Care in the Community
|
Care in the CommunityRelationship between the Health Service and local authoritiesThe interface between the NHS and local government on the transfer of hospital patients to nursing homes or residential care homes is damaged by the differences in sources of funding. The NHS is centrally funded, and local government is funded at the margin from council tax paid by local residents. Operations have been cancelled in Birmingham and elsewhere because the local authority had not budgeted to support sufficient elderly residents in nursing homes to enable them to be discharged from hospital. Nursing home places were available, but not being used for financial reasons. The NHS was incurring more costs in using surgical beds for long term nursing care than the local authority was avoiding by not increasing its budget. This situation, whenever it happens, is bad health care for the community, and a waste of public money. But the impact on the local community is obvious and thoroughly exposed in the press and on television. The local authority is accountable to its electorate for the way the community is run, even if the impact is felt in a service, like the NHS, that by law is the responsibility of central government. As a result, the immediate crisis in Birmingham was resolved by the City Council diverting funds earmarked for other areas in its budget. This is a case of democratic accountability working in practice at local level, while central government gave plenty of exhortations but no money. Birmingham Council should perhaps have acted two or three months earlier. But if a similar problem had resulted from budget anomalies affecting different ministers in central government, because ministers are insulated from local issues, we believe the problem would either have been ignored or taken much longer to resolve. |
|
Sheila
Porter-Williams |