The new enhanced role for councils in care and health

Last week’s national children’s and adult services conference saw health secretary, Andrew Lansley, outline an enhanced role for local government in care and public health, reports Michael Burton.

Not only was last week’s annual children’s and adult services event a sell-out, but it was also graced by a full turn-out of secretaries of state, ministers and shadow ministers from the two departments of education and health.

Education secretary Michael Gove’s speech in its exhortation for more academies and free schools opting out of their education authorities was not entirely welcome news to the predominantly local government audience.

But health secretary Andrew Lansley’s speech was another matter altogether.

For a department which has been historically the least proactive in wanting to work with local government, his content was about as pro-councils as he could manage without handing the NHS over to town and county halls altogether.

In fact, he revealed to the audience that five years ago, he had indeed had discussions with Tory London borough leaders about the feasibility of transferring the NHS to council control, but decided against it. After all, he told delegates, would councillors really want to make decisions over whether to spend money on a leisure centre or cancer treatment?

He continued: ‘If local government was responsible for health, it would dominate every decision taken by the council. It’s not the job of politicians to decide clinical priorities, but to be involved in strategy.’

Local government’s role according to the coalition’s health agenda is three-fold.

First, it needs to help reduce costs to the NHS of treating old people by devoting council care resources to helping them be independent at home.

Second, councils have a new key role in the public health agenda outlined in last summer’s health White Paper, with directors of public health coming primarily from a non-medical background. And third, although Mr Lansley did not touch on this in his speech, councils could provide back-office services, such as HR, payroll, accommodation and auditing to the new GP consortia, when they are up and running.

Much of his speech was devoted to the care agenda, in particular, the extra £2bn promised in the CSR for adult care. Mr Lansley said this had exercised the minds not just of his department but the ‘Treasury, Number 10 and the deputy PM’, not surprising, bearing in mind that councils were bearing the brunt of spending cuts and the temptation would be for them to cut back on their care costs.

He recalled: ‘It was a real concern, and we feared there would be a rise in emergency admissions to hospitals.’

As a result, ministers had agreed to find an extra £2bn divided between councils and the NHS. Mr Lansley told a press conference after his speech that this was deliberately front-loaded, with £800m earmarked for the next financial year, to offset the front-loaded cuts to council funding announced by the CLG in the Spending Review.

He emphasised that the two sectors would be expected to work in tandem, saying: ‘Health and social care must be complementary, not conflicting. Cost-sharing, not cost-shunting. We are locking health and social care together in the funding mechanism.’

The health secretary gave more details about the funding and more help for the NHS to put in place post-hospital care, or re-ablement services for people needing help regaining their independence after a spell in hospital. The NHS will be given an extra £150m in 2011/12 for re-ablement services, and £300m a year from 2012/13, part of the extra CSR social care cash. And a ‘toolkit’ has been launched that will help councils to work with the NHS on re-ablement.

Later, the chairman of the LGA’s community wellbeing board, Cllr David Rogers, said: ‘Mr Lansley’s explanation of how the extra £1bn from the NHS is going to be spent helps provide the much-needed clarity we have been calling for. There was concern about how PCTs would work with councils, and it’s reassuring to hear the Government is as committed as we are to making sure this money goes to the people who need it most.’

The health secretary also stressed that prevention, use of technology and personalised budgets would all help keep the elderly independent and in their homes, rather than ending up in hospital as a cost to the NHS.

As he said: ‘Falls alone cost £1bn a year and one-third of people with dementia who go into hospital never come home again.’

He singled out his visit to North Yorkshire CC, which has introduced a telecare service which monitors the elderly and has saved £1m by helping elderly people remain in their own homes with support. He added: ‘North Yorkshire CC told me specifically about falls where, every hour spent on the floor equalled one day in hospital, and how its approach to using technology saved more than £1m and reduced care package costs by one-third.’

North Yorkshire CC’s corporate director of adult and community services, Derek Law, later commented on the speech by saying he was ‘frustrated by the lack of progress in other parts of the country’, and added: ‘I can’t understand why other councils aren’t achieving the results that we have achieved.

‘Telecare ticks many boxes. For the person using the technology, it provides choice, dignity, empowerment and independence. For the carer or family member, it offers reassurance and peace of mind, 24 hours a day. And for us it offers cost-effective, person-centred care.

‘For the health service, it enables earlier discharge, reductions in hospital admissions and a more joined-up service with social care.’

Mr Lansley also devoted part of his address to highlight the local authority role in public health. As he said: ‘The principal determinant of the health of a population is socio-economic, and that’s not down to the NHS, but is the responsibility of local government.’

The heath White Paper envisages new public health directives being in place by 2013. Mr Lansley added ‘There won’t be, necessarily, medical people. We want to rebuild the public health profession.’

Cllr Rogers later responded: ‘It was encouraging to hear the health minister acknowledge councils as being at the heart of public health. This has been the core business of local government since its foundations. Closer working with the NHS will help build on our successes.’

Mr Lansley also announced a network of early trail-blazers, a ‘collection of pioneering authorities to show how health and wellbeing boards could work in future’, will be set up.