Sustainability and Transformation Plans (STPs), health and social care integration and the funding crisis in social care

Back to all Motions

2017 Local Government Service Group Conference
14 February 2017

Conference notes with alarm the growing crisis of underfunding of local government and the NHS, giving rise to a crisis in social care and related health services.

Local authorities have undergone average cuts to their budgets of 37% up to 2015/16, while inflationary pressures have increased. A further £6.1 billion will be taken from councils by 2020. The share of Gross Domestic Product (GDP) spent on health in England alone is projected to drop from 8.8% in 2009 to just 6.6 % in 2020.

Conference condemns these cuts that do not meet the care and health needs of many of our elderly and vulnerable citizens and are the root cause of poverty pay, zero hours contracts and increasing work pressures on our members working in social care.

Conference notes that it is in this context of cuts that NHS England has set up 44 newly-defined, sub-regional areas to develop ‘Sustainability and Transformation Plans’ (STPs). Local authorities, NHS providers and NHS commissioners have been set the task of formulating plans to integrate health and social care services for their ‘footprint’ area. There are also moves towards more integrated health and social care in Scotland and Wales and a 10-year vision for health and social care in Northern Ireland.

Conference believes that health and social care integration is urgently needed and that care workers commissioned by councils deserve pay and conditions commensurate with those providing care within the NHS.

Sub-regional planning like STPs and combined authorities will only represent a useful method of organising social care if cuts are reversed and the necessary long-term funding made available. This must also be done with the involvement of staff and users and through collaboration, rather than competition and market solutions. The experience of public health members transferred to local authorities has not been auspicious, with many suffering frozen pay and worsening conditions.

Conference is therefore concerned that:

1) STPs are being established without the real involvement of local authorities, public scrutiny, genuine workforce involvement and without clear lines of democratic accountability;

2) The funding environment of devastating cuts in local government and the requirement for STPs to make a combined saving of some £22bn in the NHS in England are creating a process of planning for cost reductions, rather than for genuine health and social care integration, service improvements and a focus on improving pay, conditions and training of social care workers;

3) Some STP plans include proposals to privatise clinical support services and “back office” admin and to establish Accountable Care Organisations (ACOs) – the model preferred by US private healthcare – to manage all care in a locality. ACOs could themselves be privatised;

Conference therefore calls on the local government service group executive to:

a) Work closely with the health and community and voluntary sector service group executives to fight cuts and develop a joint response to STPs and health and social care integration;

b) Encourage joint working on health and social care integration and funding cuts in social care between health and local government lay structures and paid officials within UNISON at all levels;

c) Continue its excellent work to highlight and tackle the underfunding of social care, the poor pay and conditions and lack of training and career development opportunities for social care workers and the challenges posed by staff transfers;

d) Continue to promote the Ethical Care Charter in home care and the Residential Care Charter and develop plans to organise care workers;

e) Continue to develop alternatives to cuts and privatisation and promote the proper funding and in-sourcing of social care;

f) Continue to work with branches to oppose outsourcing of care to Arms Length Trading Companies, co-ops and mutuals;

g) Work with Labour Link and the shadow local government, health and social care teams to promote an alternative to underfunded social care and a framework of quality pay, conditions and career opportunities for care workers;

h) Develop an alliance of campaign organisations, academics, providers and users to campaign for quality social care.