Select Committee on Health Written Evidence

Evidence submitted by the County Councils Network (Def 37)


  1.1  The County Councils Network (CCN) is a Special Interest Group within the Local Government Association (LGA), with all 37 English Shire Counties in membership. The County Councils Network promotes the voice of counties within the LGA and the values and interests of the English Counties. Together these authorities represent 48% of the population of England and provide services across 87% of its land area.

  1.2  The CCN acknowledges that the Local Government Association (LGA) and the Association of Directors of Social Services (ADSS) are also making a joint submission to this Inquiry. The CCN supports the comments made by the LGA and the ADSS, and in particular the concerns raised by these organisations regarding the impact of NHS deficits on the provision of social care services.

  1.3  This submission seeks to reflect the particular issues arising for county councils and the CCN's concern that problems currently being faced in several county areas are likely to become more widespread unless the impact of NHS deficits on social care is understood and addressed.


  2.1  The CCN made a response to the Government's White Paper, Our Health, Our Care, Our Say, in which we expressed support for the broad principles outlined in the paper, in particular the acknowledgement of the leadership role played by local authorities and the proposals for a more holistic, whole-systems approach to service delivery.

  2.2  However, we also outlined our concerns about funding the proposals in light of existing funding pressures, particularly the £1.77 billion funding gap identified by the ADSS and the LGA, and the context of wider demographic changes which will see people living longer, and both older people and those young people with severe physical and learning disabilities, needing care and support for longer.

  2.3  County councils have a particularly strong record of engaging in partnership with health authorities. Research undertaken by the LGA and the ADSS, which has been analysed for county specific implications, shows that 75% of counties have entered into pooled budget arrangements with PCTs (Section 31), compared with the national average of 21%, with counties contributing almost double the national average (£10.5 million). Furthermore, it is apparent that counties face particular pressures on their services when compared with other local authorities. The same research reflects that counties face significant demand and volume pressures, with care placements for older people at 57% (exceeding the national average of 38%) and care placements for people with physical disabilities at 68% (exceeding the national average of 44%). It is therefore apparent that NHS funding issues will have a particular impact on county councils.

  2.4  Our response to the White Paper, developed further to comments received from county members, also outlined our concerns about the impact of NHS deficits on the delivery of social care services. We have now canvassed our member authorities to develop a more detailed perspective of the impact of these deficits on local services.


  3.1  Some counties have indicated that they have identified potential funding difficulties arising from NHS deficits but that these have not yet been realised. These counties continue to maintain service provision and partnership arrangements but anticipate problems in the future. As a result we have received reports of a "more robust approach to partnership working", and the preparation of contingency budgets to cover future withdrawals.

  3.2  Several counties are experiencing substantial amounts in outstanding payments from health partners, which, in some areas, are being redressed by the slowing down of existing agreements. This in turn has a negative impact on front-line services.

  3.3  It is therefore apparent that whilst NHS deficits might not result directly in funding withdrawals all areas, there is still an impact on counties, their services and existing partnerships.

  3.4  Other county councils are experiencing the direct effects of NHS funding withdrawals. The examples we have received show withdrawals ranging from £20,000 to £1.8 million. These withdrawals are already having an impact on the provision of social care services. In Wiltshire, the county council has committed to focussing on providing or funding services to those whose needs are substantial or critical. In Hampshire, care will only be given to those with critical care needs. Counties have already identified that these changes will have an impact on the provision of domiciliary care, day services, transport, meals services and residential and nursing home placements. However, the scale of the withdrawals means that there are also likely to be significant budgetary implications for services on a county-wide basis.

  3.5  Whilst withdrawals and cost-shunting are currently being experienced by a relatively small number of county councils it seems likely that this number is going to rise. In Somerset, health partners have notified the county of their intention to pay an inflationary uplift of just 2% for 2006-07 on joint funded and pooled budgets (which amounted to £15.7 million 2005-6). There is also likely to be a health review of funding within Learning Disability Services in the county, which could result in excess of £1.5 million being withdrawn. In some areas, health partners are not communicating details of financial pressures to their partners and several counties report increased distrust and further breakdowns in communications between partners.

  3.6  The CCN is concerned that the withdrawals of NHS funds, and the resulting funding pressures and deterioration of relationships will have a significant impact on service users, their families and carers. Counties are already making changes as a result of funding pressures; cutting day care services, residential placements and intermediate care and increasing charges.

  3.7  Furthermore, we are concerned about the impact of these pressures on existing strategic partnership working, such as that undertaken via Local Area Agreements and Local Strategic Partnerships. Some counties have indicated that they are undertaking considerations of processes of "due diligence" before signing an agreement in order to make partnership arrangements more robust. Such a process is likely to impact upon both the scope and the timescales for LAAs, and in turn impact upon the work of other local partners.


  4.1  The CCN would urge the Government to consider the long-term implications of NHS deficits on the provision of social services. Whilst counties and their partners continue to work together to ensure the provision of services for local people, it is becoming apparent that NHS deficits are having an impact on both local partnerships and services.

  4.2  We are concerned that immediate changes are being made without consideration of the longer term implications.

  4.3  The issues raised in this paper affect all public bodies as well as the voluntary sector. The CCN feels strongly that all public service agencies must be able to work together to plan effectively for the medium and long term without the turbulence which such changes cause.

  4.4  The CCN feels that NHS deficits are already compromising partnership arrangements and that there is potential for the withdrawals currently being experienced in some county areas to become more widespread. We are concerned that this issue is adding to existing funding pressures on social care services and feel strongly that local services should not be compromised as a result.

  The CCN would be willing to give further evidence to the Health Committee in respect to this inquiry.

County Councils Network

7 June 2006

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