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End of austerity? Not yet for public services
MV’s Andrew Laird argues that we must bring public services closer together to keep future demand under control.
This week, the Chancellor confirmed that the public finances are improving. But with Brexit fast approaching and businesses crying out for government support to deal the impact, public services are unlikely to see the financial floodgates opening any time soon. The budget heralded a few bits of good news, including an extra £650m for social care and an extra £84m over the next four years for children’s social care programmes. However, this budget was always going to be a short-term bridge to get us to next year’s Comprehensive Spending Review (CSR) which will set out the funding detail for public services for the next three years.
Whatever the precise detail of the CSR it is certain that Councils and the NHS will continue to be under extreme pressure to both meet immediate demand and to avoid financial collapse. For councils, who are legally obliged to run a balanced budget, this challenge is particularly severe. Any thought of spending a bit extra now to reduce demand for services in two or three years’ time pales in comparison to the risk of having to file a section 114 notice (and effectively declaring bankruptcy). You can barely read a local government publication without being informed of yet another council on the brink of financial collapse. This short term pressure means that any discretionary spending, which might have the effect of reducing future demand for services, is cut to allow councils to afford immediate need.
Take children’s social care, arguably the most important service delivered locally by councils. Councils have a range of statutory services for children which they have to provide. These are mostly at the expensive end of the scale and kick in when children are in most need. In order to balance the books, it is the upstream services, such as early help (which engages with families before they reach absolute crisis point) are cut. Council leaders know that cutting these services will only increase demand for more expensive statutory services in years to come. They know this doesn’t make sense – but they often have no choice.
In the NHS, the system is dominated by large acute trusts (hospitals), who provide care for patients once they are already ill or injured. These services are expensive – but when the demand is there it must be met. This means when budgets need to be tightened it is the services which might prevent someone needing expensive hospital care, such as public and community health, which are impacted. All of which simply builds up future demand for costly hospital services.
It goes without saying that children on the edge of social care or patients on a path towards hospitalization would much rather receive early help to avoid spiraling deeper into the system.
So what can leaders in councils and the NHS do now to help keep future demand under control and prevent their services from collapsing?
Integrating services will be an important way of allowing scarce resources to be more focused on prevention. Bringing together the services which operate at various points of a patient’s or service user’s pathway removes physical and mental siloes and allows funding to flow more fluidly towards managing future demand.
For example, in the Black Country, GPs surgeries have become part of The Royal Wolverhampton NHS Trust, bringing primary care, community care and acute care under one roof. This gives GPs the opportunity to form closer links with hospital colleagues and become involved in additional clinical work, as well as reducing administrative demands on their time. According to data released earlier this year, the outcomes are promising with emergency admissions from the integrated practices have reduced by nine per cent.
In Cornwall, the council are moving towards an innovative model where children’s public health is being fully integrated with traditional council children’s services such as social care, early help and education. The aim is to create a single service which can identify struggling children and families early (through public health and schools etc.) and focused resources on supporting these families to avoid the full social care system.
Funding the work to achieve integration is often highlighted as a challenge – but there have been (and still are) a range of central government programmes which support local areas to explore integration and the resulting new delivery models. Examples include the Department for Education’s Innovation Programme and Government’s Mutual Support Programme.
This is a really tough time for public services – but it’s not enough to simply focus on getting through another year while knowingly storing up bigger challenges for the future.
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