David Fothergill: Centralisation of social care would be a costly mistake

16 Feb

Cllr David Fothergill is the Leader of Somerset County Council and the Health and Social Care spokesman for the County Councils Network.

We’ve heard the phrase “health and social care are two sides of the same coin” plenty of times over the last few years.

The Department of Health became the Department of Health and Social Care in 2018 as the government sought to fuse a closer relationship between the two, whilst the Coronavirus pandemic showed how interrelated both services are.

The government has shown it is willing to learn lessons from the pandemic before it has finished, with last weekend containing headlines about proposed reforms to the NHS, which would unwind some elements of the 2012 Health and Social Care Act.

In recognition that perhaps greater integration between the health service and social care hasn’t quite worked out as well as those reforms intended, it appears ministers want to go further in deepening the relationship between the two in local areas.

We know, however, that it has been suggested in some quarters that the government may consider going one step further. Rather than closer integration, they advocate a form of nationalisation of these services, with social care being commissioned by the NHS instead of councils, as part of the government’s long-awaited green paper reforms on a future model of funding social care.

This is the model that was recently proposed by a review of Scotland’s social care system; an approach that the Scottish National Party is likely to pursue if it regains office in May.

This review’s consideration of how we both fund and deliver care services is important: how we as a country pay for social care is rightly at the forefront of everyone’s mind as part of reform. But a decision on how we fund social care through the White Paper can only come after it is decided who delivers it.

Nonetheless, unlike north of the border, we in English local government firmly believe that a centralisation of services would be a retrograde step. It would be an over-simplification that would lead to fewer care options for individuals; be more expense for the state; stifle better collaboration between health and care services; and crucially, remove local democratic oversight.

We are not coming at this from a protectionist point of view: we all got into local government to make a difference in our communities and to improve people’s lives. It is through this experience that we have a steadfast view that local delivery is best.

Of course, attempts to bring social care and health service closer together are laudable and will hopefully lead to better policy decisions, but they still perform two distinct if interrelated roles. Nor should social care be viewed through the prism of hospital discharges: just one in three people who go into long-term care each year come from hospital.

In essence, we can view the health service as a sprint: the immediate and acute health problems, in most cases are for a short period in someone’s life. Conversely, social care is akin to a marathon: care for the long-haul, with different options and intensity for people depending on their needs.

Crucially, councils boast the links to their communities: they know their people and they know their providers. From their relationships with care providers, their links with voluntary and community groups, alongside an ability to link across service areas such as housing and public health, councils have the size to be market managers whilst having the knowledge of their local areas that the NHS could never replicate.

In the debate on the future of social care to date, too much focus has been on the type of care we provide now in meeting people’s physical needs, and not enough on what care should be: enabling people to live as much of an independent life as possible.

If this future of preventative, people-focused care is to be realised, then we all need to pull together and ensure that we do our utmost to achieve it. This is why the County Councils Network last week released a report, produced by care specialists Newton, that sets a detailed blueprint on how this could be achieved.

If key foundations are put in place – namely that the government puts in place a long-term model of funding care and services remain locally delivered – this report sets out what can be achieved in the next decade if councils are put in the driving seat of local reform.

If councils, the health service, and providers, all worked more closely and intelligently with each other in wrapping services around the individual, then we can keep tens of thousands of people living more independent lives each year and make the experience better for the 1.4 million people who contact local authorities for council-arranged care each year.

It would allow us to build a model of care that allows people to live more independently: from providing more options and support to working age adults in care, to better tailoring care packages and homecare to individuals. It would also have significant financial benefits to reducing long term care costs if fully implemented, freeing up £1.6 billion annual benefits to be reinvested in services and contributing towards a more sustainable financial future for social care.

Improving people’s independence, after all, is what social care should be about. Remember, social care is a marathon, not a sprint, and allowing people to live their lives with as much dignity and freedom as possible is key.

Instead of over-simplifying the issue, let’s all work together to create a social care system fit for the future, which builds on the foundations already in place, rather than ripping them up.

