Posted on: 14 June 2019
Hello my name is Merran,
As a Council Chief Executive I am very proud of the vast amount of work our very committed workforce delivers for the communities, neighbourhoods, towns and cities we serve. It is not always easy, however, to convey just how extensive this work is, and how much we impact upon our residents, businesses and visitors. So, with this in mind, I was pleased to be invited to write this week’s Partnership’s leadership message in the hope that I could explain a little more about the role of councils, how we work and what we do. I will also touch on the importance to us of local partnerships and try to explain some of the financial pressures we are under.
So what do councils actually do? There isn’t even an easy starting point for this! On a basic level we are created by an Act of Parliament and everything we do is a duty, responsibility or discretion under yet more and more Acts of Parliament. It is estimated that Local Authorities have over 200 statutory responsibilities, including maintaining roads; taking care of children at risk; maintaining street lights; supporting adults with learning disabilities; collecting waste; ensuring services for children with special educational needs; processing planning applications; providing a library service; maintaining parks; supporting vulnerable and elderly adults; and so much more.
Some of the things we do are large-scale strategic. We all have to have a long term Local Development Plan, which sets out which land will be considered for housing development, business needs or other functions. We have responsibility for public health and the long-term improvement of population health. We plan for new schools, roads and other infrastructure as towns and communities expand. In Wakefield, we are taking a 20 year view on tackling poverty.
Others are more personal. We help many residents into employment through intensive support, including difficult to reach young people, residents with learning disabilities and those with mental health or other health problems. Our alcohol and drugs rehabilitation services bring a decent quality of life back for many. Our housing benefits teams assess thousands of applications for financial help with housing costs. We have schemes to help people threatened with homelessness. We encourage people to get active in our leisure centres and parks. We marry people in our Town Halls, and register their family births and deaths.
For 24 hours a day, 365 days of the week we have on call emergency duty teams for adult and children’s social care, emergency planning, highways and events management.
In fact, there isn’t much we won’t get involved in and that’s because, in reality, we are far more than a sum of our statutory duties; we are the key shapers of our place. We have no statutory duty to support business but we do because our residents need jobs and skills. Many of our residents are entrepreneurs and want help starting new business, so in Wakefield our support also includes a peer network for start-ups.
We can do the minimum to keep parks clean or we can do what we have done at Wakefield’s Pugneys Park; build a ‘Room on the Broom’ trail to get children walking; provide running buggies for parents who want to exercise while out with their baby; organise a Nordic Walking Group; support water sport; get children studying nature. Our libraries don’t just lend books; we have a cookery book club to encourage families to explore home cooking and our Wakefield Unhampered Reading Scheme, in which librarians put together hampers of books to stimulate reading and creative thinking. I could write hundreds of blogs and still not cover it all. (Don’t panic, I won’t!).
We want money coming into the District, again creating jobs, so we also encourage tourism, running festivals and supporting arts and leisure organisations. Sadly, you have missed our annual Rhubarb Festival and Roman Festival this year, but put them in your diaries for next and meanwhile come along to our Liquorice Festival in July. We have amazing countryside for ramblers and, of course, both the Yorkshire Sculpture Park and the Hepworth Gallery, both previous winners of Arts Museum of the Year. We also have our own nationally recognised museums and we run two castles!
Councils are run by elected politicians (known variously as councillors or elected members); in Wakefield we have 63. Some decisions can only be made by Full Council; that’s by a majority of all 63 meeting together, which happens every month. Most decisions are delegated to an Executive Group, called Cabinet, made up of the majority political party, which for us is Labour. (In Councils with no clear majority, Cabinet may be cross-party). Each Cabinet Member takes responsibility for a particular portfolio of services; we have Adults, Health and Wellbeing, for example, as well as Children’s Services; Economy and Regeneration; Highways; Culture and Leisure; Communities; and Corporate Services. Some day-to-day decisions are delegated to these lead Members, others to officers (yes, we have some power!).
