Shifting from acute to primary and community care

Author: Paul Carter, Local Government Chronicle - Jan 10, 2012

Two thirds of councils see local government as unengaged in shaping health reforms while almost three quarters believe the sector has had little or no influence over them. These are the depressing results from a national straw poll conducted by Localis for the Kent Health Commission – a new forum which aims to use Government reforms to transform health and social care in the county of Kent. But apathy can’t be allowed to rule.

Councils have a massive role to play in shaping the future landscape. From a revolution in community health to joint health and social care commissioning, to the provision of commissioning support and the championing of the patient within the healthcare system, we should not sell ourselves short. Nor must we miss the opportunity for a significant shift from acute to primary and community health, keeping local people out of hospital if they can be much better treated in their local community.

To accelerate this work locally, I established the Kent Health Commission. Working with local GPs, local MP Charlie Elphicke (Con) and Dover DC leader Paul Watkins (Con), we set out to investigate how to make the most of the new national health reforms to get the best possible healthcare locally.

We have just presented our interim findings to health secretary Andrew Lansley. Fundamental to this report is the recommendation for a minimum 5% activity shift from acute to primary and community health. Releasing in Kent some £59m a year – or £5m per Kent district – this would enable new community services to be developed, commissioned and provided to patients in a setting more accessible and suitable both for them and for their health needs.

Nor is this pie in the sky. Groundbreaking work with acute trusts in Liverpool presented to the commission demonstrates how intensive and holistic community support can reduce non-elective hospital admissions by up to 88%.

We want Clinical Commissioning Groups to have much greater choice in the provision of community health with new private and voluntary sector providers entering the market.
CCGs should also be free to draw on a range of sources of commissioning support, including the services of local government. Joint commissioning and access to health and social care must become the norm. Pooled CCG and social care budgets must be developed for integrated joint assessment and commissioning and single point access for local people has to be made a reality.

Issues over who pays simply deflect from patient care. So in establishing the Kent Health Commission we realised we had a choice, a choice which is reflected for councils across the country: we remain as we are or we use the new health and social care reforms to deliver further improvements to local healthcare, ensure better use of public money, and provide better patient care.

In particular, we can be clear what good local community health could look like and how we intend to achieve it. There is an important, and increasingly narrow, window of opportunity for local government to decisively influence the nature of the future healthcare system

I encourage all within the sector to make best use of it.

The Kent Health Commission is being supported by Kent CC and Dover DC, with expert advice from Localis, the local government think tank, and MHP Health Mandate, the specialist health policy consultancy.

Paul Carter (Con), leader, Kent CC

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