Memorandum by the Local Government Association
(DD 34)
1. The Association welcomes the opportunity
to submit its views to this inquiry. The Association's member
authorities perform a significant role in promoting the health,
well-being and independence of all those in our communities. They
undertake this role, not only as providers and arrangers of social
care and housing services, but also as the arrangers of other
key local public services, such as recreation, leisure and community
safety services.
2. The LGA believes that it is important
to recognise the vital role that Local Authorities have in promoting
the independence of older people in their communities, through
a wide range of planning, commissioning and providing processes,
and that therefore a secure and sound basis for Local Authority
finances, in all its functions, is a necessary element of preventing
delayed discharge. The LGA recognises, however, that although
sufficient funding for Local Authorities is a necessary requirement,
this in itself will not resolve all the current difficulties.
3. The Association believes that delayed
discharges or delayed transfers of care can most effectively,
efficiently and economically be reduced by the adoption of a whole
systems, partnership approach to the management and arrangement
of health and local government services that is designed to promote
the independence of older people. This approach will have the
most impact on preventing unnecessary hospital admissions and
stays, but will also be beneficial in reducing delayed discharges.
The Association believes that this approach is necessary because
it believes that delayed discharges are a symptom of the current
difficulties facing the health and social care services, and not
a problem that can be solved in isolation.
4. The LGA and its member authorities are
committed to the development of high quality, effective and integrated
social and health care services for older people, in order to
avoid the distress which can result from stays in hospital. The
Association has consistently encouraged authorities to give full
consideration to the contribution that the entire range of local
government services can make to promoting and sustaining the health,
well being and independence of older people, and reduce delayed
discharges and winter pressures on the NHS social care services
accordingly.
5. The Department of Health's (DH) report
on Health and Social Care planning for and response to winter
pressures in 2000-2001 was published in March 2001. That report
indicated progress made on delivering integrated packages of health
and social care to support older people at home and prevent the
need for unnecessary hospital admissions. The report followed
the investment of significant partnership activity by local authorities
and the health service in managing a seasonal peak in demand for
intensive packages of health and social care for older people—with
the aim of reducing unnecessary hospital admissions and facilitating
timely and appropriate hospital discharge.
6. However, effective joint working between
the NHS and local government and exhortations to this end cannot
by themselves resolve the problem of delayed discharges. Fundamentally,
measures to reduce hospital admissions and facilitate timely discharge
from hospital will only be viable if local authority provided
and arranged services, and in particular the personal social services,
are adequately and robustly resourced. At present, however, they
are not.
7. Delayed discharges inevitably add to
the distress that many older people experience as a result of
hospital stays and the Association fully supports the government's
initiatives aimed at their reduction. The LGA believes, however,
that some perspective on this issue is required. Whilst the human
and public sector costs of delayed discharges are rightly the
focus of continuing scrutiny, it is important to acknowledge that
delayed discharges are not a new or recent problem and that neither,
certainly in recent years, is there evidence of a significant
increase in their number; indeed the Department of Health's own
figures indicate a reduction in the number of delayed discharges
over recent years.
A WHOLE SYSTEMS
APPROACH TO
PREVENTATIVE HEALTH
AND SOCIAL
CARE FOR
OLDER PEOPLE
8. Allied to the need to resolve the resource
deficiencies that currently frustrate Local Authorities is the
requirement for a holistic approach, at both central and local
government level, to the design and delivery of preventative services
for older people. Without such a holistic approach, funding will
not be used to best effect. In short, the prevention of admission
to hospital, facilitated by the effective co-ordination of all
aspects of public policy and public service provision which can
improve the health and well being of older people, is likely to
yield the highest returns in terms of reducing the pressures on
acute NHS services.
9. The LGA has therefore endorsed the best
practice in local government and urged all its members to consider,
at a corporate level, the contribution the whole authority,
across the entire range of its activities, can make to the promotion
of independence for older people. The LGA has therefore highlighted
the importance of partnership arrangements with the local health
community, primarily through the Local Capacity Planning Groups
(LCPG's) and the need for these groups to seek to embrace more
fully the wider range of local authority services that can underpin
preventative health and social care for older people.
