This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
The issue we should be grappling with is not whether social care should become part of a national service structure controlled from the distant corridors of Whitehall and Skipton House. Rather, the real question is how we use the long term health plan to make NHS services more localised with a clear relationship to local democratic frameworks, integrated local commissioning and cross-public service delivery.
Government has already done two of the three jobs we need it to do on social care. It has put in place an excellent piece of legislation – the Care Act – that could provide the right enabling framework for a generation. It has also put in place a trusted inspection system with public confidence. Its third task is to properly fund the system and that should be the primary focus of the Green Paper.
Other than that, the real action should be at the local level. Using the learning from the devolved systems, particularly Scotland and Greater Manchester, Government should set the conditions to enable the full integration of health and care services under strong local governance attuned to the needs of the local population. We need local systems that are able to administer knowledgeable oversight, not the remote probing of an imprecise extra-long screwdriver guided by a hierarchy of national and regional officials.
The key characteristics of that local framework would be a single health and care plan, one commissioning team and one budget. There would be full digital interoperability to allow the combination of risk stratification, single care planning and the day-to-day work planning of a multi-disciplinary team able to meet a full range of support needs. There would be a very strong emphasis on maximising personal choice and control, and a crucial role for the voluntary and community sector in decision-making and delivery.
This is the approach that we are trying to model here in Greater Manchester, with a single cross-sectoral governance model at both conurbation and district level, single commissioning functions across NHS and local government, and local care organisations providing a mix of primary care, community health, mental health and social care services, and often other services as well.
A local model of integrated care not only provides a more direct line of accountability, it is also far more efficient , because you can do away with the need for swathes of regional and national management that would take a significant share of the resources that would otherwise be spent on front-line services.
My final point is that if one of the key goals in integration of health and care, at what level is this likely to best achieved? National organisations’ track record of joining up different services is not great to say the least. Indeed you can take your pick – physical and mental health, work and health, supported housing and welfare, public health and violence prevention. It’s not a criticism, it is an inevitable truth that the further you are from the action, the greater the distance between the institutional siloes and so the more difficult to join up policy and delivery. At local level, that co-ordination is often far from perfect but a GP and a social worker sat next to each other in a primary care centre deep in a neighbourhood operating under a locally agreed plan with a significant amount of autonomy, might have a somewhat better change of pulling off a real experience of integrated care.
In short, ‘local’ eats ‘national’ for breakfast.
Jon Rouse
Chief Officer, Greater Manchester Health and Social Care Partnership