• Simon Stevens says NHS and local government must focus policymakers’ attentions on social care
  • NHS England chief adds there is no substitute for local government’s role in public health
  • Also warns of “unresourced requirements” in providing services for children with autism

The Treasury cannot be relied upon to quantify the impact of adult social care pressures on the NHS, Simon Stevens has said.

Appearing at the Association of Directors of Adult Social Services Spring Seminar yesterday, the NHS England chief executive referenced a commitment from government last summer that “there will be no additional pressures on social care through to health”.

He added this will need to be “fleshed out” by the NHS and local government together to “hold policymakers’ focus” as funding is set in this year’s spending review.

When later asked whose responsibility it will be to quantify the impact of social care on the NHS, he said: “We need to work together on that. You can’t rely on the Treasury, excellent though they are, to quantify these matters. We need to bring evidence to bear as well.

“So between local government, the NHS, academic partners [and] the third sector, we have got a job of work over the next few months to make sure that evidence is available to the decision makers.”

He also referred to the proposal in the NHS long-term plan to review councils’ commissioning responsibilities for sexual health, health visitors and school nurses.

Mr Stevens said the plan “is a complement to, but cannot be a substitute for the role of local government, particularly on prevention and public health”.

He added: “It is blindingly obvious that we can only do this with local government and the NHS together, whether it be the epidemic of knife crime [or] the increased attention on air pollution.”

Mr Stevens said he “would hope” directors of public health and elected members can work together on reducing health inequalities through the “billions of pounds that flows” to the worst affected parts of the country.

Legislative changes

He was also questioned on the future of health and wellbeing boards, in the context of the legislative changes proposed by NHS England in February which would see the creation of joint boards of providers and commissioners that may include local government in every integrated care system. ICS are due to cover the whole country by 2021.

Mr Stevens responded: “I don’t think it needs affect health and wellbeing boards. We value the work that health and wellbeing boards are doing.

“If someone wants to come forward and say there should be an alternative structure then let’s have that discussion.”

He said the proposals had been developed following a “quite specific” request from the the prime minister to look at what legislative changes would be needed to support the development of ICS.

“Unmet need”

Mr Stevens also highlighted the “unresourced requirements” in children’s services, as he warned levels of autism in young people could undermine the effectiveness of the health and care system.

Mr Stevens said progress on providing alternative provision to institutional care for people with learning disabilities and autism is still not progressing at the scale required following the Winterbourne View abuse scandal in 2011.

The Conservative-Liberal Democrat coalition government at the time pledged to move all patients placed in similar institutions to more appropriate settings by June 2014. Mr Stevens said, while some progress has been made, there remains too much variation across the country.

Mr Stevens said assessments of placements as part of the Transforming Care programme had revealed 78 per cent of young inpatients with the most complex needs had been diagnosed with autism. He added how this group is supported through services such as special educational needs and disabilities support, education and community services is key to making the progress required.

“All of this is as fundamental to a well-functioning health and social care system, as is the conversation we are rightly having on care for older people,” he said.

Mr Stevens added it was important the promised social care green paper is as focused on learning disabilities – and autism particularly – as on support for older people.

When asked to give a guarantee money would “follow the patient” from institutions to alternative, community-based support, Mr Stevens said funding shortfalls in both adult and children’s social care must be addressed.

He said: “We have got significant unmet need there.

“You can identify a small number of people who are currently in expensive inpatient locations but let’s not confuse a stock with a flow. For a stock of those people who have been in those settings inappropriately for a long period, five years or so, absolutely [the money should follow].

“But we have also got to do is deal with the flow. In order to deal with the flow, you actually need broad-based support right down the pyramid of people with autism and [learning difficulties] and for that, frankly, there is unmet need and unresourced requirements inside children’s and adult social care.

“That is part of the argument we have got to make in terms of getting a properly resourced social care service in this country.”

A version of this article first appeared in Local Government Chronicle