10. Accordingly, it is clear that local
housing authorities and housing associations have an important
role to play in helping to prevent inappropriate hospital admissions
(especially in relation to the use of sheltered, very sheltered
and other supported housing schemes). It is equally clear that
other housing staff have a key role, along with environmental
health colleagues and Home Improvement Agencies, in assisting
with appropriate and timely discharge from hospital (especially
in relation to organising minor works and adaptations which help
people remain in their own homes).
11. The NHS, social services and housing
are already working together on the development of standards and
targets for long term care services through Better Care Higher
Standards local charters. The engagement of local authority and
housing association housing services in the development and provision
of local preventative social and health care strategies for older
people also provides a strong base for the implementation of the
forthcoming Supporting People strategy. The LGA has urged authorities
to ensure that their Supporting People Core Strategy Development
Groups and emerging Supporting People Commissioning Strategies
have effective links to LCPGs. To this end, the LGA has recommended
that the Department of Health advise that LCPG's must include
a nominated lead housing officer.
12. In addition, local authority advice
services have a key role in ensuring eligible service users are
in receipt of full benefit entitlements and in assisting those
who may be entitled to claim. Assistance with benefits can be
essential in speeding discharge and instrumental in preventing
admission. Monies, by way of disability benefits and carers benefits
have an important role in supporting so called "informal"
care arrangements but often remain unclaimed by more vulnerable
and frail older people. Grants from the Social Fund (for example,
for heaters, bedding and appropriate furniture) are often an important
element in re-establishing older people in their homes. Special
arrangements with the BA for fast tracking these benefits to support
community care arrangements may also have a significant impact
on NHS pressures. The LGA has therefore encouraged LA (and voluntary
sector partner) benefits advice services co-ordination with Capacity
Planning initiatives.
13. There is a significant amount of evidence
demonstrating the correlation between the income levels of older
people and their health, well-being and capacity to remain independent.
Promoting the take up of relevant social security benefits by
pensioners must, therefore, be central to strategies designed
to promote their independence-particularly given the well documented
level of under-claiming by this group. In 1998 the LGA issued
"It's a Right not a Lottery", a good practice
guide to benefit take up for older people. A recent survey by
the LGA has shown that 31 per cent of local authorities rated
it as very useful and 58 per cent as fairly useful. Many local
authorities have developed effective benefit take-up strategies
for older people as a result of using this guide.
14. The very real improvements which have
taken place to the government's Home Energy Efficiency Scheme/Warm
Front Scheme can also make a significant difference in helping
vulnerable people to keep warm in the winter. Chronic fuel poverty
has been demonstrated by research to be directly linked to respiratory
and cardiac problems—both major causes of additional hospital
admissions in the winter months. Improvements in home insulation
and heating will make a significant difference to ill health among
people on low incomes and the LGA has encouraged local authorities
to take active steps to improve take up of these new schemes (which
are also open to people who may have had help under the old HEES
scheme) as part of strategies designed to promote independence
for older people .
15. Successful community safety strategies
that give older people the confidence to leave their homes and
leisure services that provide sessions for older people provide
important mechanisms for prevention—both through maintenance
of fitness and through enabling older people to meet and socialise.
RESOURCES FOR
SOCIAL CARE
16. The very real pressures on funding for
personal social services (and hence the ability of local authorities
to contribute as effectively as they might to appropriate packages
of social and health care for older people) have been clearly
identified by both the LGA and our partner organisations, notably
the ADSS.
17. It can be argued that Local Authorities,
and their partners in Health have received additional funding
to reduce delayed discharge, and that this is fully sufficient
for this purpose. The Association believes that this is not the
case. To support people in the community requires significant
medium and long term funding. The funding shortage that faces
personal social services is not caused by the need to support
people for the few weeks after they leave hospital, but by the
need to fund the preventative services that prevent people from
needing hospital in the first place, or in providing them with
services that allow them to have maximum independence and dignity
in the years after they leave hospital.
