COMMENT
How could local government cuts affect NHS services?
reduce admissions or earlier discharge from hospital. As the main providers of social care in the UK, local authorities spent £14 billion on adult social care services last year alone. It is therefore vital that social care is adequately funded if the NHS is to avoid facing even greater pressure on health budgets.
Lord Victor Adebowale
Will the £1bn of extra social care funding from health have its desired effect and should NHS managers be concerned about the potential knock on effect of local authority cuts to NHS services?
L
ocal authorities came off particularly badly in the spending review and are due to face 28% of cuts between now and 2015. In addition, it was announced that ring-fencing for all revenue grants paid to councils will end next April with the number of core grants received by councils falling from 90 to fewer than 10.
Whilst removing ring fencing from all revenue grants paid to councils will allow them greater flexibility in how they spend their money, the reality is that budgets are going to be a lot tighter.
What does this mean for the NHS? The answer is that health and social care are inextricably linked. The Nuffield Trust have proved this in recent research which reveals how social care can substitute for hospital care and vice versa by helping to
Nov/Dec 10
The Local Government Association has said that ‘virtually all’ local councils could be forced to end home help for elderly and disabled people. If they are forced to deal only with those in the most ‘critical’ need, elderly and vulnerable people with health issues such as dementia, Parkinson’s disease and diabetes could fail to receive adequate care. The result may be that their health deteriorates, leading to greater costs to the NHS.
Recent media coverage around this issue has focussed on concerns that hospital beds will be taken up by elderly people who are no longer entitled to council care. There is a clear knock on effect here. The issue of bed-blocking should be a lesson learned from history.
Hospital is by no means an ideal place for the elderly and vulnerable and if they are left there when they would otherwise be receiving social care, where will regular patients go? Also, will an increasingly under pressure NHS need to discharge them or face potential financial penalities?
And what of the thousands of people with a learning disability who once lived in NHS Campuses and now live
independent and fulfilling lives? This is one of the untold stories of the last 30 years. If local authorities can no longer support people with learning disabilities to live independently via social care, they will end up being the responsibility of the NHS.
Those with mental health issues are likely to find themselves in a similar situation following local government cuts. Indeed, several of Turning Point’s Supporting People funded services have already had their 2010/11 funding decreased which is likely to place an extra burden on the NHS in the long run.
If local authorities are to limit the effect cuts to their budgets will have on NHS services, they must look at the way they commission services. Currently the quality of commissioning is not consistent and often resembles purchasing more than a person centred, locally driven design of services that truly meets the relevant needs.
I believe that a definition of commissioning would ensure consistency of services creating a real value to a joined up health provision at a time when there are fast paced, all encompassing changes being made. A definition, perhaps could be: Commissioning: the means by which you understand the needs of an individual and/or a community such that you can build a platform for procurement.
The move to GP commissioning while social care is being cut also
puts us in uncharted waters. Unless GP commissioners have clear obligations to meet the needs of vulnerable people and clear obligations to work with social care agencies, then we risk having chaos. Consistent outcomes measures that work across health and social care could go some way in driving efficiencies and putting the individual at the centre of their health needs.
We do not yet know the detail of how these cuts will manifest themselves and exactly how local authorities will choose to allocate their limited budgets. What we can be sure of is that a slash and burn approach is not the answer.
If councils make substantial cuts to social care budgets it is the NHS which will end up picking up the bill. What we need to do is look to innovation.
This means enabling greater integration between health and social care and getting the public involved in service redesign.
This will have the dual benefit of lessoning the strain on the NHS and ensuring the greater at risk and seldom heard do not suffer disproportionately.
Lord Victor Adebowale is chief executive of Turning Point, the health and social care not for profit business providing services for people with complex needs, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability.
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