationships in areas where leaders were already committed and locked in to a collaborative effort, but could have slowed progress in those areas where such commitment existed in principle, but had not yet been culturally and systemically cemented.

The latest delayed transfer figures continue to show worryingly wide variation between the best and worst performing systems.

This could be due to various factors but in a complex and demanding system where relationships are key, targets could have played a significant role in perpetuating a divisive blame-game as self-interest born of a fear of being punished from above caused a fracturing of effort on the ground.

As Lord Porter asserted, the ongoing improvement in performance on delayed transfers attributable to social care, particularly in a month when emergency hospital admissions spiked by more than 5,700, is strong evidence that councils can effectively use extra resources.

However, as Ms Dinenage’s focus on failure suggests, a nervous government will wish to continue to want to closely monitor what could become a potentially damaging situation, and it is likely to use the threat of losing control of funding as a lever to ensure minds stay focused on the political priority of alleviating pressures on the NHS.

Also Mr Stevens, whose political skill and powers of persuasion are well known, may feel the performance of council services over the winter is a vindication of his push for an end to “laissez faire”, rather than a reason to allow councils more freedom.

Local government’s resilience and adaptability may have rightly earned the sector a seat at the table, but it still has its work cut out to truly influence the tone of the conversation.

Jon Bunn, senior reporter

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