Gerard Dugdill: Anger persists over the loss of our traditional counties. Proper names and boundaries must be restored.

30 Sep

Gerard Dugdill is the Campaign Manager of the British Counties Campaign, which seeks to restore official recognition for the 92 traditional British Counties

Imagine if your name was changed against your will. John Smith became John Smith-&-Jones, because you lived next door to Mr Jones. Dorothy Black became Dorothy Grey and then Dorothy White.

Smith laughed, then protested. He tried a variety of brush off tactics until, with deepening resentment, he tried desperately to stop the avalanche of references to Mr Smith-&-Jones by ripping up all mail and returning to senders in tiny pieces. To no avail. The letters kept coming…

In 1974, on April Fool’s Day, certain citizens of, for example, ancient Lancashire found themselves in Greater Manchester, Yorkshire in Lancashire, Hampshire in Dorset, Northumberland and Durham in Tyne & Wear.

In Scotland, Glaswegians have shifted from Lanarkshire to Strathclyde, then sort of back to Glasgow. Men of Stirlingshire and Perthshire have gone to Central and back. Men of Roxburghshire have disappeared into Borders.

In Wales – or England? – folk of Newport went from Monmouthshire to Gwent, then in 1996, to a beyond bizarre mix of Newport, Monmouthshire, and a version of Gwent simultaneously killed off and brought back.

Poor Wales, defenceless beyond repair. Only Wikipedia, presumably upon instruction, can officiously carry the disingenuous spirit of our legal, accounting, and insolvency, quack-speak-ridden times:

“Monmouthshire (Welsh: Sir Fynwy) is a principal area with the style of ‘county’ in South East Wales.”

All the while of course, when you complained, the letter writers – the Land Registry, say – insisted that your name hadn’t really changed, but only for “administrative” purposes. You are perfectly entitled to refer to your previous name, Ms White, even though everybody who matters now calls you just that, save the odd annoying reference to Ms Grey still slipping through.

Those “arrogant officials” have long since decided. Who did they consult? Whose wishes did they comply with?

The indignation of years of bullying, indifference, wasted money, identity denial, identity crisis, and confusion has prompted an online petition from Pamela Moorhouse.

She says:

“It needs to be mandatory for all councils to tell everyone about the historic counties, tell how the Heath Government in 1974 removed and replaced them with the present historic nonsense names, and ignored all objections.

“Why, when being forced into Humberside, were we told ‘We’ve come to get rid of your traditional areas’ if it was all admin only? The first Government statements at the time of the change were ‘That’s it! All the traditional areas have now gone! There are none left anywhere anymore!’ Does anyone else remember?

“Nobody wanted their history changing, so they ‘pushed objectors away’, and now lie to everyone, saying that the new counties have always existed.

“Ours does it by implication. ‘Would you like to know about people who lived in 50s North East Lincolnshire?’, knowing quite well that NEL wasn’t created till 1996, introduced by our then MP Austin Mitchell, carefully as everyone in Grimsby wanted historic Lincolnshire back, after getting rid of Humberside, but the council didn’t want us back in Lincs, so suggested NEL as a compromise.

“So if it’s the people’s choice, the new counties will remain and valuable history will be lost forever, as millions are currently in ignorance about the events of 74, confirmed by people’s memories in our smart survey results.

“Can these views be published so everyone knows about 74, and the new councils keeping an eye on us for 20 years so we didn’t sneak back to the old counties? Or at least part of them?

“But we must have full education, as millions have never heard of the traditional counties.”

 A Government White Paper next month will repeortedly address these grievances. Please do sign the petition.

Gareth Lyon: In defence of district councils

3 Sep

Gareth Lyon is a former councillor in Rushmoor and the Chairman of the Aldershot and North Hants Conservative Association.

We are now approaching the inevitable and tragic culmination of efforts to undermine District Councils.

At this stage, to have the opportunity to extol the good that borough and district councils do, feels more like being given the opportunity to bury, rather than to praise them.

