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National care service unlikely but the centre will seek to exert control

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LGC’s essential daily briefing.

The County Council Networks thorough report covering its policy position on the future of adult social care covers a series of sensible proposals and points of debate, many of which are likely to be covered in the government’s green paper.

Notably, the report references the emergence of speculation and debate, possibly prompted by Department of Health having the words ‘social care’ added to its title, over whether social care should be a national or a local service, and the question of whether local government or the NHS should take the lead on commissioning it.

The Labour Party (displaying its centralist, if not centrist, impulse) pledged in its 2017 general election manifesto to create a national care service to “be built alongside the NHS, with a shared requirement for single commissioning, partnership arrangements, pooled budgets and joint working arrangements”, with scant detail on local government’s exact role in such a brave new world.

The new health and social care secretary Matt Hancock was questioned by the Commons’ health and social care committee this week on the issue of structural reform as part of bid to place social care on a sustainable footing.

Mr Hancock said while “all options are on the table”, he added he is “pretty sceptical about large top-down reorganisation in this area”.

Mr Hancock suggested the government’s approach would focus on integration and tech-savvy “inter-operability” as key threads. But he acknowledged there are significant barriers to joined-up working, such as regulation getting in the way of effective partnerships and the NHS tariff and payments-by-results method not being designed to encourage integration.

As the CCN report says: “Legislative change is required to streamline the reporting burden on the NHS and social care, along with changes to centrally led financial incentives.”

DHSC permanent secretary Chris Wormald’s appearance before the health select committee last week provided further, strong evidence that major structural change was firmly off the table.

With reference to the green paper, he said: “We will set out a vision of how the system could be better and intensely practical steps that are do-able without enormous legislation for which we don’t have parliamentary time and without enormous sums of money we don’t have.”

Playing down expectations, Mr Wormald said the green paper would not be a “panacea”.

While there appears to be no appetite for the major upheaval of large-scale structural reform, there is also currently little evidence that the government is set to elevate social care from its status as a poor relative of the NHS, or to insist that local government is treated as an equal partner within the integration push.

The way the better care fund was initially structured meant the NHS retained tight control over vital funding for ailing social care services, with the pot of cash which was supposed to encourage integration allowed to be used to address NHS funding pressures, meaning councils had to go cap in hand to health “partners”.

The improved better care fund, while paid directly to councils, came with targets and tight controls over spending plans which demonstrated a lack of trust in local government and skewed investment and behaviour away from prevention.

While the government is unlikely to, as is feared by some, opt to turn social care into a national service, it is highly likely the centre will still seek to exert its control.

Jon Bunn, senior reporter

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