Trying to handle responsibilities without resources

I welcome the recent report by the House of Commons health select committee on the impact of the spending review on health and social care – a cross-party report reflecting evidence from experts and practitioners of the health and care system.

Their knowledge and expertise adds significant value to the debate around some key challenges facing health and social care across the country, leading the select committee to warn that the government’s own agenda to reduce health inequalities is at risk because of its own actions.  

Supporting three quarters of a million citizens, Leeds’ health and care system has much to be proud of with world class examples and a history of public health innovation stemming back over a century and a half.

We want boundaries between NHS and council supported care to be blurred, so service users see care as increasingly integrated and seamless

We have great advantages from our digital health sector and academic strength allied with the leading NHS providers and commissioners and widely recognised adult care in the city.

Our health and wellbeing board has also been recognised for the way we work, linking voices from across the NHS, service users, academia and the third sector, as well as the council.

This partnership working has been fundamental in putting together our new health and wellbeing strategy, re-emphasising the importance of improving the health of the poorest fastest, reducing health inequalities and crucially putting people at the centre of everything we do. It highlights that everyone has a role to play in helping to achieve the ambitious vision we have set for the city.

Feeling the financial strain

We know health faces significant funding challenges as demographic pressures combine with medical advances to increase demand further. This is rightly something to celebrate as people live longer and we have more ways to treat ill health. But, as the health committee’s report agrees, the system is straining to cope with these pressures.

The report importantly recognises how cuts to public health funding put at risk the vision set out in the NHS Five Year Forward View, underpinned by a need for a “radical upgrade in prevention and public health”.

The NHS will almost certainly see a knock-on impact of less investment in prevention adding further pressure on the health and care system. Public health is a small proportion of the nation’s health spending and the overwhelming view among witnesses to the committee acknowledged public health cuts will be a false economy – something many experts have been warning for a long time now.

Indeed, when Leeds City Council’s Director of Public Health Dr Ian Cameron gave evidence to Parliament recently, he highlighted pressures on preventive and health protection work as a result of Public Health funding being cut by millions of pounds.

Whilst the NHS has been treated favourably compared to many other departments, the increase in health funding is less than was promised if assessed by the usual definitions

Vital work such is put at risk by lost expertise, lack of personnel, insufficient technical resources and broader support. Comments from the report itself are worth restating, where many who welcomed a move of public health to Local Authorities are now found to be left feeling “they have been handed all of the responsibility without the necessary resources to do the job”.

Promises made originally that NHS funding would not be cut, appear to be undermined when funding for what was NHS work but is now moved to councils has not been maintained with the change in responsibilities.

Committee Chair Dr Sarah Wollaston MP’s comments should also be noted:

“Whilst the NHS has been treated favourably compared to many other departments, the increase in health funding is less than was promised if assessed by the usual definitions.

“Funding cuts to public health will make it more difficult to address the challenge set out by the Prime Minister to reduce health inequality.

“The cuts to public health undermine the radical upgrade to prevention that is needed to keep people healthy, reduce the gap in life expectancy and years lived in poor health for the most disadvantaged, and reduce demand on the health service. Cutting public health is a false economy, creating avoidable additional costs in the future.”

The other major issue from a council perspective is funding for adult social care. Our ageing population needs increased care. The Care Act places additional responsibilities on councils.

Blurring boundaries

In Leeds we proudly signed up to the ethical care charter, and commit to pay care workers properly. But this takes a toll on budgets, even as we find new ways to deliver care more smartly.

Let me be clear, we are not seeking to avoid our responsibilities, but it must be accepted that in order to effectively fulfil these new duties, local authorities require sufficient funding to support the most vulnerable people in our communities.  

Leeds has been recognised as a leading venue for integrated working, gaining Pioneer status in 2013. Our efforts to ensure health and care work closer and better are undermined if funds are drained and we lose opportunities to invest to make long term savings.

We want to make delayed discharges history. We want boundaries between NHS and council supported care to be blurred, so service users see care as increasingly integrated and seamless.

But delivering change at scale and pace requires resources – human, financial, physical – and doing that on an ever shorter shoestring is a challenge.

Our efforts to ensure health and care work closer and better are undermined if funds are drained and we lose opportunities to invest to make long term savings

Consequently I echo the report when it calls for clear and direct discussions on the realities of funding and what this actually means for people who rely on key services:

“We believe it is time for the Government and NHS England to set out how they will manage the shortfall in NHS and social care finances and the decline in services to patients if the measures proposed in the Forward View fail to bridge the funding gap. If the funding is not increased, there needs to be an honest debate about what that will mean for patient care.”

Leeds is not alone in finding cuts to social care funding. Over a number of years we have increasingly exhausted any capacity for significant further efficiencies in this area and our ability to offer services reflects the pressures we continue to face.

In Leeds, we will continue to put our collective shoulders to the wheel and seek to provide the best care and health possible. We will continue to try to create a city where people are able to do more for themselves, improving their own health, being able to live at home longer because the right support is available to them.

In Leeds we retain our determination to treat people with dignity, to enable everyone to play a part in helping Leeds to be the best city for health and wellbeing and a place where people live better, longer and happier lives.

Councillor Rebecca Charlwood is chair of Leeds Health and Wellbeing Board