We also have formal Committees of Council which can make decisions; Planning; Licensing; Audit and Governance, Corporate Parenting, Health and Wellbeing Board. Then there is the Scrutiny function. Scrutiny Panels cannot make decisions for the Council, but are made up of councillors who are not on Cabinet and have a duty to help develop policy and to hold the Executive to account. This means they can question and investigate decisions that have been made, and ask for them to be re-considered, although they can’t overturn them. They also have the power to scrutinise some other parts of the public sector including, as many of you will know, health partners.
In Wakefield, our total annual spend is £666 million. Some of this is paid out, for example in housing benefits, and then paid back to us as part of the nationally distributed money from Government. Our net spend is £244 million. We are not allowed to overspend, so if it looks as if we are going to, we have to cut back services in the last few months of the year or stop some programmes (generally we manage not to overspend though). We are allowed to carry money forward, so we all hold reserves for projects that might cross years or to ‘smooth out’ expenditure against savings profiles.
We have three main sources of income: Council Tax, fees and charges, and business rates. Council Tax you will hopefully know about (and pay on time!) and fees and charges is other income we collect such as leisure centre memberships, car parking charges, and license fees. On most of these, we are not allowed to make a profit, just cover the cost of the service. Adult social care, unlike health services, is also means-tested and people may be paying a charge for services such as homecare. In Wakefield, 25% of our income comes from Council Tax and 21% from fees and charges, although much of this is to recover money paid out.
At the moment, business rates are collected by Government and then paid back across the country using a formula that recognises that areas have different needs irrespective of their business rate income. Some other national tax income is also added in, such as funding for public health. This is currently changing, however, as the Government have decided that councils should live off their own business rates and Council Tax. At the moment this means most of us have a mix of national re-distribution and some business rates we keep direct. In Wakefield we get 35% of our income from the national distribution and 17% from locally retained business rates. (This is definitely a whole other blog).
The Government is still consulting on how we can manage on our own business rates, given that there is no relationship between this income and needs such as adult social care and child protection; think of the business base difference between Wakefield and Westminster Councils, for example!
Our biggest challenge is that, since the recession and age of austerity in 2010, the national system has been dramatically cut, with most councils seeing their income drop by up to 60%. In Wakefield we now have 41% less to spend compared with 2010, with further cuts on-going. This is why many services are being reduced despite Council Tax increasing. This has led to some very difficult decisions being made and, in common with many areas; we have cut all services and stopped some entirely.
In Wakefield we have lost almost a thousand staff posts, closed swimming pools, stopped many community support services and are generally able to do less overall. We are on a constant search for new ways of working that will help maintain services, such as new technology. At the same time we are seeing costs increasing. More and more residents are in poverty despite also working, as a result of low wages and insecure contracts, and so demand for many services are increasing. We have seen a growth in family neglect, in homelessness and in poor health. We are struggling to maintain our roads and parks. Most of us are desperately trying to hang on to preventative services that are not statutory but prevent problems becoming serious.
The squeeze to do more with less is an ongoing pressure I don’t personally see going away. This is why the Government’s spending review due in the autumn, the adult social care green paper and funding for public health services is high on our agenda and eagerly awaited.
Despite this, we still spend a lot of money, employ a lot of people and have a huge impact on our places. In Wakefield, the council aims to make the whole District a place where people thrive, businesses succeed and visitors are welcome and we have a number of ‘Success’ priorities built up around this. This means our partnerships with others are crucial. We have a Wakefield Together Executive which includes our clinical commissioning group, acute trust, police, fire, voluntary sector, college and DWP. We also have a number of business networks.
One of the biggest challenges facing councils in this time of drastically reduced resources, is the growing proportion of our budgets is spent on social care. We have a legal duty to make sure care is available for people, who are unable to do certain things for themselves on a day to day basis; for example, getting out of bed and dressed, cooking or taking medication. This is not just older people; it is anyone with a disability or condition that makes these things difficult. The care might be provided by the council itself or by another provider, for example, a charity. It might be provided in a care home, a community centre, or in the person's own home. Unlike the NHS, councils must charge people for some of this care, unless their income is below a certain level.
