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Betts: GM devo deal a halfway house to aligning health and social care

Establishing clear lines of accountability to deliver health and social care integration is going to be one of the major challenges facing the sector going forward, the chair of the Communities and Local Government (CLG) Committee has told PSE – adding that GM devolution is a “halfway house towards it, but still leaves some of the questions unanswered”.

Following last week’s Spring Budget, where the chancellor announced an extra £2bn for social care and promised a green paper, Clive Betts MP said: “Obviously, we are pleased that the chancellor has recognised that the problems of social care need more money, but are disappointed that he hadn’t gone as far as the committee asked.”

He added that his committee also requested a National Audit Office review to establish a figure that everyone could agree on with regards to the social care funding gap, but “ the government didn’t even mention that”.

“To pluck another £1bn over two years and say that is enough misses the point,” argued Betts. “The chancellor can’t be certain it is enough; he has no credible evidence to back it. And we could be back here in a year’s time having the same argument.”

Discussing the GM health devo model, whose ambitions could be ‘gnawed away’ due to social care cuts, he told us: “Pooling budgets is sometimes called joint commissioning, and there are different ways of doing it.

“The one difficulty with all these things is that they tend to work until they go wrong, and then everybody blames everyone else. You really have to have clear lines of accountability, but currently health and social care have very different accountability systems. Social care is accountable to, ultimately, elected councillors on the local authority. Health is accountable to the secretary of state.

“I don’t think government yet has a clear view of how that works. The Manchester system is a halfway house towards it, but still leaves some of the questions unanswered.

“These are very different systems, and that is going to be a challenge for the future.”

While admitting that health and social care integration can go some way to reducing the stress on both systems, the committee chair noted that as NHS England’s chief executive, Simon Stevens, told them, “integrating health and social care will bring benefits, but it won’t solve the problem of social care funding in the long term”.

The Sheffield South East MP added: “If anyone thinks all we have to do is get social care and health to integrate and then everything will be fine, then they are missing the point. We are still going to have a continuing need for extra funding for social care, simply because of demographics.”

A CIPFA survey recently revealed that households in England face the highest council tax rise in a decade, on average a rise of 4%, as local authorities attempt to tackle the social care shortfall.

Betts, whose committee is carrying out an inquiry into adult social care, said: “There are massive challenges ahead. No one has given us evidence that it could all be funded by the public sector.

“Most people want to see there is a strong local element in it, with local accountability. How you put that together, recognising the significant changes about localisation of business rates, which are coming as well, are issues we need to reflect on.

“We have, however, had clear evidence from the local government sector saying that the demand for social care is going to go up faster than business rates will.

“Those are problems in the system that are going to need long-term resolution. We have had lots of problems presented to us, but not a comprehensive solution. That is what the green paper should be looking at.”

Top image: John Stilwell

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