As Chancellor George Osborne today signs off a £6bn deal dubbed ‘Devo Manc’ to give Greater Manchester control of its health budget, BASW professional officer Joe Godden assesses the pros and cons.
Councils and health groups in the region will take over £6bn allocated for health and social care from April, with full powers devolved a year later. Where Manchester leads, the rest of the country may well follow, so this decision will ultimately impact on the social work profession.
On the plus side, it could enable a shift from an illness model to a health and well-being model of health and raise the importance of the social perspective. At the moment, social care is very much the poor relation to health, particularly acute health. By pooling social care and health money there would be the potential to change that. We have all been worried about the pressures on Emergency Medicine, social workers know that many people could be treated and supported in their own homes if there was a shift of resources from hospitals to rapid health and social care response in people’s own homes.
Of equal importance is the prevention of health problems and management of long term conditions in the community. More health and social care resources in the community would save the NHS money, which could be re-invested into more and better care.
Despite this potential for positive social work, concerns remain.
Speaking on BBC Radio 4's Today programme, Richard Humphries, assistant director of the King's Fund said “a full transfer of responsibility would be a reform "on a breath taking scale" but could pose serious risks, "Depending on the detail - and the detail is really crucial and we don't have that yet - you could either see this as a triumph for local democracy or creating real risks of yet another reorganisation of the NHS when it's barely recovered from the last one."
At the moment in Greater Manchester there are 10 Local Authority Councils, 12 clinical commissioning groups and 14 NHS partners. It is not clear from the proposals whether the 10 Councils would lose their responsibilities for social care (which makes up a large proportion of overall spend), or whether another tier of bureaucracy would be set up at a Greater Manchester level, which raises questions about democratic accountability.
Another concern is that these measures could be the start of a clever way of Government distancing themselves for responsibility and accountability for health. It would be much more convenient for Government to say that any crisis in the NHS not their responsibility, as they do now by blaming councils for failings in social care.
The proposal cites the model of integration of health and social care in Northern Ireland, which has had integrated commissioning since the 1970s. It is noteworthy that in Northern Ireland social care continues to be the poor relation to health. The power of acute health to dominate the agenda and allocation of resources has not changed significantly there. In Northern Ireland the local authorities do not have responsibility for health or social care, it is the Health Boards that do and Health Boards are not accountable to the local electorate in the same way that councils are.
Social workers in Northern Ireland report many of the same problems that social workers in the rest of the UK find regarding social work with adults but their experiences of integration are worrying (and echo the experiences of social workers working in integrated teams in other parts of the UK.). These include problems ensuring the social perspective is heard, supervision of social workers by non-social workers and the continued dominance of the medical model and expenditure based on the medical model.
All the main political parties are pushing some form of health and social care integration in England and from a service user or patient perspective the vision of integrated services is supported by BASW, but with some huge caveats.