The Local Government Association said the chancellor should hand over 0.5 per cent of the NHS funding settlement for 2008-11 to councils.

LGA chairman Sir Simon Milton said: ‘In the next three years alone, there will be more than 400,000 older people, many of whom will require social care. Without additional funding, local government may potentially face a situation, by as early as 2009, where it cannot afford to provide support to 370,000 people with lower levels of need.

“There is a strong and compelling argument for ministers to invest in preventative services, provided by councils, for older people in their homes.This would save the NHS money, and consequently provide better value for money for the taxpayer.”
But NHS Confederation chair Bryan Stoten said “the answer is not to rob Peter to pay Paul”. The NHS, like local government, was facing a potential zero real terms growth from the Comprehensive Spending Review, due to be announced this month.
It was “of course” sensible to invest in prevention, but local services needed to be improved by health and social care commissioners working closely together, he said.

In the 32-page document, Who Pays? Establishing the responsible commissioner, the DH gives advice on potential flash-points – such as paying for looked-after children or continuing care patients who are placed out-of-area, and those receiving jointly funded packages with local authorities.
The guidance states:

• Local authorities should inform PCTs beforehand of their intention to place a child in care in their area, and whether this will be long or short term and in urgent cases, the PCT should be notified within two weeks of the placement or as soon as reasonably practical;

• PCTs who place a patient requiring continuing care in a care home or independent hospital in another PCT area should only do so after notifying that PCT and decisions should be made promptly, particularly when the patient is being discharged from hospital;

• Local authorities placing residents with health needs should work closely with the responsible PCT to ensure the resident’s health needs are fully assessed and can be delivered through an appropriate joint care package and PCTs must ensure no-one is deprived of services as a result of funding disputes.

Other areas covered include care of asylum seekers, prisoners and psychiatric patients.
The DH said itexpected all disputes to be resolved locally, using “pragmatic solutions where responsibility is notimmediately obvious or where itmay be shared”. Strategic health authorities should arbitrate where this was notpossible.
Does the guidance help you clarify potential funding disputes? Email editor@commissioningnews.com to
share your views.

The issue was raised by the third sector capacity-building organisation, Futurebuilders, in a meeting with prisons and probation minister David Hanson.

Futurebuilders chief executive Richard Gutch told Commissioning News after the meeting that his organisation had been forced to turn down prospective investees because there was no immediate prospect of them winning contracts.

These projects had planned to offer mentoring back into jobs, direct employment, housing, drug treatment, or a combination of support that started while offenders were still in prison.

“We think there’s a huge potential and high social impact from projects of this kind. The typical experience of an ex-offender, is that they come out, can’t get a job, they have lost touch with their family, can’t get a house and they re- offend. So it’s trying to find joined-up ways of addressing all those issues. But these organisations are really struggling to get any assurance about the commissioning side of things.”

Frustration was building because it had been three years since the National Offender Management Service (NOMS) had been launched and a commitment was first made to opening Services up to competition.

Mr. Gutch added that the minister supported a plan for Futurebuilders to work closely with the first six probation trusts, due to launch next April, to try and find contract opportunities for third sector organisations. Futurebuilders was also planning to draw up a document on joining.

A Ministry of Justice spokesperson said NOMS was committed to working with the third sector and Futurebuilders. NOMS’ “long-term vision” focused on engagement through commissioning, joint commissioning and partnership arrangements. Implementation of the Offender Management Act [which became law in July] “will inevitably take time as we need to prepare the system”.

NOMS was not going to be abolished, as suggested by some media, the spokesperson added, but its structure might be changed.

The Health care Commission is set to reveal findings of a national audit in November. The exercise was sparked by the Cornwall scandal, in which people with learning disabilities were found to have suffered years of institutional
abuse.

The HCC declined to comment on the findings in advance, but it is understood the commission  has quizzed NHS trusts, staff and service users on whether commissioners have visited the service  in the past year, and what kind of practice and policy is in place on adult protection, advocacy,  restraint, medication, patient activities and staff competence.

Health ministers are currently considering  whether to transfer funding for learning disability services from health to social services, a  Department of Health spokesperson confirmed.  “However, it is important that appropriate  consideration is given to any decisions on roles and responsibilities, and the department will advise of the process for this in due course.

”  Consultation on a revamp of the Valuing People strategy will be launched in the autumn, the DH spokesperson added.

Mencap’s head of campaigns and policy, David Congdon, said his charity backed the proposed transfer to councils. “The critical thing, if that occurs, is making sure the right sum of money is transferred from the NHS.”

He said councils were becoming less reliant on residential institutions for these service users.  But he believed their biggest weakness was failing to plan ahead for the transition of young  people into adult services.

The Commission for Social Care Inspection’s learning disabilities lead, John Fraser, said “significant” improvements were needed to commissioning of learning disability services.

There appeared to be a lack of ambition for the lives of people with high support needs and too many out-of-area, high-cost placements that were not scrutinised by the placing council, he said. Many commissioners were also failing to work in partnership with private sector providers  “on purist grounds”.

“You can throw money at a poor service and  ‘warehouse’ someone for years, but if you put a  bit more money and thought into a good intervention, you’ve got a good chance of  lowering your costs over the longer term and significantly improving people’s lives.  “The principle of starting with individuals and building a response around them has to be the driving force in commissioning,” added Mr. Fraser. Turn to page 8-9 to find out how commissioners in Cornwall are rebuilding services.