We also have around many legal obligations in relation to children, including ensuring that they have a school place and that classes don't exceed a certain size. We have duties to assess and provide services for children with special educational needs and disabilities (often call SEND), and young people who were previously in care. We also have to assess whether a child might need support due to disability or illness, a parent's disability or illness, low income, abuse or neglect. We must also investigate cases where a child is considered to be at risk of significant harm and put a plan in place to keep that child safe. In the most extreme cases we sometimes have to remove a child from their parents. Where we can we use hugely invaluable foster parents, and are in constant need of more. We do also run residential care for children with severe and complex needs, often learning disabilities combined with physical disabilities, many needing 24 active care.
I mention all this in detail because sometimes people ask why we don’t just stop doing everything except our most basic statutory duties. Why do we still run museums while cutting social care, for example? The answer is two-fold.
Firstly, most of our statutory duties kick in at the high end of care. If we wait until we legally have to help, people who access care will be in a much worse state, will have often lost the opportunity to progress in their lives, and the care they need will be the most expensive.
Secondly, not waiting means investing the things that stop the worst happening, and those things are most of our other services, as well as many of those provided by our statutory and voluntary sector partners. In Wakefield, for example, all our libraries are being fitted with sensory tables to help stimulate people with dementia or learning disabilities; one of our libraries is completed converted to dementia friendly furniture and signage. Our museums and castles service runs hundreds of educational events for children, helping to raise aspiration and attainment. Our public health team have worked with our town planners to ensure robust health assessments of new developments, helping to ensure a healthier future.
A good national example of this is domestic violence. Between us, statutory agencies have many duties to victims of domestic abuse, but these are often oblique; the route will often be because a child is at risk, or it is a criminal offence, or the victim is a vulnerable adult. Yet domestic abuse is a huge problem across West Yorkshire and Harrogate and is a causal factor in much of our intervention in children’s lives, if not adults. In Wakefield, domestic abuse is one of the main forms of violence in the District and a significant factor in the numbers of children with child protection plans and those who are looked after by the council. Investing in family therapy, education for young people and support for potential victim is better than waiting for an offence to occur. I am hoping we might see some change if a current Government bill becomes law; one with the potential to create a step change in the national response, to create a more effective approach to tackling domestic abuse
When considering all of the above you can see why partnership working is both critical and essential and why long term sustainable funding is needed for all of us; Councils, NHS and voluntary and community organisations.
The relationship between health and social care is obviously a key one for us, in terms of practical partnerships and system working; from joint planning on prevention and early intervention to integrated arrangements for formal services. Our Clinical Commissioning Group Chief Officer, Jo Webster has joined the Council’s management team, which has also brought new thinking in how our wider services, such as economic regeneration, contribute to a healthy place.
This is why the work of primary care networks (or primary care communities) is critical. If done right we will see more in terms of early help and interventions; of a holistic view of people’s physical and mental health, and of communities doing more for themselves and one another. To do this the NHS, councils, voluntary and community organisations need to work better together, to join up care whilst changing the conservation with local residents. You can see a good example of this in the work we are doing in Wakefield through the two connecting care hubs where council, NHS, housing partners and community organisations come together to provide seamless care. Other examples are the work we are doing around supporting people, adults and children, with mental health concerns and our housing and health partnership.
Local residents and communities often know far better than us what makes their communities healthy and sustainable. In Wakefield we have a network of community anchor organisations who work on a whole number of fronts: health projects, help into employment; healthy eating; friendship networks and so much more. By getting all of this right we can eliminate duplication of effort, provide better value for money but most importantly support more people with the right level of support at the right time and place.
Finally, this is also where the work of West Yorkshire and Harrogate Health and Care Partnership comes in. The six Council Chief Executives involved are keen to have the opportunity to share and spread learning, as well as deepening our own system knowledge. I for one welcome the opportunity to have an equal voice around the executive group, because only by really working together can we make a positive difference to people’s lives, including our own.
Have a good weekend,
Merran
What else has been happening this week?
Yorkshire Ambulance Service
A £2.1 million investment at Leeds and Huddersfield ambulance stations has provided new Ambulance Vehicle Preparation (AVP) facilities where a dedicated team now prepares vehicles ready for clinicians when they arrive at work to start their shift.
