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
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. KEY ISSUES
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
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