18. In evidence of the above, the ADSS/LGA
budget survey of July 2001 confirmed that "winter pressures"
remain a pressure largely because in many cases the provision
made when an individual is discharged from hospital creates a
medium term commitment. Expenditure of some £172 million
is being incurred in the current financial year as a result of
commitments entered into last winter. Of that total, £100
million is met one off this year from additional Promoting Independence
Grant, about £45 million is budgeted for and some £30
million is within the projected £200 million overspend for
social services in the current financial year.
19. The LGA/ADSS budget survey indicated
two main reasons why local authorities cannot respond to hospital
discharges—lack of funding and, in some cases, lack of residential
provision at affordable prices. The short term funding arrangements
(as noted above the £100 million supporting a significant
proportion of the ongoing expenditure commitments is non recurrent
and falls out in 2002-03) exacerbate these problems, in a market
which is generally under funded, where capacity has reduced and
where local authorities are not monopoly purchasers. Securing
extra capacity now means revisiting prices and once they have
been raised, the clock cannot be turned back.
20. The Association welcomed the Government's
acknowledgement of these pressures, as expressed through the announcement
of a Special Grant for community care services to prevent delayed
discharges, in October 2001, of £300 million over two years.
The cash injection that this grant will provide over the next
two years will clearly help to maintain and provide some extra
capacity in parts of the social care system. The Association welcomed
the publication of the Agreement "Building Capacity and Partnership
in Care", which under-pinned this funding and reflects best
practice in local authorities in terms of the joint working and
commissioning of services between the statutory and independent
social care, health care and housing sectors that is required
to help reduce delayed discharges.
21. Welcome though this additional funding
is, it is only short term funding and still falls far short of
what has been sought by the LGA. Whilst it will provide a degree
of respite for many councils, a major funding gap still remains
and whole systems commissioning will only work when there is sufficient
government funding to meet the needs of the users of social care.
Even with the investment and the resulting improvements envisaged
by the Secretary of State, a firm commitment to ongoing additional
funding across the SR2002 review period will be needed to maintain
both an adequate commissioning role and the continuing care provision
needed to avoid bed blocking.
THE NEED
FOR INVESTMENT
IN PREVENTATIVE
SERVICES
22. The financial pressures described above
have, we believe, inevitably resulted in an under-investment by
Local Authorities and the NHS in those preventative services
that can reduce or defer the need for acute or hospital care.
In this respect, the Association is particularly concerned about
the extent to which priorities for the NHS have focussed on the
capacity of the acute or hospital sector and appear to have eschewed
adequate investment in the type of community health service provision
that is essential to both preventative health and social care
and facilitating timely discharge from acute care. The Association
believes, however, that the development of Primary Care Trusts
offers an opportunity to redress the current imbalance between
the allocation of NHS resources between acute and community services.
WORKFORCE ISSUES
23. The Association believes that the very
great difficulty its member Authorities face in securing sufficient
staffing (whether directly with its own staff or indirectly with
staff in independent sector providers) to provide personal care
is well documented elsewhere. The Association is concerned at
the effect of this staff shortage on, not only delayed discharge,
but the ability of its member Authorities to deliver the support
to older people that they need in order to prevent admissions
to acute hospital care in the first instance.
24. The combined effect of the minimum wage
and a healthy economy mean that our members are increasingly competing
with other employers, at a time when their ability to pay the
wages necessary to recruit and retain people in the profession
is increasingly constrained.
25. The LGA therefore believes that the
underlying reasons for the growing shortage of personal social
services staff—particularly home care staff and occupational
therapists-must be addressed if its member authorities are to
be able to deliver the services older people need so that they
can lead independent lives.
CONCLUSION
26. The Association and its member authorities
are committed to the effective, integrated delivery of public
services which can both facilitate timely discharge from hospital
and prevent unnecessary hospital admission in the first instance
and which, fundamentally, allow older people to lead independent
lives. However, these objectives can only be achieved if all relevant
public services are made aware of the value and potential of preventative
services in meeting this goal, they are clear about the role they
have to play in whole systems approach to promoting independent
living for older people and the appropriate resources are identified
and committed to local public services for this task.
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