Delivering High Quality Care for All - The role of local government
- Published on Wednesday, 03 February 2010 00:00
- Written by Cllr. David Rogers OBE
From a local government perspective, the key issue regarding the provision of local health and social care at present, is that each locality is different and, therefore, it is important to get the right local solution in any given area.
That is the basis for the community leadership role of local government and the need for us to be answerable directly not only for the services that we provide or commission ourselves, but also to take the lead with other local partners; whether that is health partners, PCTs and others, or the fire service, voluntary sector and the whole range of people that contribute to a person's sense of wellbeing in the area where they live, in their home and in their community.
Is integration the answer? Well, ultimately, it depends on how you define integration. In regards to the bodies that are accountable locally, I believe we do have the responsibility to take the lead. But when I talk about integration, I am not talking about local authorities running everything, I mean taking a leadership role and bringing other partners to the table, ensuring that each of their agendas is best suited to meet the needs of individuals and communities locally.
We are elected by local people to do our best with limited resources. On the question of resources, recent studies (Total Place pilots) have shown that only 5 per cent of total public spending in an area is actually spent by local authorities, the other 95 per cent is spent by national government through the benefit system and other mechanisms; through the NHS and various quangos.
The public assume that we have a large influence financially, but in effect, we are relatively small players. Nevertheless, we still have that role as community leaders to try to bring the process together to the best possible advantage.
The current legal basis for local government separates the cabinet or executive role from the scrutiny role. Consequently, it is the cabinet members who have the leadership responsibility for decision making about services; it is then up to all non-executive members to be community leaders in their own right for their own particular part of the local authority area - in their own ward, town, or village - and to ensure that not only are they scrutinising the services that the council directly provides or commissions, but increasingly, look beyond that to the other local partners, to ask are their policies and spending plans benefitting my community - that is the vitally important role of scrutiny.
There are some areas where this is already happening, but there is also a lot of scope for the development of that greater role, looking outside the authority's own business, to the whole range of local partner activity.
For example, in local government, we are only too well aware of the effect of financial constraints because we have been living with them for years. Theoretically, this can be a driver for better services or for thinking about the provision of services in an entirely different way and that comes back to integration.
If the partner organisations can sit around the table and agree the direction in which they should be going in that particular locality together - we can contribute this much, or alter our policies in a certain way - that will not only save tax payers money, whether local or national taxpayers, but it should also result in better services. I recognise however that it's much easier to talk about the theory of this, and much harder actually implementing it!
Whilst a lot of progress has been made and there are very good examples of where health and social care are coming together almost as a single body - in Herefordshire for example, and a London Borough where there is the same senior leader for both health and social care services - this cannot be imposed externally, from above, or from central Government. There must be a willingness of those responsible in each individual area to say this is the way forward; this is the way we want to proceed.
Fundamental barriers, therefore, do exist to the successful provision of health and social care:
- The funding mechanisms are different for local government services and the NHS or other nationally funding systems;
- The inspection regime is different and tends to look at particular aspects of individual services, whilst there is an element of how local partnerships work, it is still not really the main reason for the inspectorate's existence, they concentrate on one field or another and they cost a lot of course;
- Then at the grass roots level, the terms and conditions on which the staff is employed, their location etc.
None of these barriers are insuperable and the principle about trying to achieve as much as possible is a very good one and I would certainly encourage my own colleagues in local government and with the partners involved particularly in health locally to get stuck in and make it work.
There has been considerable publicity recently regarding the lack of public understanding regarding the services available and how the health and social care system is managed. This is a result of a lack of communication at a local level.
If an authority is integrating the services, or working together more closely with its partner organisations, then communication is a secondary issue because it ought to be clear that whichever part of the structure you are working with or trying to access, staff within those services should know what the other parts are doing and should, therefore, be able to provide that information to the citizen.
It is possible to communicate effectively, but it comes down to the willingness of the individuals in those positions locally to say yes, we are going to set about this in the appropriate manner and make it happen.
In brief then, all the political groupings represented in the LGA are very keen on two aspects in particular in regard to progress on this agenda:
Firstly, local leadership, local decision-making to the extent that that is possible within the constraints that we know exist; and
Secondly, giving those who need the services as much input in designing those services and making their own decisions wherever possible - whether you want to call that personalisation or choice and control - but that principle of designing the services around the individual and individuals having direct payments or their own personal budgets in order to purchase those services, that practice is growing quite rapidly in social care.
It is beginning to happen in health care, and I believe that that is the way forward, because in the end, individuals know best about what is going to meet their needs and help them lead as comfortable, secure and as healthy a life as they can.
To conclude, the LGA has a number of concerns about the costs and implementation of free personal care at home; the latest in a fairly long line now of Government initiatives that sound superficially attractive, but actually have hidden dangers for local authorities.
Whether we are talking about free bus passes - which have turned out to be a benefit for those who have them, but the scheme has not been fully funded everywhere, and, therefore, has been a burden for some local authorities in some parts of the country - changes to the licensing laws, or the free swimming initiative, this is something else, where you would say at first glance, that sounds good, that is going to be a great scheme, but when you look behind it, it is not.
The reason I say that is because the Government's estimates of the numbers of those individuals who would be eligible are far from robust. Therefore, there is great uncertainty about the numbers of people who would take up this initiative.
For areas which currently have a large number of individuals who fund their social care themselves - self-funders - there is no reliable information as to how many of those individuals would want to switch and take up free personal care. And yet, at the same time, the Government is saying that the risk of the numbers not being accurate, and therefore funded, must lie with local authorities, rather than central Government.
So our message to the Government is, firstly, if you are confident in the robustness of your figures you take the risk, and if you are not confident, then it is unfair to pass the risk to local government.
Secondly, this is inconsistent with most of the Green Paper on the future of health and social care, and whilst we broadly supported that and most of what was in it, this new initiative seems to have come like a bolt out of the blue.
Thirdly, the proposed implementation date of the legislation currently going through Parliament is October of this year; in other words, half way through the financial year. So even if this gets through, we would rather it was delayed until the start of the following financial year, so that there could be a longer period not only for budgetary planning purposes, but also for all the training and other preparation that will be necessary for social care staff and others.
So there are three aspects here for the Government to consider, uncertainty about the numbers, inconsistency with the overall thrust of policy and the timing of the implementation date.
This comes back to the fundamental point that each individual's needs are very different, and each local community's needs are very different and, therefore, it is local government's community leadership role and the need to ensure that we are in a position to integrate what is available locally and make it right for an individual in their home and in their local area that is clearly the right direction in which to go forward.
Cllr David Rogers will be chairing GovToday's Health and Social Care 2010 - High Quality Care for All Conference and Exhibition to be held on the 17th February 2010 at Church House Westminster.
Please see www.hscreform.co.uk for more information.
The Local Government Association (LGA) is a voluntary lobbying organisation, acting as the voice of the local government sector. We work with and on behalf of our membership to deliver our shared vision of an independent and confident local government sector, where local priorities drive public service improvement in every city, town and village and every councillor acts as a champion for their ward and for the people they represent.
The 423 authorities who make up the LGA cover every part of England and Wales. Together they represent over 50 million people and spend around £113 billion a year on local services. They include county councils, metropolitan district councils, English unitary authorities, London boroughs, Shire district councils and Welsh unitary authorities, along with fire authorities, police authorities, national park authorities and passenger transport authorities.
For further information, please see www.lga.gov.uk.