Where will power lie?

Ministers and leaders of top-rated councils will be able to use
their new joint venture, the innovations forum, to float ideas that
may help to break the gridlock preventing the effective delivery of
social care. The suggestion that attracted most attention at the
forum’s first meeting this week was put forward by Kent Council,
which proposed that commissioning budgets for the health and social
care needs of older people should be handed in their entirety to
local authorities. Such a move would speed up delayed discharges by
placing ultimate responsibility for the whole process from hospital
to home in the hands of a single commissioner.

In itself the proposal makes excellent sense and echoes the
thinking of the House of Commons health committee chairperson,
David Hinchliffe. But it also runs against the grain of much that
is already happening in adult health and social care. While the
advent of children’s trusts is likely to underline the role of
local government in commissioning and providing children’s
services, its role is far less assured in relation to adult care
where primary care trusts appear to hold the whip hand. In this
light, the Kent plan looks like a pre-emptive strike to halt the
drift of social care towards the health service.

But the truth is more complex. PCTs are still finding their feet in
the swirling waters of a rapidly changing health service. The first
29 hospitals have been lined up for foundation status and the rest
are due to follow in the next five years. But if the prime minister
has his way even more radical reform is likely. The result could
easily be a turf war between foundation hospitals and PCTs
struggling in the new world order. Here, it is in the interests of
social services to make common cause with PCTs to ensure that the
power shift from hospitals to communities continues unabated.

Kent’s proposal shows that the case for a system of adult social
care based in the community, for the community and fully
accountable to the community remains to be made. Councils have an
outstanding record in local accountability and user involvement. It
is one that must be used to advance towards the objectives and the
values that they share with PCTs.