Give councils control of health budget

Glyn Gaskarth says localising the health service would give councils an incentive to improve adult social care

The budget asked Local Authorities to cut their budgets by a quarter over the next four years. In contrast, the £100 billion plus national health budget will be protected and increased. Perversely this means cuts in the £6 billon social care budget controlled by local authorities. Social care can (in some cases) save the health service money by keeping the elderly healthy and reducing the need for costly medical treatment. We must end this false separation between health and social care.

The coalition agreement offered the Conservatives an opportunity to reassess their pledge to increase health spending. The Liberal Democrats did not promise to increase health expenditure over the Parliament or ring fence health expenditure from cuts. However, the Conservatives have retained their NHS spending pledge. Mr Cameron defined his political philosophy in three letters NHS. He means to honour that commitment.

The question now becomes what constitutes the health budget. If we assume it excludes those areas not directly controlled by the Department of Health then some of social care is excluded. Social care includes many features necessary to allow the elderly to continue to reside in their homes and ensure young people grow up in stable homes. It includes home adaptions, respite care, meals-on-wheels and home-help for people with disabilities. These services can prevent costly admissions to A&E and care homes. Other services such as fostering and adoption can reduce Ministry of Justice expenditure in latter years e.g. young children who are left in care are more likely to resort to crime than those that are adopted. Age UK predicts social care will be cut by £900 million over the next two years.

So what is the solution? Both social care and health services need to be commissioned by local authorities. Health funding should be provided in a block grant to upper tier authorities. This does not mean we should extend the ring fence on health to social care (as Age UK suggest). We should not extend the provision of free services. Instead local authorities should refocus the combined health and social care budget to serve as a means of targeting resources to reduce the recourse to costly medical care. Different local authorities will experiment with diverse policy approaches. These could include linkages with housing provision, transport and other policy areas too, such as:

• Diverting money from acute care to finance better lighting, grab rails, stair rails and the provision of slippers for old people to reduce the incidence of falls.
• Repairing the pavements or providing grit to prevent individuals falling and breaking their legs/hips at times of severe weather. County Durham and Darlington NHS Foundation Trust paid Durham county council to increase gritting of roads and pavements to avoid accidents. The aim was to reduce expensive A&E and long stays by patients.
• Providing an increased emphasis on recruiting potential parents to foster or adopt children to reduce the length of time children spend in care.

The Government should be concentrating on getting the best possible value for taxpayers’ money. Local Authorities should be empowered to reduce (or at least lower the increase in) demand for costly health care treatment. The current healthcare ring fence makes this more difficult. It should be altered to ensure we target expenditure on interventions that can reduce overall health expenditure in the long term. These expenditure reductions will not occur because we have introduced charges or cut provision. They will occur because we have funded targetted early interventions to reduce the demand/need for latter more costly intervention.

The views expressed above are my personal views and not those of my employer or any other organisation with which I am associated.