Let us start by defining the problem and with three very significant facts.
First, there have been weekly declarations of black alerts at Nottingham University Hospitals. A black alert is when there are no spare beds at the hospital for incoming emergency cases.
Second, nationally there has been a 40% increase in bed blocking, when people can’t leave hospital for want of care at home, which for the most part is provided by councils.
Third, it costs £2500 to keep a patient in a hospital bed on average, and £450 to care for the same patient at home.
So the logical and practical thing to do would be to increase the amount of cash available to councils. This would allow councils to relieve the pressure on hospitals and effectively to save money.
But this has not happened. Indeed the opposite has been the case. Councils, including Nottingham, have not only had to cater for an ever increasing number of elderly and disabled. They have not only had to find additional money for the minimum wage. But the very budgets we use to pay for services like adult care have been substantially reduced by the very government which is expecting us to do more. So, this year in Nottingham, there is a £10m gap, and this is simply to keep the service going.
This is not just a Nottingham phenomenon, it is happening across England. The Government’s response has been belated this year, as it was last year, and it has been to try and bridge some of the gap by requesting an increase of 3% in the council tax.
I have two things to say about this.
First, this 3% levy will still leave a £7m gap so is inadequate. Second, resorting to council tax rises is unsustainable, especially in poorer areas. Poorer areas have a lower council tax base but a higher demand for adult care. So the council tax rises are far more punitive and far less able to cover the costs than in better off areas.
This means that councils all over the country are left with a problem: do is they increase the council tax knowing it is unfair, regressive and not fit for purpose and should be funded centrally: or are they prepared to see a service for the most vulnerable elderly and disabled deteriorate, and bed blocking in hospitals increase further still.
The whole situation reveals a real failure of planning and coordination by central Government.
It took until the last minute for government to realise the problem in 2016 and announce the 2% council tax – a levy which given the magnitude of the problem, is nothing more than a sticking plaster. Far from tackling the problem with a longer term solution, it has simply repeated the exercise with yet another 3% plaster in 2017. This tells me they have no plan. To have no plan when the NHS is in crisis and the crisis was so predictable and when it actually costs more not to provide for council adult service, is a dereliction of duty.
All I can say at this stage is that we in this council will do our utmost to keep the service going. It will be a priority; but will be at the expense of other services and, if we can come to arrangements with the Local Clinical Commissioning group which we will have to, it will be at the expense of other parts the NHS.
But in the end, there has to be a long term solution and that solution has to include more money; and more money means more tax to pay for it. I would start with corporation tax but that is my view.
What is clear is that we can’t go on as a nation with the immature approach we have; that decent key public services can be provided on the back of ever increasing number of efficiencies and we do not have to pay.
In my view we are past the point of relying on efficiencies some time ago. It’s just that government hasn’t realised it and virtually every council, every hospital and thousands of patients are now seeing the consequences.