The AVP service is operated by a team of ancillary staff who work on a 24-hour a day/seven days a week basis to ensure that ambulance crews are able to access fully equipped, re-fuelled and re-stocked ambulances at the beginning of each and every shift. This includes checking medical devices and medical consumables. Previously, ambulance staff were required to carry out these duties at the start of their shift. The £2.1 million extra investment in Leeds and Huddersfield was secured by Partnerships likes ours (also known as integrated care systems) and related partnerships in Yorkshire and the Humber.
Carers Week 2019
7.6 million people work as unpaid carers for a family member or friend. Around a quarter of people aged 45-64 are carers, and even that’s an underestimate. Between them, unpaid carers contribute not only vital psychological and social support to their loved ones but £132 billion to the economy every year. Carers Week is an opportunity to celebrate this contribution. Caring can be hugely rewarding for those who do it but often takes a huge physical and emotional toll.
Our Partnership was proud to promote a host of events taking place this week to connect carers to their communities in Carers Week 2019 (10-16 June). The events were part of a raft of support delivered by local partners and community organisations across the area. There are an estimated 260,000 unpaid carers living in West Yorkshire and Harrogate and among this figure are many children and young people who care for parents with long-term health conditions. We recognise that carers are significant in delivering and supporting health and care. That is why the Partnership is working on initiatives like identifying young carers, connecting GPs with carers’ support organisations and signing hospitals up to John’s campaign (which helps carers of people living with dementia), which helps carers in our hospitals. We also want to raise the profile of the valuable support they give locally whilst sharing the excellent work taking place across the whole of the area – and most importantly ensure that this is applied for all carers no matter where they live in West Yorkshire and Harrogate. Sharing and spreading good practice and learning is a priority for the Partnership. You can read our carers plan here.
You can also read this article from NHS England which is all about ‘care for young carers’ from GP surgeries.
Joint Committee of the Clinical Commissioning Groups - Patient Public Involvement Assurance Group
The PPI Assurance group of the Joint Committee of Clinical Commissioning groups which is made up of Governing Body members for Patient and Public Involvement of each CCGs met this week. The group received a presentation from Martin Pursey from NHS Greater Huddersfield CCG about a new contract for integrated urgent care services (IUC) across Yorkshire and Humber. The IUC service went live on 1 April 2019 and provides regional call handling and clinical advice along with a new separate dental clinical assessment and booking service. Jenny Hamer from Academic Health Science Network presented on phase two (cholesterol) of the West Yorkshire and Harrogate Healthy Hearts Programme.
Phase two of the project aims to support people with high levels of cholesterol, or those with a future risk of developing a heart attack or stroke, by switching their current medication (statin) to a more effective one (if their current one is not working) or by prescribing a statin to people that are currently not taking one. Patient voice is key to ensuring phase two of the Healthy Hearts Programme is a success. The group also discussed the latest position of vacancies and recruitment for PPI Lay members and engagement processes across the Partnership.
Transforming local eye care services
The demand for eye care services in West Yorkshire and Harrogate is huge. In fact eye care has now taken over from orthopaedic and musculoskeletal (MSK) as the highest demand area in planned care. We also have regional variation in how services are delivered, and in patient outcomes and experiences, all of which must be addressed.
To make sure that all eye care patients in West Yorkshire and Harrogate receive the same high standards of care, when they need it and in the most appropriate place, we must:
Make the best possible use of the different skills offered by, and the availability of, those who work in eye care services. By working differently and developing our dedicated workforce, we can help meet the demand for services now and for the years to come.
- Promote the importance of self-care and prevention, particularly around sight loss. Half of all cases of sight loss are preventable so through public information and appropriate screening services, our aim is to bring that percentage right down.
- Look at how and where our services are delivered. Eye care services don’t always have to be delivered in hospitals and many can be safely delivered at local clinics or high street opticians for example. By making the best use of the expertise we already have in our communities we can move some services out of hospitals and into local settings.
- Use technology to our best advantage. Digital connectivity has the potential to improve efficiency in service delivery, reduce costs and improve access to care. Through trials and pilot schemes, we can test any relevant advances in technology and make significant progress in transforming eye care services.
