Labour in local government is innovating to compensate for lack of government funding, writes Paul Brant
This winter the health and social care system is under unprecedented pressure, and parts of it are buckling. This was entirely predictable with an aging population, new costly treatments and the massive cuts to councils. Despite the underfunding however, Labour councils are showing how to innovate and improve essential provision.
First however, the money! The government’s additional council tax rises for social care are only a sticking plaster which raise inadequate sums in the wrong parts of the country. Liverpool’s three per cent extra council tax rise will only raise about £7m, but the additional minimum wage costs in social care alone will cost over £24m by 2020. Councils with the greatest care needs often have the lowest council tax base, for example over 80 per cent of our properties are in the lowest two council tax bands. Council tax is now paid by even the poorest, so these rises are a regressive way of raising cash compared to general taxation.
While the hospital crises always makes better TV, the health and social care system acts as one. This is why the National Health Service chief Sir Simon Stevens has said that more money is urgently needed in the system, but it should go to social care first. Many delayed discharges result from an inability to source complex packages – there simply are not the carers available.
There is no way that the current system can survive on the financial envelope available. A majority of hospital trusts are in deficit, many care homes and companies are exiting the market. Many councils are uncertain if they can meet the forecast demand in their areas in the next few years. More money in the system is urgently needed. It must come from central government, preferably direct to councils, if not then via the NHS-shared Better Care Fund. Councils of all political colour are united in saying this.
On the brighter side, we should not forget that this situation arises from two great developments. We are living longer, and formerly untreatable conditions can now be managed by our NHS. It is a cause for celebration.
Labour councils have also shown we can innovate, even in the current climate. There are ways to improve the current system which have been trailblazed here in Liverpool.
First, I sit on the clinical commissioning group board and we have a joint NHS/council director who helps us jointly plan services. The integrated working means that we can work on joint projects such as our re-ablement centres where patients are placed in a council facility for six weeks, getting care packages sorted and the NHS providing geriatricians, physiotherapy etc. Acute hospital beds are freed up, and far fewer hospital readmissions follow the patient’s return to home. A better service at lower cost by working together.
We are also working towards a pooled budget with our CCG, shifting cash into community, primary and social care. We hope to partly introduce the scheme shorly.
A public-public partnership of the council, the local NHS Community Health Trust and our GP federation will be the first in the country. This council/NHS partnership can allow co-location of social workers, primary and community health provision. This should enable close working and swift multi-agency responses to meet care and health needs. Our hospitals are also keen to get involved in the near future.
We are also looking at shared finance arrangements, using council borrowing capacity to fund capital projects, maybe even hospital facilities, with the NHS paying a revenue stream. Lower overall costs, more efficient services and better outcomes for residents.
There is a genuine desire in all parts of the health and social care system to ensure that, despite the underfunding, that we continue to improve our services. Labour councils are showing how we can be flexible across the public sector driving innovation.
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Paul Brant is cabinet member for health and adult social care for Liverpool City Council. He tweets at @PaulDBrant
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