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Councils must not be ‘undermined’ as a partner in local health provision

The crisis in social care can only be addressed with a different relationship between health services and councils, which doesn’t undermine the role of local authorities, the chair of NHS Confederation has stated.

In an appearance before the Communities and Local Government Committee, Stephen Dorrell said that the consequence of failure to join up public services was placing “avoidable demand on the National Health Service”.

Both Dorrell and Simon Stevens, the chief executive of NHS England, warned that acute shortages in social care are contributing to increasing rates of demand and delayed discharge.

Dorrell said: “I feel very strongly that the local authorities and the NHS in each locality need to develop a different relationship with each other in order to address prevention, intervention, early discharge.”

The government is understood to be considering allowing councils to raise the council tax precept in response to growing outrage about the funding shortfalls in the social care system.

Dorrell added that “some statements to the press in different localities” had indicated that “old behaviours [were] reasserting themselves”.

“I think it is absolutely important, going into the New Year, that those behaviours are discouraged,” Dorrell said.

He insisted that improving health outcomes would not just involve health and social care, but other services such as housing and even libraries.

In particular, Dorrell said that trust between the NHS and councils was “undermined” when local authorities were “not seen to be making a contribution as a partner” to public health services.

He called for more integrated care, which would “reintroduce local accountability” to decisions about healthcare.

NHS England has now agreed to start providing the HIV prevention drug PrEP after losing a legal dispute with the National AIDS Trust, which challenged its argument that the drug was the responsibility of local authorities.

Stevens also told the committee that integration alone couldn’t solve the funding pressures on the NHS, and should not be made mandatory on a national level because there would be “no security” about the social care floor contribution.

He defended the controversial sustainability and transformation plans (STPs) as a way to deliver integrated care “within the system”.

Stevens added that when the STPs are implemented in the spring, they will need “a governing partnership involving councils and all parts of the NHS to actually put them into action”.

Speaking at the Health+Care conference earlier this year, Dorrell said that STPs offered a “new vision” for integrated care.

Mark Lloyd, chief executive of the LGA, told the committee recently that some STPs had been “introduced in secret”, with health services excluding councils from decisions.

In the longer term, however, Stevens said that the only option for social care would be “a big set of changes and a new consensus”. He repeated his suggestion of a “triple guarantee” on pensions, housing and care funding for older people.

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Peter   15/12/2016 at 13:48

It is not just about the money. Integration of Health and Social Care needs to address the fact that the NHS, Cabinet Office and DoE refuse to talk about basic integration of a) Management at the highest level, and move out of silos. b) a single integrated ICT secure network to move sensitive data around the system. c) new legislation that removes any remaining boundaries between Direct Health Care providers and other secondary public, private and voluntary services providing care. Make it clear in this legislation that personal healthcare data will never be sold, traded or given to insurance, pharmaceutical or other private sector organisations. This will potentially allow for reduction in the top heavy management structures, and allow clinical employees of various services access to the information required for the jobs they need to do. By all means allow an "opt out" for the 2-3 % who do not want to share their personal data, at personal risk to themselves. But for the rest of us trust the healthcare professionals to share the data they need to provide efficient, safe, secure services.

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