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Reframing adult social care

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Giving a presentation to NHS trust non-executive directors about local government recently, I was struck by an interesting observation. The fact that the average age of local authority elected members is 60 attracted more interest than the fact that local government accounted for nearly a quarter of all public spending.

I’m not sure what this tells us about the unfolding renaissance of NHS-council relationships, but money and the implications of an ageing population are at the top of the agenda for both services.

In a hostile financial climate, finding the money to pay for care casts dark political shadows

With adult social care the largest controllable chunk of the budget for most councils, the government’s ‘progress report’ response to the Dilnot Commission in a few weeks’ time is awaited with anxious trepidation.

The key proposal - a ‘cap’ on people’s contributions to care costs - is widely supported. But in a hostile financial climate, finding the money to pay for care casts dark political shadows.

Quick fixes are not on the agenda - expect the promised white paper that will accompany the Dilnot progress report to remind us that it’s not just about the money.

This will leave local government holding the baby of immediate funding pressures but with a centre stage role in leading the implementation of wider reforms.

Smart councils are recognising that trying to do the same with less won’t work. Their ‘offer’ has to be completely reconstructed. It has to move from a means-tester of tightly rationed residual care for the poorest towards a more universal model - featuring information and advice, low-cost preventive support and the promotion of wellbeing. This will be a model that aims to prevent the need for entry into the formal health and care system in the first place.

This is a challenge for the local authority as a whole - health and wellbeing boards are pivotal - and not just an add-on to social care. It will be a tough transition for councils. Their municipal pride has been invested in traditional services that are valued by existing users but that have become increasingly unsustainable in the face of changing contours of demography, choice and personalisation.

But it will appeal to swelling ranks of older people who want to be active participants and contributors to their local community for as long as possible. Something that many councillors - average age 60 - are well placed to understand.

Richard Humphries, senior fellow, The King’s Fund

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