The Big Idea: how to care for the elderly and vulnerable

This week in politics started with the widely welcomed announcement from Ed Miliband: following on from the sterling work of our Local Government Innovation Taskforce, the next Labour Government will decentralise power and money to local communities. This was promised across a range of prized issues including worklessness, skills, crime, childcare and education. Most significantly he pledged to “Keep elderly and vulnerable people out of hospital with locally managed integration of health and social care programmes, focused on the whole person, not just their individual conditions.”

Why does this matter? Because, currently, health and social care services in each community are spread across a range of organisations – Councils (often more than one), hospitals, GPs, Clinical Commissioning Groups (again often more than one), NHS England, community health services, the voluntary sector and the private sector. This means the system is confusing, lacks accountability, often helps people too late, and is very expensive both for individuals who see their savings disappear to meet the cost of their care and for the state as we struggle to provide for an increasingly elderly population.

In Nottingham we’ve started to stitch our services together. Our Care Delivery Groups put together care staff in each community ensuring joint working across organisations. We’re developing a joint “front door” that should mean common treatment however you come into contact with care services. It also means that we can use constantly improving technologies to intervene sooner delaying a person’s reliance on care services.

This is a good start and shows what can be done. The Government’s Better Care Fund is now encouraging all areas to work this way. However, latest signs are that some of  the money behind it may yet be re-directed into propping up hospitals. The periodic lobbing of cash into the acute sector is a Whitehall addiction and one we must wean ourselves off in Government. Hospital pressures are a symptom of services in the community that are over-loaded or aren’t working – that’s where we need to invest. Ed’s proposal would flip the Better Care Fund on its head. Rather than asking what areas Councils and CCGs could join together it would pool budgets by default. This is what the system needs.

So, how would this be governed? Andy Burnham has previously said Health and Wellbeing Boards could take the lead. Though a mixed picture across the country they are a good forum as they ensure local politicians, Council officers and health commissioners work together and make the fruits of their labour public. In Nottingham we have made integration of health and social care one of our Board’s four priorities and would be eager to take this further.

There’s been plenty of criticism of our supposed failure to find the big ideas to tackle Britain’s problem. Well this is a big idea. It won’t send voters marching to the polls but done right it could revolutionise the way in which all of us are treated in later life. We need to get behind it.

Alex Norris  is a Labour Councillor (@CllrAlexNorris). He is Portfolio Holder for Adults, Commissioning and Health and is the Chair of Nottingham’s Health and Wellbeing Board