The report warns that without these reforms, social care in England risks ending up in the same situation as the Netherlands, where cost inflation and austerity measures have led to the scaling back of the Dutch equivalent of personal budgets.

The think tank’s new analysis of council cost data shows that each additional direct payment issued to someone with a learning disability, between 2002-10 adds between £15-25,000 to a council’s overall expenditure on learning disability services. This may reflect the fact that personal budgets are identifying new and previously unmet needs, and it is possible that the new system will save money for other sectors such as the NHS. The finding should nonetheless ring alarm bells in Whitehall about the pace of change.

This means embedding new measures such as “Social Care Related Quality of Life” (SCRQoL) that assess the quality and impact of social care services. If councils are better able to manage the contribution a service makes to a person’s wellbeing, and use that information to create a vibrant, competitive market that delivers best value for money. With a robust outcomes measurement system in place, emerging commissioning tools such as payment by results and social impact bonds could be developed within social care.

To reconcile the shift in relationships that outcome-based commissioning implies, commissioners will need to play a greater role in developing the market and “place shaping”. This will ensure that people with learning disabilities have a real choice between a wide range of services, so that people are able to access wider public services including employment and leisure as well as residential services and day services.

Report author, Daria Kuznetsova said: “We need to make a decisive shift away from managing outputs and instead develop new metrics and commissioning approaches based on outcomes. This will drive a focus on value for money, rather than simply cost, and it will help commissioners identify effective forms of intervention that help people with learning disabilities to live the lives they want to lead.”

Care for people with learning disabilities accounts for more than 23% of the adult social care budget, and represents the fastest growing part of that budget in last five years.

In this report NLGN argues that local government must remain in the driving seat when commissioning care services and facilities for older people, but that the current local funding strains are unsustainable in there present state. With too many frail elderly people being forced to sell and move out of their homes, the report argues that a nationwide ‘combined social insurance’ offer is needed to pay for a higher quality of care for Britain’s ageing population. In particular, a combination of gradual social insurance payments by all should be supplemented by a chance for the baby-boomer generation to buy into a higher-grade of care options through a Government-backed ‘first charge’ on the equity of their properties, only to be recouped after death. In this way, a new higher quality care ‘guarantee’ could commence in 2030 funded by the compulsory social insurance payments, and until then, retirees would have the choice to commit a small portion of the eventual proceeds of their property to an insurance fund to cover their own-home care costs for the remainder of their lives

It is expected over two million extra people will need care by the middle of the 21st century, however state funding for social care is currently growing at a much slower rate than the population explosion among older people demands. Health experts have predicted that the UK is heading for a funding gap of £6bn within two decades unless the system is changed. The Government is expected to publish a new Social Care Green Paper within the next few months.

NLGN’s social insurance scheme would be based on citizens make gradual contributions over the course of their working lives, with regular contributions added to a hypothecated social insurance fund. This scheme may be funded solely on worker contributions or on a national insurance basis with contributions from both workers and employers. Similar scenes already exist in Germany and the Netherlands.

NLGN also calls for a new ‘equity release scheme’ to protect older people from having to sell their homes to pay for care costs. It advocates allowing homeowners the option to pay for immediate care by freeing up a portion of their home value which would only be realised as a ‘first charge’ on their property after their death. The state would cover the immediate costs until such a time that the capital would be available.

NLGN Director Chris Leslie said that the reforms would help more people to grow old with dignity. He said:

“Local and national government need to work together to solve this enormous demographic challenge. We believe that the only option is to move to a nationwide social insurance model, with a transitional phase involving a voluntary ‘first charge’ on home values for those facing care needs before 2030. However, we also believe that a new role for local government should be set out – less reliant on the council taxpayer to fund social care, but more reliant on elected councils to shape how the money is spent and how services are commissioned. A giant national quango for elderly social care would be too unwieldy – we need tailored provision to fit local circumstances and community needs. If councils extend their commissioning powers into the wider health and social care arena over the coming decades, this would be a thoroughly good thing.”

This week’s revelations surrounding the 2007 death of “Baby P” has highlighted concerns over current procedures and whether care systems are ability to adequately examine and take action on child abuse. Notwithstanding the eventual lessons to be learned from this tragic case, the NLGN paper argues more generally that while post-Climbie reforms have made children’s services more effective, integration within single services is not enough. Children and adult services are still too disjointed. The report argues that case workers should have access to information about a child’s entire household to ensure that they are not at risk from any relevant adult.

The report states:

“Existing frameworks are still not flexible enough to embrace a “family” approach and the reality may well be that people can still slip under the radar of preventive services, particularly as some of the families that are most at risk are hard to reach”.

“A culture of brokering, passing cases on to other agencies rather than directly providing support to families, has been identified as contributing to the continuing deficits in responding to families in need”.

The report recommends extending the Common Assessment Framework (CAF) for children at risk to the rest of the family so that a better picture of all influencing factors in a child’s situation can be assessed.

It also calls for more information sharing between services to establish “flags” or “triggers” of a child at risk. For example, admission to A&E services for alcohol abuse should automatically require information on children to be shared with children’s services.

The paper also urges better data sharing between different council offices and other public agencies, finding that schools and GPs often fail to share important information about a child with other agencies in the community. It also suggests that in some areas information between local charities and the local council are not always joined up.

NLGN also urges the Government to press ahead with its ContactPoint software, an ‘information sharing index’ that monitors adults who work with children which had been criticised as unnecessary expenditure in recent political debate.

