How we can learn from Shirley – and save untold sums in our health and social care system

Shirley was an elderly person who lived in Barnsley and had significant health and social care needs.  Local services from the council, the acute trust and from community services assessed her needs and did their best to help.

Yet in 2007 Shirley ended up in hospital 12 times with a total stay of over six months.  The cost of this to the taxpayer was well over £200,000 – expensive and ineffective.

Then the light went on.  Why not let Shirley decide the type of help she needed?  Let her have her own budget and commission her own services. Make sure the service providers join together to deliver for her specific needs.  Shirley employed a personal assistant.  The result just a year later was only two hospital admissions, huge financial savings to the NHS (175 bed days) and most importantly Shirley’s own view: “I feel I have control over my life again – I feel as if everyone is working together to help me”.

How many Shirleys are there in our health and social care system?  The potential savings and improvements to people’s lives must be enormous.

Of course most people have started to recognise this but the question is how to release this potential not just in health and social care but across all public services.

There are, of course, those who still want top-down approaches, such as a combined health and social care leviathan run from the central state – a frightening prospect. Very little creativity and innovation has ever come from such methods and the lack of local knowledge on the ground will only lead to missed opportunities and poor citizen satisfaction.

The role of the centre should be to identify weaknesses and needs and to set minimum standards across the public sector – after all few people want a postcode lottery if it means basic services cannot be relied upon.

However, the delivery of those standards, the priorities within them, and the delivery specific to local needs and priorities needs to be a partnership between the centre and the places where real people live in the real world.

The lesson of Shirley’s experience was to devolve control of her services, indeed her life, back to her and it brought huge rewards to both her and the public purse.  A future Labour government would need to understand this value of devolution to places with their own budgets.

But Shirley changed her life in the knowledge that a framework of standards would be there if things did not go to plan. That’s what we in local government must also understand.

Localism cannot be a free-for-all devolution which creates massive discrepancies in quality and which does not recognise needs that vary between areas. We don’t want the survival of the fittest model currently promoted by the Coalition Government.

Localism has to be underpinned by minimum standards and by a financial framework which allows them to be met whatever the local context.

A future Labour government would need to rely on creativity and innovation since ministers won’t be in a position to simply spend money on problems as in the past.  They will need willing and able partners in local communities to deliver new solutions and Labour’s ambitions.

That will have to be a negotiation, a new contract between the centre and localities, and the principal partners have to be local councils.

If Shirley could do it then so can we.

Sir Steve Houghton is the Leader of Barnsley Metropolitan Borough Council and a member of the Local Government Innovation Taskforce which is currently carrying out a Call for Evidence on public service reform.