As we mentioned in a recent blog, the NHS is working on Sustainability and Transformation Plans. These have ambitious aims of improving everyone’s health, improving the quality of services and stopping the cost of healthcare from going up. So local health leaders (and some local government leaders) have been getting together to make a plan. Our local area is North Central London, and covers Barnet Enfield Haringey and Islington as well as Camden. The Camden part of the plan is the Local Care Strategy.
One of the curious aspects of the plans is that local leaders are required to involve their local populations in planning but were not allowed to share the plans with the local population until NHS England had approved them. So planning has been going on for months, with no real input from local citizens. Camden has a long tradition of involving people in planning services, and recently the council leader, Sarah Hayward, took the decision to publish the Sustainability and Transformation Plan or STP.
So we now have two hastily arranged public meetings run by the council asking people about the plan, and a board meeting in public held by the CCG where people can talk about the plan, and still no clear strategy to involve local people in actually shaping what the overall plan contains. This is not the way that an inclusive, accountable NHS should work. The five local Healthwatch in the North Central London (NCL) area have agreed a statement of principle urging STP leaders to ensure meaningful consultation and engagement.
It is good that Camden CCG has involved people in discussing the Local Care Strategy. It’s good that the council has published a summary of the STP, and is asking local people to give a view. But it is worrying that the different local partners in health and wellbeing are not working jointly on such an important area of work. It is hard to know where and how to have a say, and whether your voice will be listened to. For engagement to be meaningful, it has to be a core part of the decision making process. There needs to be a clear mechanism for ensuring that views and ideas captured from engagement activity are raised and responded to at the top level. Otherwise, it is a token exercise to placate people, not a genuine attempt to involve them in planning.
There is some cause for optimism. The STP is divided into a number of service areas, each with its own programme of work. These include work on mental health and work on urgent and emergency care. There are some clear plans for involving people in these two areas. The local Healthwatch organisations are supporting the programmes to set up mechanisms for engaging people, and we will hold them to account for how they engage people. Each local Healthwatch is taking responsibility for working on a particular aspect. In Healthwatch Camden we are working on the Urgent and Emergency Care Programme of the STP. Our colleagues in Voluntary Action Camden are organising a meeting where local VCS groups can find out more about the STP.
We want to see a holistic approach, spanning health and social care, bringing a way that people can contribute to plans on whatever area of the STP interests them. We want an approach that lets people know how their views are making a difference. We want plans that local people can trust – because local people have shaped them.
Social care under stress
Recent news media has carried an increasing number of stories about the crisis in funding for adult social care. One of the sources for the stories is the “Home Truths” report from the Kings Fund and Nuffield Foundation. It highlights:
• a growing funding gap for adult social care within the existing system which will reach at least £2.8 billion by 2019/20.
• some parts of the country rising numbers of older people who have difficulty with the basic activities of daily living – such as washing, dressing and getting out of bed – had been left without any support at all.
• NHS has to pick up the costs of reductions in community support and care or people are
stuck in hospital beds at great expense and problems are allowed to escalate to crisis point rather than prevented by good community support.
There have also been drops in the numbers of GPs and district nurses, which affect the provision of care for people at home.
The situation in Camden is less acute than in some other places. There is a good record of health and social care working together to provide appropriate services. However, the strains are starting to show, here as elsewhere. Camden Council has decided to raise Council Tax to help pay for social care, but the amount raised will not be enough to fill the funding gap.
The response to the crisis in Camden is based on:
- support people to maximise their independence through building resilience of
individuals, families and our communities
• Focus on keeping people healthy through preventing, delaying and reducing
need for support
• provide high quality, affordable personalised care and support to those people
who are most vulnerable
• ensure our local services are fully integrated around the individual;
• make the best use of available digital and other technology;
• ensure a fair and consistent approach to contributions;
• ensure all decisions are made to deliver optimal value for money.
In early 2017, the council will be engaging people about what this means in practice.
At a recent public meeting, people voiced a concern that it means cuts are on the way. It certainly means that some changes are on the way. Healthwatch Camden would like to know your experience, if you are someone who uses social care or a carer for someone who does. Do you get help from the council? Have your services been reduced? How does this affect your life? Or do you pay for your own support? How easy is this to do?
We would also like to hear from community organisations that support people who need social care. Do you provide befriending, or social activity, or practical help such as hot meals or home repair services? Have you had to reduce what you do? Or is it expanding? We know there are lots of helpful local groups in Camden, many with no statutory funding. We are very interested in what is happening in neighbourhoods. Over the next couple of months we will be talking in particular to groups in the West of the borough (West Hampstead and Kilburn). We would love to hear more about what you do. Contact Victoria Armitage (Victoria.email@example.com).