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Health white paper reveals plan to shift cash away from hospitals...
Health white paper reveals plan to shift cash away from hospitals

By Nick Golding

Directors of adult social care must lead a preventative healthcare revolution, with funds diverted from hospitals to help them succeed, government has said.

Under the health white paper released this week, primary care trusts will be ordered to transfer funds into joint projects with councils to provide support in homes, and away from hospitals. Those failing to make progress will see their annual spending plans blocked by central government.

Social care minister Liam Byrne told LGC: 'We are clear the NHS has to move a much greater fraction of its resources into preventative healthcare. In the future, the NHS won't have local delivery plans signed off unless they can demonstrate that.'

He said directors of adult social care will get powers to deliver the changes, adding: 'The director of adult social care has an ultimate responsibility for helping the local community to deliver social responsibility and social inclusion.'

Social care managers have welcomed the paper, but warned more money will be required to bring about the changes.

Under the proposals set out in the Our health, our care, our say paper, councils and PCTs will work together to give service users more choice over their care. Yet health secretary Patricia Hewitt warned they would initially receive only 'modest' amounts of extra cash to set the ball rolling.

Ministers want 5% of resources shifted from hospitals to primary care, but councils also need a financial boost in next year's public sector spending review to care for an ageing population in which more people with severe disabilities survive into adulthood.

The document also says individual budgets, which give users more control over their care, could be implemented nationwide by 2009.

Councils will be expected to provide a helpline for carers and emergency respite support by 2008. So-called 'prescriptions' outlining the continuing care plan for those with long-term needs will also be brought in.

PCT and social care budgeting cycles must also be aligned by 2007, with joint management teams implemented by the following year.

Julie Jones, the president of the Association of Directors of Social Services, said: 'It's a very good white paper and has all the things we wanted to see.'

'I like this statutory role for directors of adult services and joint leadership with the PCT director of public health on joint commissioning of services.

We are also pleased with the emphasis on support for those with long-term conditions.'

Christine Paley, Thurrock Council's director of housing and social care, was equally optimistic about closer links between the two sectors. But she added: 'We need to find new ways of coming together.

If we can't we are letting ourselves down.'

Questions remain as to how councils, who have warned that a disappointing funding settlement will force them to restrict access to social services, will deliver the changes.

This goes against the government's vision of providing additional services to improve the quality of life of those with less severe problems.

Niall Dickson, the chief executive of think-tank the King's Fund, said: 'The big challenge is making all of these well-intentioned policies reality. We know that local authorities and primary care trusts are still struggling to engage in prevention as they are concentrating on those in greatest need.'

The paper also gives councils new power to scrutinise contentious NHS decisions, including hospital closures,

which can be referred to ministers.

A full review of local democratic accountability of health is set to be completed in April.

White paper - what directors are saying

'Can they really change the direction of the NHS after 57 years of it being about acute care and hospital care to more community based provision?'

John Bolton Director of community services,

Coventry City Council

'The very existence of legislation bringing health and social care together will be a huge driver for better

joint working.'

Alan Adams Executive director of adults and community care, Surrey CC

'The government currently gets it wrong by pouring more money into the cash-thirsty NHS while starving

social care of resources.'

Ray Jones Director of adult and community services,

Wiltshire CC

'Further integration of functions with health is deliverable although the

current turbulence around PCTs will impede progress initially in some areas.'

Richard Jones

Director of social services, Lancashire CC

'It is imperative that any shifts from hospital to community based care are accompanied by an appropriate transfer of cash.'

Cllr David Rogers (Lib Dem)

Chairman community well-being board, LGA

'The level of historic debt in the south-east of England means that the only way forward for many NHS

trusts and PCTs is to reduce services.'

Cllr Ray Ellis (Con)

Chairman, health overview and scrutiny committee, Hampshire CC

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