When Theresa May announced the biggest public sector cash boost in living memory last year – £20bn for the NHS – several figures in local government questioned the wisdom in investing in one half of health and social care without the other.
Last week, we got a sense of déjà vu. Whilst the government published its long-term plan for the NHS, it delayed its proposals for adult social care. To not publish both simultaneously is a missed opportunity.
There are plenty of elements of the NHS long-term plan that can be welcomed by upper-tier local authorities. The plans contain an important shift of emphasis away from acute care to preventative care, an increased focus on care in the community, primary care, and on mental health.
More choice for patients, joined-up care in the community and increased support should be welcomed by residents and those working within the health service. The County Councils Network has long argued for a holistic approach: keeping people out of hospital for longer is good for the individual, social care and the NHS.
But there remains a lack of precise detail on how the care in the community agenda is to be rolled out and the extent of local authority involvement.
The NHS plan outlines that integrated care systems (ICSs) should be in place everywhere by April 2021, building on sustainability and transformation partnerships (STPs). But it then says that the “government will set out further proposals on health and social care integration” in the forthcoming green paper.
Lessons should be learned in the integration agenda. For instance, there were clear successes in the rollout of the better care fund, but scope for improvement in other areas.
Ministers should use this time when they are refining the long-awaited green paper to set out a clear mandatory role for local authorities in ICSs, with councils having an equal role to the NHS to recognise that health and social care are interdependent. An individual with complex care needs always needs support from both the local authority and the NHS.
The long-term plan outlines that some £7bn of the NHS funding will be spent on care in the community and on mental health. Local authorities, with an intimate knowledge of their areas, track records in partnership working, and democratic accountability should have a say in where this money is spent in their areas.
The same applies to another facet of the NHS plan: the expansion of personalised budgets. Councils have empowered people to have choice over decisions impacting their care, whereas the NHS has not. The health service would do well to work with local government on this agenda and learning should be taken from pilots of joint care and health plans in Nottinghamshire, Gloucestershire, and Lincolnshire.
Worryingly, whilst the NHS plan says that the “NHS cannot be a substitute for local government”, it does suggest some elements of public health commissioning could be carried out by the NHS. Instead of shifting the deckchairs around again, we should be seeking to work together.
As the County Councils Network’s forthcoming report with Shared Intelligence will show, the transfer of public health to local government – despite a challenging situation – has been a success overall.
With their procurement and commissioning expertise, councils have made a better use of resources to mitigate yearly funding reductions in public health and have embedded preventative services across a whole range of linked services under local authority responsibility, which the NHS could not do.
The report outlines that health professionals are less enthusiastic about the transfer, but the newer integration agenda with public health’s strong preventative focus, as outlined in the NHS plan, could be the missing piece in this particular jigsaw.
Our network will call for fully-funded public health budgets in the spending review. This is a key foundation to deliver the NHS long-term plan ambitions on prevention and to help reduce demand on social care. However, we should be under no illusions that a sustainable solution for social care is the big prize.
Whilst the delay in the social care green paper is disappointing, it does provide the window of opportunity for local government to argue for at least one fifth of the NHS windfall to be invested into adult social care, alongside sustainable system reform.
The County Councils Network will continue to argue strongly for extra resources for social care, and this year’s spending and fairer funding reviews are a chance to put counties on a more sustainable financial footing.
We must look at the experience of the integration agenda over the last few years. Whilst progress has been made in areas, the funding pressures in adult social care have been an impediment to long-lasting change. There is a clear lesson here: reform is difficult when half of the health and social care service is trying to make change with one arm tied behind its back.
David Williams (Con), spokesman for health and social care, County Councils Network, and leader, Hertfordshire CC