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‘Should NHS take over social care?’ asks Birmingham chief


Birmingham City Council’s chief executive has questioned whether social care should be taken over by the NHS, stating that the former sector was unlikely to “win” financially while it remained part of local government.

Speaking in a fringe session at the Society of Local Authority Chief Executives & Senior Managers annual summit in Brighton last week, Dawn Baxendale suggested she had experienced first-hand shortcomings in the integration of services through failure to join up the care of her mother, who recently died.

“I’m just coming to the conclusion we have a David and Goliath situation between health services and social care,” said Ms Baxendale. “I don’t think David is going to win in this situation.

“Because of where the NHS sits in the national psyche, should it be one system? Should we be running social care at all?”

She called for a debate about the sector’s status because “there is not enough money” in the system, and urged a “genuine understanding” among national decision-makers about social care’s plight.

This viewpoint was challenged by Andrea Sutcliffe, the Care Quality Commission’s chief inspector of social care, who pointed out that new siloes hindering the integration of services could emerge.

“Even if social care came into health – and I’m not arguing that it should – but there would still be a boundary with housing,” Ms Sutcliffe said.

She paid tribute to councils and their chief executives for doing a “cracking job” by “maintaining or in some places increasing” the budget available to social care, despite local government experiencing reduced funding.

Ms Sutcliffe said councils had a “local leadership role with the democratic mandate that you have but the health service doesn’t”. This meant they could “make a difference” on service integration.

Robin Tuddenham, Solace’s spokesman on community wellbeing and chief executive of Calderdale MBC, said local government was being “too nice as a sector” and urged it to “call out” the government’s failure to recognise the vital role of councils.

He was critical of the fact that he had not personally been sent a letter from the Department of Health & Social Care informing him of his area’s share of the £240m of extra resources for social care announced by health secretary Matt Hancock earlier this month.

“That letter came to the leader and foundation trust. It was forwarded to me – they said ‘we thought you should be aware of this’. This is the culture we are working with – the centre and the local.”

Helen Bailey, interim chief executive of North Somerset Council, was critical of the fact her council would be required to make “monthly returns”, which were “stressful” about social care performance in return for the money.

And she was critical of the general level of complexity of working with the health service: “Working in a very small unitary, my life is full of meetings attended by hundreds of health people. The resources and bureaucracy that exists in the health service is making that work harder and harder.”


Readers' comments (5)

  • We need a unified service for social care, the demarcation lines are arbitrary, with increasing pressure on local government finances plus a ageing population the sector cannot continue to carry the burden. NHS has received additional funding unlike LG. Lets get real.

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  • And that is exactly why social care will not go to the NHS - the NHS generally wins its funding battles, and local government doesn't. So why would government add to its funding pressures by putting the full weight of the healthcare lobby behind social care?

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  • As was noted in the article even if Social Care was brought into the NHS there would still be issues with demarcation lines due to interfaces to services still delivered by the local council such as housing. Support for greater co-working in multi agency functional teams would go a long way to solving that. This would also assist in resolving problems arising from demarcation lines within the NHS, why should one patient with complex needs have to deal with multiple departments in isolation, resulting in multiple visits to different departments in the same hospital on different days or treatments being delayed because the patient is already on a treatment from a different department that is contraindicated with the treatment to be given.

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  • Anonymous comment. That is why social care should be transferred to NHS. Whilst NHS notionally has to break even, and individual Trusts balance, there is no weight of the law, unlike LG which has to present and agree a lawful budget, signed off by the Statutory 151 officer. Its why LG have been a convenient target for Whitehall.

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  • I agree with Ms Baxendale, what social care need that is actually met by Adult Social Care doesn't arise from a health need?

    Isolation and loneliness were the last true social needs not met by social care and they've given the power to prescribe on this need to GPs.

    Andrea Sutcliffe's comment about the boundary with housing seems rather pointless. Yes, there would still be a boundary but there would be one less for housing as they would have health and social care as a single group rather than two separate and very differently-governed bodies.

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