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Lancashire County Council is being left to foot the bill for care that should be paid for by the NHS, one of the authority’s senior officials has said.
Principal social worker Mark Howe told a recent meeting of County Hall’s scrutiny management board that there was a near-daily battle over where the dividing line should be drawn for some care costs.
It comes after it also emerged savings the authority had intended to generate by securing a greater contribution from the health service towards a joint funding pot for adult social care were proving difficult to achieve.
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The difficulties come against the backdrop of increased demand for care services, county councillors on the board heard.
Mr. Howe said particular problems were caused by the “complexity” of cases and how these were then funded – especially in relation to mental health and so-called “continuing healthcare”. The latter is the system via which the NHS provides for patients who are primarily considered to need ongoing help as a result of a health issue, rather than simply requiring social care.
“We are fighting daily, almost, with our health colleagues over cases where we believe that health should take that responsibility, but social care end[s] up having to shoulder it, which has a really big impact in terms of [the] cost of packages of care,” Mr. Howe explained.
“I think there’s some big challenges…in terms of…cost shunting…and we’re being left with the bill when we shouldn’t be,” he said separately.
His concerns were echoed by the county council’s director of finance and commerce, Noel O’Neill.
“The funding is there in the NHS and in social care. Some of it is for health stuff, some of it’s for social care – [and it is] that split we‘re struggling with.
“We can’t afford to pick up and pay for the health element of that care. But at the moment, that is the way it is working – and we have to get to the bottom of that.
“That is one of the issues [facing the authority, but] it’s not the only issue – we can do things more effectively and that is what we are going to do,” said Mr. O’Neill, who stressed he was not “belittling” the demand pressures also being placed on the NHS.
When Lancashire County Council set its budget last year, it included a plan to save £28m by improving “cost sharing” practices with the NHS.
The measures included increasing the amount the authority claims from the health service for residents’ continuing healthcare needs – and seeking increased NHS investment into a cash pot known as the Better Care Fund (BCF). The fund pools some of the resources of the NHS and local authorities across an area in an attempt to better integrate care at a local level.
At the time, the NHS in Lancashire and South Cumbria warned that there could be “unintended consequences” of County Hall’s savings plan – and highlighted the potential implications of “joint-funded package” schemes.
Speaking to the Local Democracy Reporting Service (LDRS) earlier this month, deputy county council leader Alan Vincent said the proposal had “not worked out as we would have preferred” – but added that talks remained “amicable”.
“We are having ongoing discussions with the NHS about what’s a fair and equitable share of the pot for who does what – but we haven’t achieved the share that we think is due to us,” said County Cllr Vincent, who is also the authority’s cabinet member for resources.
The LDRS approached the NHS Lancashire and South Cumbria Integrated Care Board (ICB) about all of the issues raised by the county council.
In response, the organisation’s chief executive Kevin Lavery said: “We are in discussion with Lancashire County Council about whether the ICB should contribute more to the BCF. It is already a very large fund, in excess of £200m per annum, and the ICB is the largest funder.
“The whole point of the BCF is to focus on keeping people at home, ignoring our organisational boundaries, joining our services up, focusing on prevention rather than sickness and doing the right thing for patients.
“Any extra contribution will need to deliver better value for money.”
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