Hewitt Review: hope and experience

The Review of Integrated Care Systems by Rt Hon Patricia Hewitt, Health Secretary in the Blair government and commissioned by the current Health Secretary, Steve Barclay, was published today. It is a very welcome report; the question now will be how and to what degree it is implemented.

The focus of the Review was on the 42 Integrated Care Systems (ICS) established last summer under the Health and Care Act 2022. Its Terms of Reference included greater empowerment (and accountability) for local ICS leaders, a reduction in national target setting and an enhanced role for the Care Quality Commission (CQC) in oversight of the system.

Local government is a key partner in the ICS; within our system of Kent and Medway, and in particular its Integrated Care Partnership (ICP), which I chair, the three statutory partners are Kent County Council, Medway Council and the local NHS or Integrated Care Board (ICB). The County Councils Network played an important part in the Review (acknowledged by Patricia Hewitt in her Foreword), as did its Chairman, Tim Oliver (Leader of Surrey CC). I was able to take part in a number of ICS and local government leaders' calls with Patricia Hewitt and her inclusive approach was clear.

I cannot claim to have yet fully read and absorbed an 88 page report, but its general approach was increasingly clear as the Review developed and is confirmed today. The Review identifies six key principles:

- Collaboration within and between systems and national bodies

- A limited number of shared priorities

- Allowing local leaders the space and time to lead

- The right support

- Balancing freedom with accountability

- Enabling access to timely, transparent and high-quality data 

These principles aim to deliver a shift from focusing on illness to promoting health, with a shift in ICS budgets towards prevention of at least 1% over 5 years; more freed up and autonomous local systems; reducing the barriers between primary and social care and developing complementary strategies for health and care workforces; and shifting the approach to finance to embed change.

These are good aims, and the Review is full of accurate and important assessments of our current situation, with its over-centralisation, its fragmented approach and the degree to which we are, and remain on a treadmill of dealing with pressures within the system rather than addressing the factors that make those pressures worse. For example: "We are currently one of the most centralised health systems in the world, and ICSs give us an opportunity to rebalance this."

The challenge now will be to deliver on this. One section of the Review has the title 'Why it can be different this time' and Patricia Hewitt recognises (not least from her own experience as a former Secretary of State) that prevention, integration,moving upstream and financial sustainability have long been national policy aims. Her contention - and this is a view that I have argued in our debates on the ICS at County Council - is that strong cross-party support for ICSs, building on the experience of recent years, gives the opportunity to truly do things differently. 

Let us hope so.

Three days left for street party road closures applications

As at the time of last year’s Platinum Jubilee, KCC has waived fees on road closures for people seeking to celebrate His Majesty the King’s Coronation with a street party. However, there are now just three days left in which to submit an application - they must be presented by this Friday, 3 March.

You can find our media release about waiving fees here. We will be posting more about the Coronation weekend in the near future.

Kent Stands with Ukraine on invasion anniversary

Today Kent County Council, like so many organisations, communities and individuals across the country, marked the anniversary of the Russian invasion of Ukraine. 

Amid the horror and shattering cruelty of the invasion, and the indirect impacts that the resulting economic disruption has brought home to all of us in daily life, there has also been a heartening response in this country and our allies, not least in the welcome given to Ukrainians forced to flee the conflict. In Kent, which has taken more Ukrainian guests under the Homes for Ukraine scheme than any other comparable area of the country, we have seen an extraordinary response from people across the county.

Some 4,202 people from Ukraine have been matched with 1,737 sponsors in Kent. Not all have yet come here, but 3,209 have done so. At present, 1,889 are staying with 905 sponsors; others have already done so and moved on, in some cases returning to Ukraine and in other cases moving into the private rented sector. 

Last year there was concern that, once the six month minimum period for hosting came to an end, many hosting arrangements would come to an end. KCC moved ahead of many other councils in raising the rates for payments to hosts from a flat rate £350 per month, regardless of the numbers hosted, to a higher set of rates ranging from £400 per month for hosting one Ukrainian guest to £1,000 per month for 7 or more. This seems to have had an effect; instead of 60% of hosting arrangements coming to an end after 6 months, as we feared, just 7% did so. 

This scheme was set to run through until the end of the financial year in March 2023, since there was at that time uncertainty over future provisions for the scheme. DLUHC confirmed before Christmas that there would be a continuation of the scheme into financial year 2023-24, though with reduced payments to councils but an increase (to £500) in payments to hosts of Ukrainians who have been in the country for over a year. This payment does not, however, increase if there are more guests. KCC has therefore announced that we will, for the next twelve months, support hosts in line with the scheme we had previously announced, but with a higher payment (£500 rather than £400) for single guests who have been here for over 12 months. In other words, we will combine the government’s provisions with our own.

