Posted by Marcia White on 15 February 2012
The Health and Social Care Bill is suffering yet another buffeting in parliament as confidence in the proposed legislation erodes even further.
Criticism from health leaders and MPs is at an almost perilous level for a bill which is now increasingly being seen as unnecessary in achieving the outcomes of improving patient care by changing how the NHS is run.
In local authority circles many social services managers believe that despite its title, health secretary Andrew Lansley’s bill offers far more gains to health than it does to social care.
For local authorities, the most significant aspect of the proposed legislation is the creation of Health and Wellbeing Boards.
Made up of social care and health commissioners and locally elected representatives, the boards will ensure joined-up strategies to improve health and wellbeing are based on local, rather than national, considerations.
A more integrated approach to local health and social care commissioning does indeed offer huge benefits in being able to better identify and address needs specific to local communities.
There are also huge cost savings to be made through a greater focus on early intervention and preventative services.
Patients and their families, too, are due to reap rich rewards from locally accountable services more responsive to the needs of smaller communities.
Care and health integration
Some local authorities are already realising this by working in closer collaboration with their health partners. The government wants to see more of this.
But many directors of adult social services believe that for health and wellbeing boards to truly be effective the funding gap in social care needs to be plugged.
Social services directors, commissioners and managers are still awaiting the government’s response to recommendations set out in the Dilnot review of funding for adult social care. This is to be outlined in a social care White Paper due out this spring.
Last year saw directors in England tasked with finding a massive £1bn in savings from existing adult social care budgets as part of the wider cuts to local authority settlements.
Reductions were found through efficiency savings, new income streams and cutbacks in services. However the cuts are part of a three to four year programme, which means there is limited scope to make additional savings in these areas.
In order to commission services effectively, health and wellbeing boards need to be adept at understanding not only what their local needs are but also how much money is in the pot to address these needs, especially in relation to the funding of long term care.
As Peter Hay, president of the Association of Directors of Adult Social Services (ADASS), said: “Good integration of care is a major part of the Bill, yet this will be badly compromised if there is a failure to find a national solution to funding long term care.
Adult social care services and funding
Unlike the National Health Service where all care is free at the point of delivery, the majority of social care services for adults and the elderly are paid for by people in need of those services.
This makes it even more the remarkable that the government plans to present the white paper in the spring, after the bill has concluded it parliamentary passage.
There is a task ahead in dovetailing the social care White Paper with the legislative requirements of the health and social care bill while ensuring that what benefits the patient stays centre stage.
Could it be, like what some people fear, that the government’s response to filling the social care funding gap will fall well short of what’s required, thereby passing on the cost of improved elderly care to service users.
Ask any independent provider and they will tell you good services cannot be provided on a shoestring. Local authorities need to invest in developing a talent pool of people with good commissioning skills in order to meet the meet these funding challenges.
Like the bill time is running out for getting this right – there is still time if local authority leaders are willing.