Progress | Centre-left Labour politics

Why health needs to be local

To make the NHS fit for another 70 years, we need to meet the challenge of changing demographics and fix the social care crisis

Since 2010, councils have dealt with a £6bn funding gap in adult social care services. This has been met through £3.4bn of savings to adult social care and £2.6bn taken from additional savings to other services. The government’s one-off investment of £2bn over three years runs out in 2020, and allowing councils to levy an extra three per cent precept on council tax simply shifts the burden of a national crisis onto local residents.

Even after these changes, adult social care still faces an immediate and annually recurring gap of £1.3bn, which is the difference between what care providers say they need and what councils currently pay – and as a result there will be an overall funding gap of £2.2bn by 2020.

It will be up to the next Labour government to solve both the current social care crisis and also to find a sensible approach to meeting the longer term challenge. Ensuring our most vulnerable fellow citizens receive the care and support they need to live in dignity and comfort is fundamental to our values.

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Funding councils properly would create immediate better outcomes for people who need support, and would have a knock-on saving to acute costs in the National Health Service.

The Better Care Fund was meant to be a catalyst to encourage and formalise joint commissioning of services, but while there are examples of very good practice these are not uniform and depend very much on trust and good relationships between local government and NHS colleagues.

With new funding, councils will be able to implement new ways of working. The acute sector is still finding it nigh on impossible to close beds, which is where the savings to implement integration were meant to arise. Even models such as health devolution in Greater Manchester with transformation funding are struggling under financial pressures.

Adequate funding would also help find the crucial missing piece of the jigsaw: homecare. Local government is finding it increasingly difficult to commission homecare at rates that allow providers to pay wages that are commensurate to the value of caring for our most vulnerable people, or to provide the level of care that service users really need.

Many Labour councils have prioritised addressing this challenge by adopting Unison’s Ethical Care Charter, designed to ensure both decent care for vulnerable adults and good employment standards for care workers. Councils that have signed up agree to pay at least the real Living Wage to all care workers, to schedule care visits according to the needs of the individual – with care workers given enough time to provide the care needed –and pay for travel time.

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Truly effective interventions are locally designed – preventative early intervention will not work if it is attempted to be remotely imposed from Whitehall. This is why it is vital that local councils retain control of social care.

One suggestion would be to set the eligibility criteria, allow people to choose the sort of care and support they require, and then for it to be free. The savings in the system would come from no longer requiring an army of commissioners to dictate how many minutes and hours an individual should have – and it would most certainly crack that thorny issue of fifteen minute visits. This system is operated successfully abroad and is worthy of consideration by Labour in planning for government.

Integration of health and social care systems should be on the basis of the NHS and local government being equal partners. When a health and care plan is agreed on the basis of evidence from a joint needs assessment the spending on that plan should have a mechanism where it is jointly agreed, implemented and monitored.

For the first time ever this would make health and social care governance truly accountable. The Health and Social Care Act 2012 would need repealing, which is also important if we are to end the private sector infiltration of our health system.

As a Labour party our whole philosophy is encapsulated in our proudest achievement – the introduction 70 years ago of a National Health Service. It should be the mission of the next Labour government to establish another equally sustainable and iconic system, that will also endure for 70 years or more – and that offers a further guarantee that all citizens, irrespective of their circumstance, will have equal access to the care and support they need to live in comfort and dignity for the rest of their lives.


Linda Thomas is leader of Bolton council and Labour’s Local Government Association lead on community wellbeing


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Linda Thomas

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