Plans announced last week to transfer commissioning powers for learning disability social care services from the NHS to local government could not have arrived at a better time.
The proposal, outlined in the hotly-anticipated paper Valuing People Now: From Progress to Transformation, is supported in principle by most of the sector.
It has been on the lips of politicians and officials ever since institutional abuse was exposed at learning disability services in Cornwall and Sutton & Merton in 2006-7. The paper followed a scathing Healthcare Commission audit, A Life Like No Other, published a day before, which exposed nationwide institutional failures at specialist in-patient healthcare services for people with learning disabilities.
Alongside poor care and a lack of understanding of human rights, the audit of services run by 72 NHS Trusts and 17 independent organisations found there was “a potentially large and hidden issue” where organisations were providing residential care instead of specialist healthcare.
In light of the commission’s findings, the impetus to shift commissioning responsibilities from a medical to a social care model gathered even more momentum.
However, councils, NHS and learning disability organisations warn that issues of inadequate funding, poor quality services, and “cost shunting” will not be easily resolved.
Under the new proposal, all commissioning powers for learning disability social care services will transfer from the NHS to local government in April 2009.
Rob Greig, national co-director of learning disabilities, argues that local authorities are better qualified to commission social care services because they are the lead body for social care commissioning, the social inclusion agenda and wider citizenship issues.
The move will also cut out transaction costs for transferring money from the NHS to councils and stop “unnecessary local tensions” caused by annual renegotiations over money, says Greig. But, as nationally collected data on NHS spend on learning disability services is not as “accurate or robust as it should be”, agreements will have to be made on a local level, he adds.
Councils and NHS organisations will hold responsibility for negotiating and agreeing on a “genuine amount” of funding which, when transferred, will not be ring-fenced. In preparation for a slew of arguments, the government plans to set up a national mediation service to resolve any disputes over money.
But fears from adult social care directors and councillors over “cost shunting” on learning disability services are loud and clear.
Anne Williams, president of the Association of Directors of Adult Social Services, warns that the transfer of commissioning powers will be “futile” unless new funding is found to support councils, which already operate under huge budget pressures, to take on services that are “starved of money”.
“Unless such funding is found, the consequences of transferring insufficient resources will haunt local authorities, and the people for whom they are responsible, for a very long time indeed,” says Williams.
This concern is shared by Anne McDonald, programme director at the Local Government Association, who believes that councils face a major risk if they take over responsibility for people with learning disabilities but have inadequate funding from the NHS to care for them properly.
In the worst case scenario, says McDonald, this could leave people, who access different services in the local authority, “falling out of the bottom”, as money is redirected into learning disability services in order to meet the shortfalls of NHS transferred funds.
James Churchill, chief executive of the Association for Real Change, an umbrella body for providers of learning disability services, questions whether local authorities will cut services because of tightening eligibility criteria and the government’s public services’ efficiency programme, laid out by Sir Peter Gershon to make savings of £21.5bn in 2005-8.
“The twin worlds of Valuing People Now are going to collide with a set of rules that local authorities labour under. It won’t be Valuing People Now it will be Valuing People Never,” says Churchill.
Equally, although the government states that the NHS will hold on to healthcare commissioning, there are widespread concerns that once “large sums of money” for social care are taken out of the NHS it could “lose sight” of its responsibility to meet the health needs of people with learning disabilities.
This is a view shared by David Congdon, Mencap’s head of campaigns and policy, and Alison Giraud-Saunders, joint co-director of the Foundation for People with Learning Disabilities.
Although Giraud-Saunders believes there is “real logic” in bringing together all the money for social care commissioning, she has mixed feelings about the transfer as in the past some PCTs did not pass on learning disability partnership board development funds.
However, Keith Bild, chief executive of the British Institute for Learning Disabilities, argues that commissioning for learning disability services needs “massive support and change” to urgently develop the capacity of local services to support people with learning disabilities, regardless of who takes on the role,
Even though Congdon fully supports the proposal, he argues that the success of Valuing People Now is dependent on a system that is financially robust enough to deliver upon its priorities an issue not addressed in the paper.
With that in mind, Lewis’s mediation service looks set to have its hands full leading up to next April.
HOW SERVICES ARE COMMISSIONED TODAY
According to Department of Health estimates, about £2bn of NHS cash is spent on learning disability services. Roughly 85% of that is allocated to social care services, with the remaining 15% spent on mainstream healthcare and forensic services.
Under the proposals in the Valuing People Now consultation document, only funding and commissioning powers for social care services would transfer over to local authorities.
Currently, 80% of local authorities have agreements in place with primary care trusts, where services are either commissioned jointly or councils take lead responsibility for commissioning social care services through a pooled budget, with the NHS operating as the middle “financial” man.
Some 20% of local authorities do not have local agreements, which leaves all commissioning power, for social care and health services, with the NHS.
This applied to both Cornwall Partnership NHS Trust and Sutton and Merton Primary Care Trust where investigations in 2006 by the Healthcare Commission and Commission for Social Care Inspection exposed major failures in learning disability services.
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This article appeared in the 13 December issue under the headline “Will funding follow new powers?”