Time to Merge Health & Social Care?
Earlier today I asked the Local Government Minister whether should remove the social services function from local government and merge it with the new Local Health Boards.
This question built on my speech last week at the RESEC (Research in Specialist Elderly Care) conference in Bangor where I suggested that government departments ought to be working together in planning for our future care needs, and that they should be examining the regulatory framework & inspection regime to see whether it’s fit for purpose.
For some, giving the LHBs responsibility for social services would be a controversial step, especially those running our county councils; for others who are tired of poor performance in the delivery of social care this would be a sound move to make.
One of the biggest barriers to strategic planning and the provision of seamless care is the fact that two organisations are responsible for people in the health and care sectors. A person in hospital is the responsibility of the NHS, if they are discharged with a care package they will have the input of usually both health and social care workers, who in turn are accountable to the NHS and local government. In theory there’s no reason why this shouldn’t work but the practicalities are quite different.
The first problem is at the point where a person is capable of being discharged to their own home but the discharge planning is flawed. According to hospital managers local government are slow to put in place an appropriate package of care, I suspect they are right. However many of our hospitals are also slow to ensure that the district nursing service is lined up and involved in advising on the appropriateness of the discharge. Age Concern told me this week that they are seeing an increased number of unsafe care packages being put in place. This is a disgrace for a nation that purports to care about the elderly.
The second problem is for those who require nursing care in a residential home. The experience of most families is the long drawn out battle between LHBs and local government over who should pay the care home costs where a person has, for example, dementia. By 2050 there will be 1.7 million people in the UK with dementia, an increase of 81%, and for many a care home is needed. Having had constituency experience of the disagreements between statutory bodies over funding this is a big issue. The dispute is usually over the actual level of nursing care required for the patient, a rather stale and impersonal spat between two organisations charged with caring for the individual.
Planning for our future care needs is one of the greatest challenges we face, we must be bold. Who exercises these functions is an important part of that debate.
February 4th, 2010 at 10:11 am
I posted this on another blog a few days ago – seems apt to put it up again:
I have always been a believer in simple transparency when it comes to democracy and taxation. We the voters should be able to see what our elected representatives are spending our money on, and if we don’t agree with the policies we can use our votes accordingly.
This should be true at all levels of government. So starting with the County level, I have always been thoroughly confused by the statements I receive from my local council – Cardiff.
In 2008/09, Cardiff Council had a net expenditure of £476 million. This was financed from Council tax receipts of £113 million, Business rates of £84 million, and the balance of £280 million from the Revenue Support Grant from the Welsh Government.
So the first interesting fact to note is that Council tax only accounts for less than 25% of net expenditure, and if business rates are added, Cardiff Council still only collects 41% of its revenues directly, relying on grant from Welsh government for the remainder.
The other interesting fact which is buried in the accounts is that Cardiff Council actually collects 4 times the amount in business rates that it is allowed to keep, with the remainder being sent to the Welsh Government to redistribute on an all-Wales basis. Nothing wrong with redistributing wealth to the poorer councils, but is seems odd to give so much in one hand and to receive the same back in the other.
Then turning to the Council’s areas of expenditure, the biggest single expense is education at £205 million, followed by Social Services at £112 million, Highways & Waste at £48 million, Parks & Leisure at £23 million, others totalling £18 million and finally Management at £44 million, and capital financing at £24 million.
Two interesting points here – the first is the cost of management which seems excessive. This is in fact only 11% of total expenditure, but it would be interesting to see how this compares with other councils.
The second point is social services which seems an anomaly to me. This role does not really fit the role of a municipal body, and why is it not managed as part of the NHS???
So few suggestions:
Firstly, remove social services from Cardiff Council, and make them part of a Social Services Agency, maybe operating at a Regional level and funded directly from Welsh Government. This would remove £113 million from the council budget, plus a corresponding pro rata reduction in management and financing costs (12 million & 7 million respectively). This would result in a new nett expenditure of £345 million for Cardiff Council
Secondly, increase the amount of revenue that County Councils can retain from business rates from 25% to 66%. The remaining 34% can be returned for redistribution on an all-Wales basis as before, although it is unlikely that Cardiff would be a beneficiary.
This would increase directly collected revenues to 334 Million or 97% of revenue, with the balance made up from payments received from Welsh Government for specific services provided, for example election costs in general elections. The Council would become effectively self sufficient and would then be able to offer the electorate a direct democratic choice – services or taxation.
Coming back to the Social Services Agency, I suggested that this could be established on a regional level, and would be similar to the Morgannwg NHS or the South Wales Police, and maybe over time the areas served by such bodies could be made progressively co-terminus wherever practical. I would establish regional management boards for each of these bodies, which would be democratically elected using the regional votes cast in the Assembly elections. The 4 regional AMs would be directly appointed to the regional management boards (resolving the lingering question of what they actually do) with 8 further appointees drawn from backbench AMs or County Councillors, in direct proportion to regional votes cast for each party. While not a perfect system, it does at least introduces an indirect democratic link and an element of accountability.
The Assembly should become more accountable once the LCO system is abandoned, and that just leaves Westminster……