What are the stages to reform?

This is the fifth think piece in the LGA's series 'Towards a sustainable adult social care and support system'.


Foreword by Cllr Izzi Seccombe OBE

Cllr Izzi Seccombe

When the LGA embarked on this set of think pieces, we did so with a degree of optimism that this final publication in the series would land shortly before the publication of the Government’s green paper on care and support. ‘Before summer recess’ was a line that Ministers and officials stuck to when it came to questions on when the green paper would be published.

With the announcement of significant new funding for the NHS, and confirmation that the linked NHS plan will include a focus on both full integration between health and social care and a review on the function and structure of the Better Care Fund (BCF), the Government changed its mind at the eleventh hour on the green paper. Better, they said, that it aligns with the NHS plan. ‘Autumn’ – albeit a Government autumn – is the new deadline. One can see the logic. If we’re serious about integration then why not publish both documents around the same time? The answer to that, or rather the problem, is twofold.

First, aligned publication of the NHS plan and the social care green paper would only really work if both sides had broadly equal status. In such a scenario, you could imagine the needs of each service being treated equally, along with similarly balanced recognition of the role each plays in sustaining and strengthening the other. The announcement of an additional £20.5 billion a year for the NHS by 2023/24, with no equivalent promise of new funding for social care, is just the latest in a series of developments demonstrating the absence of such equality.

Second, if health trumps social care in the Government’s reckoning, there is a risk that the NHS plan might pre-empt some aspects of the green paper before that document has had its full public consultation and before the Government has had time to reflect on its findings. This could create space for NHS England to have at least partial influence on the future of care and support. That may not necessarily be a bad thing. Simon Stevens, chief executive of NHS England, has spoken previously about the importance of securing more funding for social care. But he has also been clear about the bottom line: “I do not think that the NHS makes any apology for arguing that most acutely ill and unwell people are, when times are tight, where we have to put particular attention.”

Whether that’s right is a matter of personal opinion. But if, as some commentators have said, the additional funding for the NHS is not sufficient, one can easily imagine a not-too-distant future in which a preoccupation with the NHS acute sector continues to dominate the agenda. We only need to look at the experience of the £2 billion 2017 Spring Budget funding for social care, routed through the improved BCF, to know that, in such circumstances, social care money for local areas can become quickly and heavily influenced at the national level to support the NHS.

Therefore, while NHS England influence on the future of social care may not necessarily be a bad thing, it’s clear that it may not necessarily be a good thing either. And to borrow from Simon’s tack, I do not think that local government would make any apology for arguing that funding for vital social care and support services that keep people well and independent in their communities should remain firmly with democratically accountable local government as demand grows.

This isn’t about drawing battle lines. Far from it. The NHS and social care have a solid history of working well and closely together to the benefit of the people we share a mutual and deep commitment to. Councils’ performance on reducing delayed transfers of care attributable to social care is clear evidence of that. But when it comes to the Government’s green paper on care and support, local government should be in the driving seat in much the same way as NHS colleagues will drive the NHS plan.

The delay to the care and support green paper is therefore a real concern. But if national government cannot act, local government will. That is why the LGA is seizing the moment, demonstrating its leadership and writing its own social care green paper covering all adults.

Over the coming weeks, and building on the extremely helpful contributions from the more than twenty high profile sector experts who have participated in this think piece series, the LGA will set out its own vision for the future of social care, its links to health and its links to wider wellbeing. We will conduct our own process of engagement and consultation and report back in the autumn.

As we therefore consider the next stages for reform in this final publication, and with our own green paper on the horizon, I can think of no three better people to close this series out. As one of the foremost commentators on adult social care, Richard Humphries offers an invaluable ‘starter for nine’ on the lessons we should learn from previous attempts at reforming care funding. Stephen Dorrell is a distinguished and authoritative voice on health and social and argues why, and how, the relationship between health and local government needs to change. And as one of the most respected figures in social care – over a career spanning four decades – Sir David Behan lays down a challenge to us all; to be ‘bold and courageous’ in securing the right kind of future for people who need care and support.

I have every confidence that local government is ready for that challenge.

Cllr Izzi Seccombe OBE
Chairman, LGA Community Wellbeing Board