Comment

Shouting about health and care integration in the capital

Cllr Kevin Davis, London Councils executive member for health and leader of Kingston Council, celebrates the work being done in the capital to integrate health and social care, but argues there is still a long way to go.

It is no secret that London boroughs, along with councils across the rest of the country, are facing huge pressures in their adult social care budgets. The fact that the capital’s population is growing at a significant rate is not new – yet core funding from central government has fallen by more than 60% in real terms since 2010. 

We, as council leaders, have a duty towards an ever-increasing number of older residents, and those with complex additional needs.  

In his Spring Budget, the chancellor announced an additional £2bn for adult social care over the next three years. Notwithstanding the fact that more detail is needed of how the additional funding will benefit London, this investment is welcome news. Our social care departments are struggling with huge financial challenges and, prior to this announcement, we were estimating a funding gap of £600m by 2020 in the capital. 

Fortunately, this is now likely to have been mitigated by the injection of new funding.  But whilst the short-term pressures may have eased, the long-term financial sustainability of adult social care remains uncertain. In the Budget, the chancellor also announced plans for a Green Paper on the long-term funding for adult social care. This, again, is a welcome step, but we don’t need to wait for a Green Paper to argue for what we believe are some of the solutions.  

Transformation of the way councils deliver health and social care is essential to ensuring sustainability in the sector. London Councils has long believed the best way to do this is through further devolution to local government – putting more power in the hands of those who are closest to people’s needs and challenges of their communities. They are best able to understand those being supported from the get-go, continue listening to that person’s needs and make the right decisions at the right time.  

The new devolution deal for London is a welcome step in the right direction, giving the capital more powers over transport, infrastructure and criminal justice. It also promised a new Memorandum of Understanding on health to follow the London Health and Care Devolution Agreement of December 2015. This agreement will allow us to go further in improving the health and care offer to Londoners, and move faster towards a fully integrated system. 

A long way ahead 

But there is much more that can and should be done, as the work of health devolution pilots have made crystal clear. Comprehensive integration of health and care plans is already progressing in many boroughs, including Hackney, Lewisham, Barking and Dagenham, Havering and Redbridge. In Croydon and Kingston – my own borough – councils are focusing on service delivery to older residents through better co-ordinated care. 

London Councils has been consistent in making the case that Londoners are given access to high-quality treatment when and where they need it. The availability of community-based services, delivered through partnerships between the NHS and local government, afford residents more opportunity to live fulfilling and independent lives in their own homes for as long as possible, in turn easing the pressure on already stretched residential care providers and hospitals. 

Used to their full extent, opportunities thrown up by a fully integrated health and care system could be a game-changer and it is our responsibility to find the right way to push forward on this, ensuring the widest and fastest improvement in the health and wellbeing of Londoners is achieved. 

Central government must listen to local voices and grant us the tools we need to deliver vital frontline services against an increasingly challenging financial backdrop. But London government – the boroughs and the mayor – in turn must recognise that successful integration and reform will require strong political leadership from councils, underpinned by a strong commitment to work together towards the same set of goals. 

These ambitions are shared across other parts of the country, and by learning lessons from areas such as Greater Manchester – ahead of the game in terms of health devolution – we will be better placed to establish what works for our city.  

Celebrating the successes 

As well as continuing the work to drive forward integration in the capital, we must also shout about it. It is important to demonstrate to Londoners that we have the drive and dedication to make devolution a success. 

London Councils consistently calls on government to be ‘given the tools to get on with the job’, but we will also only be successful in encouraging the transfer of further powers if we outline the successes of what is already happening locally. To do this, leaders across the city must recognise the important role they play in advocating for change and clearly demonstrating how we’re already getting the job done.

And the capital has a lot to say. We’re at the forefront of the integration agenda and, just last year, our performance against the national conditions in the Better Care Fund surpassed other regions consistently in at least five of the eight national conditions. 

But we cannot rest on our laurels; accelerating the work to move the integration agenda forwards must go hand-in-hand with communicating our achievements. We know pressures in social care will be eased in the short term by the welcome injection of new cash. Longer term, there remain substantial challenges to be addressed in order to deliver truly sustainable models of care and health in London. 

Now is the time for London leaders to stand up, celebrate local successes and demonstrate how the tools from devolution can be an enabler of integration and reform.