Adult care directors see benefits in health reforms, but warn of major risks

The government’s healthcare shake-up offers “significant opportunities” for people to be more involved in the health and social care they receive but reforms on such a scale inevitably create significant risks, the Association of Directors of Adult Social Services has said.

In its submission to the government’s consultation, ADASS also warned of the financial and resource implications of the reforms for local authorities.

The association nevertheless said it strongly supported a number of the government’s proposals. These include the focus on an agreed set of outcomes across the whole of the health and social care system, the role given to local councils for health improvement and public health at a community level, and the establishment of statutory health and wellbeing boards (HWBs) to strengthen the local democratic legitimacy of the NHS.

It also backed the prospect of local authorities commissioning – on behalf of GP consortia – a range of services where councils have considerable investment and expertise. The ADASS submission highlighted mental health, learning disability, enablement, long term conditions, continuing health care, carers, drugs and alcohol services as examples.

However, the association – which represents directors of adult social services in local authorities in England – warned that there was a range of issues that would need careful consideration.

ADASS suggested that managing the transition from the existing system to the new one “has major risks associated with a loss of organisational capacity at a time when local government will be subject to significant resource reduction and the NHS has to make productivity gains in the order of £20bn”.

The submission argued that that there was a major need to involve existing and new bodies, local authorities, citizens, local communities and providers in co-designing the changes at national, regional and local levels “to achieve a different system that delivers different outcomes across health and social care rather than reinventing the system we have worked in to date”.

Other issues include:

• The risk of greater fragmentation between health and social care “if the aspiration for integrated commissioning is not mainstreamed, and the potential loss of co-terminosity between existing health and local government boundaries”
• The need for links between HWBs, GP Consortia and the NHS Commissioning Board “to be defined clearly in the development of transition plans and the creation of the new architecture, as well as clarity about management of the whole system and where responsibility lies”
• The role, resources and statutory powers allocated to HealthWatch to “ensure that it can effectively represent the aggregated views of users and patients and hold both HWBs and GP consortia to account”.

ADASS also flagged up the financial and resource implications for councils as a result of the White Paper’s proposals.

Among its key concerns on this front are: the level and nature of public health budgets transferred and staffing transfer arrangements; the costs of health and well-being boards and local HealthWatch; arrangements for joint commissioning and pooled budgets; and the NHS, flexibilities and place-based budgeting.