Councils threatened with ‘non-incentives’ to move health integration forward

The government has indicated that it will start “increasingly scrutinising” local authority performance and look at putting in incentives – or non-incentives – to encourage them to “step up to the mark” when it comes to effective health and care integration.

Speaking at yesterday’s major Health+Care conference, health minister Philip Dunne told delegates that his department will continue to work “with both the NHS and local authorities increasingly in an integrated way to try to ensure that patients are treated in a setting which most meets their needs”.

But he was extremely critical of the ‘blame game’ that often takes place at the interface between health and social care, which can be best exemplified by a recent NHS Providers report that was accused of misinterpreting how social care funding should be used: NHS bodies claimed that their local organisations had been unable to secure a commitment from councils that the £1bn social care uplift would be used to reduce delayed transfers of care (DToCs), while the LGA argued the money wasn’t just meant to reduce pressure on the health system.

Speaking at the conference, Dunne said: “I think there’s been a tendency, and I see this in the area I represent, for one side or the other of that equation to blame the other. And we are doing a lot of work now – following the Budget in particular in March, when we committed an additional £2bn of funding to be spent on social care – to ease these pressures.

“One of the consequences of that funding announcement was that we are going to be looking at increasingly scrutinising local authority performance in reducing DToCs. And the first quarterly returns are due out next month, which we’re looking at carefully to try to put in place some incentives and, if necessary, non-incentives, to encourage local authorities to step up to the mark.”

But it’s not solely down to councils to make this work, he admitted: the government will also be working with acute trusts in order to free up between 2,000-3,000 hospital beds this year, which is equivalent to around five new hospitals, in preparation for winter.

“We can expect to see hospitals, primary and community care, and local authorities working increasingly closer together to ensure people are not stuck in hospital unnecessarily, relieving pressure for NHS staff who are looking to deliver the highest quality of care to those who do have to be in hospital,” added Dunne.

Part of the issue could also be related to councils feeling shut out of discussions about health integration. Just a third of local authorities understand how accountable care systems work, for example, despite these – considered a subset of sustainability and transformation plans – being hailed as ‘the next big thing’ in terms of restructuring.

In a separation session, Sir David Behan, the chief executive of the Care Quality Commission, also revealed that the government now wants his organisation to be able to regulate local government commissioning, rather than just NHS providers. They are now looking into how this can be carried out legally, especially in the context of section 48 of the Health and Social Care Act – which essentially allows for investigations of social care services and local authorities if it is approved by the secretary of state.

Sir David was speaking as part of a panel discussion alongside Wendy Thomson, the managing director of Norfolk County Council – a job title that owes much to the local authority’s “commercial and entrepreneurial spirit”, according to her – and Dr Phil Moore, chair of the NHSCC Mental Health Commissioners Network.

During the debate, Thomson emphasised that it is fundamental to look at home support and prevention above all else, because “you don’t need to discharge someone who was never admitted” to hospital in the first place. Part of this is linked to a point made earlier in the day by Lord Carter, who leads on a major and ongoing efficiency review of the NHS: as well as improving services, the population itself has to be better educated to ensure they don’t make use of services that they don’t realistically need, or in inappropriate settings.

The health minister’s comments on social care closely trail a scathing report by ADASS from earlier this week, which found that despite the cash boost in the Spring Budget, the overall outlook in the sector has remained eye-wateringly negative.

The report prompted a handful of health and care bodies to reignite calls for a system-wide review of the care market, which prime minister Theresa May must prioritise in her administration to ensure social care is strengthened in the short, medium and long term.


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