It is increasingly regarded as an open secret that the Government sees the future of local government as lying in massive county-wide unitary councils, possibly supplemented by a patchwork of parish councils.

This outcome will come as no surprise to those of us who have followed closely the treatment of district and borough councils over recent decades.

Whist there surely has not been a deliberate strategy to systematically undermine district councils and prevent them from functioning as effectively as they can, it is sometimes hard to discern how such a strategy would manifest itself differently from the effects of the cruel and negligent treatment of this tier of councils by successive Governments.

By way of context, the UK is already something of an outlier in Europe in terms of the average size of the lowest tier of local government, its funding and its powers. France, Spain and Germany in particular, entrust far more responsibility to bodies equal to, or smaller, in size than English district and borough councils.

Yet district and borough councils are a very prominent feature of local political life in the UK, and almost always the arrangement of responsibilities means that they are on a hiding to nothing.

Taking Council Tax as an example. Being a tax which must specifically be paid as opposed to being deducted automatically like PAYE or NI it is consistently amongst the most noticed and most hated taxes in the country.

It is well known that your local council will arrange collection of this (and other understandably unpopular taxes like business rates); what is less well understood is how little of this tax is actually collected for the district/borough itself to use.

Indeed, many districts and boroughs I know are obliged to hand over more than 90 per cent of what they collect to other less local and less accessible authorities, such as the county council, fire service, or Police and Crime Commissioner.

This may seem like a small point but it should not be underestimated how much responsibility people will ascribe to the authority whose headed notepaper they receive their tax demand on.

In many cases, district and borough councils have managed to freeze or reduce their Council Tax charge without this even being noticed by their electorate as it is more than cancelled out by substantial increases from other authorities.

This leaves districts and boroughs as the unloved collectors of money due to others while having no say in its spend.

The situation is, if anything, even wore on Business Rates. This absurd tax is divided between the various tiers of Government, with councils facing tax revenues being “clawed back” by central Government if they succeed in fostering local businesses, boosting economic activity, and ultimately receipts by too much… yet facing the full force of economic headwinds if substantial local businesses get into trouble, relocate, or downsize.

This awkward position, of being consistently in the frame for decisions which are made elsewhere and imposed locally – with districts and borough as the most accessible and identifiable local representation taking the blame is now established in almost every area of council activity.

In key competencies such as planning and development and licensing, councils room for manoeuvre has been strictly limited for some time – with central Government and an army of unaccountable and remote inspectors being able to overrule decisions at the drop of a hat.

Over recent years though this has extended into many new areas by the back door – local councils are responsible for attracting and fostering local businesses, except that all the decisions about key infrastructure to support businesses are made at a regional or national level.

Local councils usually have responsibility for parking, except that county councils have the ability to use the trump card of responsibility for highways to effectively dictate policy – along of course with the Government’s green agenda balancing the scales further against car users.

Councils have responsibility for recycling and numerous environmental matters – but the heavy hand of central Government is starting to fall here too – often with no appreciation for local factors or demographics.

With these and dozens of other wounds being administered to the body of district and borough councils it could be argued that the Government may be considering the right thing in handing everything over to vast unitary authorities – even if they may have been a party to the assassination.

Yet this is to ignore the fact that it is much easier for most people to get to know their local councillor and to raise issues with them. It is to ignore the fact that there are massive differences between Aldershot at one end of Hampshire and the New Forest on the other – and that local identities matter in politics.

Ultimately there is a risk that the Government ignores the wishes of local people to have the power to make more of the political decisions which affect their lives.

One could even argue that it is time for those driving such thinking to get out London and meet some people who are not centralising special advisors…

 

Archie Hill: Strong devolution must mean giving more counties unitary status

6 Aug

Archie Hill is a researcher at Henham Strategy. He also works in the research team at the Centre for Policy Studies.

Just over a year ago, during his very first week as Prime Minister, Boris Johnson made a speech in Manchester, warming to a familiar theme:

“We are going to give greater powers to council leaders and to communities. We are going to give more communities a greater say over changes to transport, housing, public services, and infrastructure that will benefit their areas and drive local growth.”

