Firstly, I must admit that I have an interest in this subject; not only as Lead Member for Adult Social Care, and as Chair of our local Health & Wellbeing Board, but as a registered, practising social worker. This week NHS England set out an ambitious vision for the NHS over the coming five years. A vision which breaks down the barriers between GP’s and hospital care, which moves more healthcare back into the communities which desperately need it and places public health front and centre in a bid to create a Health Service fit for the 21st century.
Local government is mentioned numerous times in this visionary document. Our recently returned responsibility for Public Health will become even more significant over the next 5 years. The roles and responsibilities of Health and Wellbeing Boards are discussed as possible conduits for local commissioning and decision making. All welcome and in line with our Liberal Democratic view of the world. In this field of policy we as a party have made huge strides in the Department of Health through Paul Burstow and Norman Lamb; integrating budgets, mental health waiting times, carers’ rights and, fundamentally, the Care Act.
The Care Act will, in my view, be one of the finest achievements of our Liberal Democrats in government but it will never garner the same headlines as a five year vision for the NHS. The Care Act provides individuals with new rights, puts new duties on local government and will be, most likely, be central to social work education for the next 50 or 60 years.
Much of what we hear about social work is around children’s social work but day in, day out there are social workers across all our local authorities working with adults to support them to live full and rewarding lives. The link between the NHS and local government is arguably most clearly seen in adult social work and social care. It is local authority social workers who legally assess an individuals needs before they are discharged from hospital. It is local authority social workers who legally assess a carers needs to support them in continuing to care for their loved ones. It is local authority social workers who legally assess an individuals mental capacity and can become decision maker for that individual if necessary.
And herein lies the rub, the budgetary gap in the NHS is well rehearsed, with an estimated deficit of £30bn by 2020. The gap over the same period for Adult Social Care delivered via local government is £14bn. When looked at in percentage terms this equates to a 28% and 29% budget required respectively.
In my term of office as Lead Member and Chair of our Health and Wellbeing Board we have reduced our adult social care budget every year and will continue to do so next year. However, much like the NHS, we have and will continue to redesign our services to make them fit for the 21st century. Both Paul and Norman have been instrumental in integrating budgets between health and social care but when Simon Stevens says he needs an additional £8bn by the end of the next parliament; I believe him. Local government will need additional funding to meet the demands of increased focus on our Public Health remit, effectively implementing the Care Act and responding to increasing demand from an increasingly more knowledgeable population.
Liberal Democrats have long been the party of local government. The NHS will undoubtedly be a battleground for the next election but let’s make social care OUR issue. Let’s own the debate, let’s champion the seemingly tireless workforce delivering social work and social care in our communities. We Liberal Democrats should be backing an annual funding uplift for adult social care in line with our commitment to the NHS.
Personally, we should be the party calling for the College of Social Work to become the Royal College of Social Work. Respect where respect is due.
* Simon Allen is the Cabinet Member for Wellbeing on Bath and North East Somerset Council
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6 Comments
” It is local authority social workers who legally assess an individuals mental capacity and can become decision maker for that individual if necessary.” …Surely something only a court should decide if necessary/needed?
Thanks for your comment M Harvey.
Under the Mental Capacity Act 2005, social workers can assume the role of decision maker for an individual where they lack capacity. This is not done in isolation without consulting friends\family\carers\supporters, other professionals and not before carrying out a full assessment and completing a Best Interests checklist to ensure any decision is the proportionate and the least restrictive option.
The Mental Capacity Act 2005 is under review by the Law Commission but it goes to show that the work and role of social workers who work with adults and the legal framework they work within is little understood by many.
I should hope the Mental Capacity 2005 is, ATOS have completely abused and/or ignored it along with the NHS otherwise how was it possible in 2006, for someone with severe head injury, inc fractured skull not identified/ignored, cranial nerve damage/ palsy, sub-archnoid hemorrhage (caused through secondary injury through negligence in delay/ill treatment and no memory after coma, along with other things, get discharged from hospital 3 days later and the negligent employer responsible/liable for cause of injury, be the one making decisions and/or to accommodate early discharge?. The reason, no matter health or family input/decisions, the mentally incapacitated, be it temporary or otherwise, should have their own independent legal representative, as those wrong decisions made cause further medical and legal problems for the afflicted and open to exploitation/further abuse.. Abuse after all happens via those close or known to you 9/10.
Thankyou Simon for this important post. I support additional funds for the NHS but without proper investment for social care then we are storing up even more demand on the NHS. Talking to colleagues who work in this area they talk about elderly people who are in hospital because they can’t manage on their own any more at home, whether temporarily or permanently, and through a lack of relatively straightforward care and support, are deeply unhappy, away from neighbours and friends, prone to infection, and occupying an expensive bed. They also talk about shortages of staff to work in these caring roles because the pay is poor, the hours are unsocial and the roles are not respected. It appears that the 2015/2016 Spending Review will yet again have local government funding as a residual, getting the crumbs when the NHS and education are protected. This is bad news for social care, and bad news for the vulnerable people who depend on it. Thankyou for highlighting this issue.
Janet, would you agree therefore, that a form of district nursing needs stepping up rather than done solely through private care agency?
Thank you Simon, I agree with all you say. I think the points you make are well-understood by relatively few people, mostly those similarly active in the field, who generally have a high regard for Paul’s work in the first part of the current government, and Norman’s more recently. But “people” in general – and importantly the media – only have a shallow understanding of the significance of the links between ASC and the NHS, and overwhelmingly concentrate on the latter. This is beginning to change with HWBs, Healthwatch, and the Better Care Fund, but will take a long time to have a significant effect. We all need to do more to promote better understanding of the issues, the effect on individuals who need both social and health care, and the interlinked financial effects. As chair of the LGA’s Community Wellbeing Board for a number of years up to 18 months ago, I believe I made a small contribution to this! If you’re at NCAS this week, give my regards to former colleagues – and enjoy the conference…..