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Counties call for devolution of health and social care

English counties are calling for the devolution of health and social care budgets in the wake of the Devo Manc agreement.

An inquiry by the County All-Party Parliamentary Group (APPG), in associating with the County Council Network, has found that nearly eight in ten counties in the UK feel their existing funding pressures in adult social care are severe or critical. An additional 84% say it is the biggest financial pressure they face.

The APPG found that counties must face duel pressures of an ageing population and a funding settlement that allocates them four times less per head for services compared to some areas. It says that the impact of this can be seen in the NHS with delayed discharge rates 43% higher in counties.

The report, the State of Care in Counties, warns that a devolution divide could open between urban and metropolitan areas, further increasing social care pressures in county areas, following last week’s announcement of plans that the combined authority in Manchester will control their entire £6bn health budget.

An overwhelming majority (96%) of counties say these financial pressures are a long-term issue with 97% saying Care Act duties would only increase their funding pressures.

Respondents felt that investment in demand management, better use of technology and health and social care integration were the most effective ways of tackling these pressures.

Other recommendations from the Inquiry include:

  • Decentralisation of NHS England;
  • Overhaul to the NHS tariff system;
  • A fairer funding settlement for counties;
  • A breakdown of silos between health and social care workers;
  • Health & Social Care Deals to enable counties to negotiate devolved deals suited to their local challenges.

Henry Smith MP, chair of the County APPG, said: “These findings are a reminder that though significant progress has been made, the unique pressures in county areas means government still has work to do in removing the barriers to integration.

“The Manchester announcement underlines that devolution is way forward for health. The pressures on their services are not as high as in county areas and this strain will only increase over the coming years – and the need to break down the operational silos.

“By aligning targets across the NHS and local government, devolving control and providing a fairer funding settlement, care in county areas can continue to improve and meet the future needs of local people.”

Cllr Paul Carter, care spokesman for the County Council Network added that giving counties more devolved control over local health and care services is “vital” if they are to meet the growing pressures on their services.

“Counties have substantially more older residents, complex care economies, but receive significantly less spending per head than metropolitan and city authorities – a successful integration process must take account of these challenges,” he said.

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