Magna Carta for localism: Better care

The CPS paper proposes that while the NHS should be the focus for medical treatment, all non-medical personal care should become the remit for local councils.

The report says:

The efforts of the PCT and the local council often overlap. Given that many of the people who receive social care services also receive local health services, combining these budgets into a single pot would provide an opportunity to reduce cost and improve service delivery. A range of professionals from GPs to health visitors to environmental health officers interact with residents to provide services that can improve long-term health.

The says the proposed change would rng the following benefits to care services:

Residents would have a single entry-point for their health and social care needs. This would take the form of a single assessment to determine eligibility. This type of model should enable earlier intervention and result in better case management.

Pooling budgets across services that deliver public health benefits will enable local authorities to innovate. For example, investing more resources into improving poor quality housing or getting people back into work would improve health outcomes in the longer term. Pooling personal budgets across health and social care can be an incredibly powerful tool for preventative action.

It also points to an example of the type of improvementthat could be achieved:

In the UK, resources for long-term care for the elderly are currently channelled through various government departments: the state pension and various benefits are the responsibility of the Department for Work and Pensions while state support for care in the community is shared largely between the Department of Health (which allocates funds to “continuing care”) and the Department for Communities and Local Government (which funds “community care”). To confuse matters further, housing related support for the elderly is funded by a ring-fenced grant called “Supporting People” (which replaced housing benefit as the way that those in sheltered housing paid for their care).

This means that there are three separate points of entry for those seeking health care, social care and housing-related support. As a result, community services do not touch most of the elderly until they see a GP or are admitted to hospital with a serious illness.

In an effort to tackle this problem, Hammersmith & Fulham Council has, in the last year, been integrating the PCT and Council executive teams under one joint Chief Executive. This goes far beyond the Section 75 pooled funding arrangements. For the first time, it is amalgamating the PCT's “continuing care” budget (where the PCT currently spends £55 million on healthcare in the community and other local health services) with the council's “community care” budget where an additional £72 million is spent currently. It is also integrating home care and housing-related support services.

This has already led to innovation. Adaptation times (the time taken to adapt a property for the needs of elderly residents) have fallen from one year to three months. £150,000 has been saved. More elderly people are now able to control how their budgets are being used as the council rolls out its personalised care planning (which emphasises self care, supported by case management to ensure a preventative approach wherever possible).

This approach is in sharp contrast to the current system which is disproportionately focused on the provision of episodic care in hospitals.

The next stage includes proposals to re-commission home care services for all care groups. The council will move funding from sheltered schemes budgets to a targeted housing-related support service for older people available to older people in any tenure, including sheltered tenants. This will deliver more hours of help and achieve £260,000 savings. More services will reach more older people for less cash.