One of the Partnership’s main priorities is to transform local eye care services so that all patients do receive the same high standards of care, when they need it and in the most appropriate place. At an event in Leeds on 5 June 2019, our planned care team set the wheels in motion for a major initiative involving eye care professionals from across West Yorkshire and Harrogate that will support this regional wide transformation.
Those at the event included commissioners, clinicians, Local Optical Committee (LOC) representatives, eye clinic liaison officers (ECLOs), charity workers, service managers and vision rehabilitation workers. Attendees were split into five groups on the day, with each group assigned a key project area - age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, cataracts or children’s eye services.
Each team is now working on specific projects related to their assigned area of eye care with the aim of developing plans for service improvement to be implemented across the region. These plans could be in the form of a shared pathway, a new use of technology or a workforce initiative for example but all plans will reflect clinical evidence, best practice and patient insight.
Project teams will consider the four key areas detailed earlier in the development of their plans and will aim to collaborate with patients and patient representatives throughout the process. Once implemented, these improvement plans will have a significant benefit for eye care patients, and for those who work in local eye care services.
We’ll keep you updated as work progresses on the different themes and projects.
We’re getting together with our neighbours to end social isolation
The final phase of the 'Looking out for our neighbours’, pilot campaign to combat loneliness and isolation across West Yorkshire and Harrogate, is proud to support The Jo Cox Foundation’s ‘Great Get Together’ taking place from 21 – 23 June.
There was a photo / press call on Monday at Jo Cox House, Batley. Throughout June the campaign delivers one simple message ‘Get together with your neighbours’. Whether it’s simply saying hello, having a cup of tea or doing something for your neighbour, the Great Get Together is the perfect reason to connect with those in your neighbourhood. You can download your free resource pack, including summer messages, from ourneighbours.org.uk/resources. We will be evaluating the campaign with the aim of having a report completed by August. Please do continue to spread the word and most importantly tell us the difference you have made since the campaign started. Thank you. You can download your free helpful neighbour pack here.
Long Term Plan Engagement
Communication and engagement colleagues met with Healthwatch this week for an update on the report of findings from the surveys and focus groups carried out across the area in April / May – which focused particularly on digitalisation and personalisation – and long term health conditions. Hannah Davies, CEO for Leeds Healthwatch, who has been coordinating the work across the area with her colleagues, explained that the report covers a wide variety of views on areas such a mental health, urgent and emergency care. This and other local engagement activity alongside the work of our priority programmes will support the development of the Partnership’s five year plan which we hope to publish by the end of the year. Thank you to all colleagues involved in the work.
Primary and Community Care Programme Board
The Board met on Tuesday. Board members discussed the GP Froward View programme funding principles and were invited to provide comment and feedback on the developing Partnership’s Primary Care Strategy to inform the next draft. The Board also received an update on primary care networks / communities including the imminent national development support offer that will be available soon. There was a discussion on the role of PCN Clinical Directors.
Feedback from the recent ‘check and confirm’ session was received and reflected upon, and a change in the direction of travel for the community service benchmarking programme was approved to focus more on service and quality improvement.
Workforce priorities developed by the West Yorkshire and Harrogate Primary Care Workforce Steering Group which will inform the strategy were shared with the Board.
West Yorkshire and Harrogate Health & Care Partnership Area Partnership Group (unions)
Colleagues from the Local Workforce Action Board, Health Education England and the Partnership meet with union representatives from across the area this afternoon. Ian Holmes, Director for the Partnership will update them on the Partnership Board meeting last week, funding and campaigns. There was also a conversation on the Interim People Plan and an NHS Employers update.
West Yorkshire and Harrogate Digital Programme
Govroam is transforming how the public sector works. 4,000 public buildings have joined the govroam network. To celebrate this milestone, we’re promoting the many benefits of govroam, with a view to inspiring more organisations to come on board. Watch this short film to find out more.
There are a number of resources available to support orgs in sharing the message by contacting govroam@jisc.ac.uk
You can also contact dawn.greaves1@nhs.net for more information or read our case study here.