The paper also identifies gaps in understanding between adult and children’s services, arguing:

“The divide between adult and children’s services often still inhibits the development of a whole family approach and generates challenges for families and for professionals. The barrier between adult and children’s services is caused by a lack of understanding of each other’s roles and differing priorities. Adults’ and children’s services tend to work in specialised ways; each has its own organisational, legislative and practice challenges”.

All NLGN media enquiries to James Hulme – james.hulme@nlgn.org.uk/ 020 7357 0116/ 07970721434.

The paper disagrees with a recent King’s Fund report, Should Primary Care Trusts be made more locally accountable?, which was sceptical of the need to devolve health services further and give local authorities a greater role in their delivery. NLGN argues instead that “there are not only strong democratic and service user reasons for improving PCT accountability, but crucially that local democratic control may also be a better route to swifter service improvement and enhanced management arrangements”.

The paper also comes as West Sussex County Council recently passed a motion to make health services in their area more democratic. There has also been speculation that the Government may give local authorities a more prominent role in local health services in its forthcoming Empowerment White Paper.

NLGN argues that PCTs could benefit from incorporating the expertise of senior local authority managers, particularly with regard to financial management. It points out that whilst local authorities have consistently recorded year on year efficiency savings, PCTs recently posted an overall deficit of £633million. The House of Commons Public Accounts Committee has criticised PCTs for a “lack of financial management expertise in the NHS”. The paper argues that “PCTs sometimes lack commissioning expertise and have few officers with specialist procurement skills” whilst “information, expertise and knowledge within local authorities could help inform commissioning and procurement and improve the outcomes of local health services”.

NLGN also argues that because local authorities already commission services related to health outcomes in the area, such as Children’s services, Adult Social Care and Housing, make a coherent argument for a greater role in the strategic delivery and direction of PCTs. The paper concludes by encouraging the Government to pilot schemes to link together high-performing authorities with their local PCTs.

Chris Leslie, Director, NLGN said:

“Stronger local accountability in health services is not only right in principle, but we believe that the advances in local management accrued by local authorities over the past decade should now be available for English primary care commissioning as well”.

“We suggest piloting joint commissioning and pooled budgets where there is a strong management support case to be made in coterminous 4 star councils / 1 star PCTs”.

“If such pilots were successful, it would be a reasonable assumption that a closer working relationship between local authority and PCT boundaries would improve the prospects for improved performance, value for money and increased resilience from closer integration of services”.

The report, Weighing up the Advantages: A new role for councils in tackling obesity, also argues that all authorities should have an obesity strategy in place that is directly linked to their LAAs and also improve access to local leisure facilities, for example by providing free transport to and from local leisure centres.

Citing research that access to sports facilities increases fitness activity by up to 50%, the report also argues that allowing local people access to sports facilities in independent schools that receive charitable status would help to tackle obesity, particularly in children. By 2020 the British Medical Association predicts that 20% of boys and 33% of girls will be obese.

NLGN also calls for radical changes to the planning system to promote healthy living, including ensuring every new building development must include sports and fitness facilities, such as space for a small gym. Supermarkets should also be made to ensure good public transport links to their out of town stores to ensure that poorer households have access to their goods.

The report looked at a sample of six UK local authorities to assess how well they were tackling obesity at a local level and found an “extreme variation” in the amount of work undertaken. The report however praises the work of Westminster Council in tackling obesity, including policies such as improving access to healthy food in poorer areas and improving access to physical activity opportunities for adults.

Author Michelle Redmond argues:

“Clearly obesity is a major public health issue, demonstrated by rapidly accelerating levels which show no sign of slowing down. Government at the local level is the key to halting and reducing the obesity trend. Local councils have the ability to reach large numbers of the community through well designed LAAs with specific targets aimed at reducing obesity levels”.

The think tank argues that the strength of local authorities’ financial and commissioning performance should be used to make health services more locally focussed and efficient.

Published today, Primary Care Trusts: Tailoring Commissioning finds that many PCTs are hampered by overly-centralised structures and frequent restructuring and that a lack of expect financial management and inefficient commissioning of services has hindered the delivery of community healthcare. It advocates using the financial expertise of local authorities to improve the performance of under-performing PCTs.

In the pamphlet, author Dr Victoria Barbary argues:

“where local authorities perform well and PCTs poorly, there is an opportunity to help PCTs by tapping into councils’ managerial, commissioning and financial skills. Involving local authorities in healthcare procurement would offer the possibility of joined-up commissioning across a range of cross-cutting policy areas. Funds could also be moved between services to tailor them to local needs. PCTs and town halls could thus be freed from much central government control, rehabilitate healthcare finances and tailor services to fit local needs”.

“Where PCTs are failing to meet the needs of the recipients of care, and not delivering personalised services, integrating PCT and local authority commissioning frameworks would empower service users and providers. Local authority procurement structures are more efficient, and since those responsible for them are democratically elected, more responsive and transparent”.

The pamphlet also advocates freeing PCTs from central management control and for national targets to be relaxed, as well as being able to define its relationship with local partners, particularly councils.

Download White Paper

In this new pamphlet, Rt Hon John Reid MP, Secretary of State for Health explains why for more than 50 years an emphasis on uniform national service provision in health – and elsewhere – has sold many people short and not led to greater equity. Localising the National Health Service also considers how an increased sense of local identity is feeding expectations about the local bodies that deliver public services, be they Town Hall, school or hospital.

In outlining specific proposals for increased local ‘ownership’ of health care, the Health Secretary makes his case for establishing a more localised national health service – locally driven, locally responsive and locally accountable.