Familiar, in the sense that every recent government has promised greater devolution of powers at a local level. A new wave of decentralisation is always on the horizon.

But this Prime Minister’s commitment to devolution rings true. Decentralisation may be a common refrain, but it is a long time since it has assumed so central a role in a government’s platform: the ‘levelling up’ agenda upon which the Conservatives fought and won so handsomely is rooted in local devolution. Not for nothing did the Prime Minister describe himself, grappling when pressed for a definable ideology, as “basically a Brexity Hezza.” As well as a flamboyant hairstyle, he shares with Lord Heseltine a belief that reforming local government, and setting out more coherent efficient structures which work properly, can help unleash growth around the country.

It was Heseltine, after all, whose report No Stone Unturned demonstrated the disjointed state of local government in England, with different tiers of councils operating at different levels and overlapping responsibilities; as wasteful as it is confusing. At a local level, this confusion reaches absurdity: just getting a pothole or a sign fixed can involve negotiating county, district, and parish councils, each with their own separate remit. Small wonder, then, that we found that fewer than one in five of those surveyed in our polling thought it was easy to understand who was responsible for what, across local government. This confusion leads very quickly to apathy.

In recent months, as part of a team at Henham Strategy, I have been working on a report, commissioned by the County Councils Network and published this week, setting out where the current system is failing and how powers can be devolved more effectively at a local level.

A more effective – and accountable – means of local decision-making is vital. Fortunately, the government has an opportunity to make lasting changes, in the form of the upcoming, much-trumpeted Devolution White Paper from the Ministry of Housing, Communities and Local Government.

Even before the Covid-19 pandemic, ours was the most centralised state in the western world. As the Centre for Policy Studies found in their report A Rising Tide, locally determined taxes make up just 1.7 per cent of GDP in the UK, compared to 15.9 per cent in Sweden, or 10.9 per cent in Germany. But during the current crisis, the government has felt compelled to take further control of large segments of the economy and manage it from the commanding heights of Whitehall. This ignores the real lesson of Covid, which is that it is at the local level where the most effective response has occurred.

County authorities have made some of largest contributions to the national effort, ranging from shielding the vulnerable and protecting the NHS, putting in place infection control plans for care homes, sourcing hundreds of thousands of pieces of PPE, and helping secure local businesses’ futures. When previous governments talked about local devolution, too often what they had in mind was the creation of new mayoral bodies covering a large urban area, in London, Greater Manchester, or the West Midlands. This focus on metropolitan areas has been to the cost of counties and those who live in them.

Half of our population is located in England’s counties; half of our overall economic output is created there too. They already provide accountable local leadership – in the form of elected councillors – that is readily recognisable by people who live there. Indeed, our commissioned polling found that only nine per cent of those surveyed thought that mayors should have more powers than county council leaders.

A number of county councils have become unitary authorities, and many other councils we spoke to are keen to follow suit. The opportunities of a single, more streamlined body that can speak with a unified voice for the whole county are enormous, both in terms of cost savings and more effective decision-making at scale. Where district councils too often act as a brake on development and strategic planning, unitary authorities provide a more responsive, joined-up form of local leadership across a larger population. Cornwall Council demonstrates this, bringing together representatives from health, business, transport, and local town/parish councils all round one table: the result is that Cornwall has seen the highest annual average increase in new homes in England since it became a unitary authority, all whilst saving £15.5m per year through reduced running costs. It has also been able to distribute grants during Covid faster than anywhere else.

The government must make it easier for more counties to follow this path, setting out a consistent approach to unitarisation for local leaders rather than relying on a ‘deal-by-deal’ basis. To embrace levelling up, they must start by giving local areas the means to pursue this agenda themselves – from housing and planning to infrastructure, from skills and employment to health and social care. Instead of the current patchwork system, a new, more effective form of local governance is necessary to unlock regional growth and drive our economic recovery. If, where previously there have been only promises, the Prime Minister wants action on local devolution, then it is time to make counties count.