Select Committee on Health Minutes of Evidence

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.


  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.


  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.


  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.


  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.


  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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Prepared 29 July 2002