The aim of these schemes is to sustain hosting arrangements but over time many Ukrainian guests will want or need to seek other housing. We are therefore working with district councils across the county, and in particular Sevenoaks District Council, to facilitate an increasing number of moves by Ukrainian guests into the private rented sector.

Our strongest wish is that the day comes soon when our guests are able to return to a free, unified and peaceful Ukraine. But in the meantime several thousand Ukrainians are becoming a valued part of the Kent community, and it is good to be able to support that. 

You can find the KCC media release on this here.

Road closures coming up in Shoreham and Crockenhill

A couple of road closures coming up in the area in the near future are for very different reasons.

Fackenden Lane in Shoreham will be closed for up to 4 days starting this Friday (24 February) for its full length, from the junction with the A225 to the junction with Magpie Bottom. This is to enable Kent Highways to carry out carriageway patching - which is welcome given the severe damage that this road has taken during the winter weather. There have been an increasing number of road closures for Kent Highways works recently, reflecting work getting under way to repair the winter damage.

In Crockenhill, the closure of Wested Lane for works carried out by Network Rail, which has been delayed several times, is now scheduled to run from 0600 on 15 March to 1800 on 22 March. The closure will be between Eynsford Road and the Mark Luck Ltd entrance in Wested Lane near the junction with the B2173 London Road in Swanley. The recommended diversion route is via Eynsford Road/ Main Road, Broadway/Green Court Road/Goldsel Road and the B2173.

Tackling drainage on the A225

Kent Highways drainage officers have been working to address the flooding issues on the A225 between Shoreham and Eynsford. Some of these issues, notably at the railway bridge near Preston Farm, have been persistent problems over a long time, while others such as those closer to the entrance to Eynsford have become more severe recently.

Works (cleansing, emptying chambers) were carried out by the Eynsford Station railway bridge around a fortnight ago, though there is still some root cutting that is due to take place shortly. A little to the south, a second drainage system, which drains to a soakaway in low lying land near the road, has been worked on but further cleansing is due to take place. The drainage engineer has also been in contact with the Environment Agency, since their have a pumping station appears also to be an important part of the system, pumping ground water into the river. Finally, there will be further works up the hill from these sites, where water drains into a filter pipe system in the verge.

There will be a further cleansing of the system all the way down from the area around the Preston Farm railway bridge. Taken together with what has already been done, this should make a real difference but I will urgently relay any new problems that arise to the drainage team.

KCC budget approved: high risks and a narrow path

At a day-long meeting yesterday, the County Council passed the administration's budget for 2023-24. It was the fourth budget since I became Leader, and the most difficult for many years.

I have addressed the reasons for this before, and they underlay the joint letter that the Leader of Hampshire and I wrote to ministers in the autumn. The financial year just concluding (2022-23) is almost certain to be the first in 22 years in which the budget has been overspent; the full year effects of that, and the pressures that have caused it, carry over into 2023-24, for which our budget projects a £217 million (18.2%) rise in the cost of services. This far outstrips the increase in our resources, even after a much better than expected settlement for local government in the Autumn Statement.

The main reasons for this, in addition to surging general inflation (our budget last year was set two weeks before the Russian invasion of Ukraine) were cost pressures in adult social care, reflecting the crisis in the sector and the ever more complex needs of those in need of our services; rising numbers and costs in school transport, especially for SEND students; and the increasing costs of fostering and specialist placements in Children's Social Services.

The result is that we have both to increase council tax by the full referendum limit level of 5% and deliver some £55 million in savings and increases in income. The savings include difficult decisions in areas such as non-statutory social care services, community wardens and the cost of the Kent Travel Saver. Other measures are currently out to consultation, including our proposals for community services.

The council debate was long, wide-ranging, occasionally contentious and often thoughtful. At its conclusion, the administration's budget passed without amendment. I concluded by setting out the longer-term measures - sustainable budgets, work with the health service, making the most of the national devolution agenda -needed to secure the long-term future of the council and the services we provide. "So, we have a narrow path to tread. There are some very tough choices this year and some very big challenges for the years ahead."

You can find the KCC media release here.

KCC challenges London Mayor over ULEZ

As Leader of Kent County Council, I have written to the Mayor of London, Sadiq Khan, concerning the proposed expansion of the Ultra Low Emissions Zone (ULEZ) to the outer London border.

During last year's consultation on the ULEZ expansion, KCC set out its view that the scheme would not be acceptable without an extension of the scrappage scheme to areas bordering London, including affected areas of Kent. This view has not been accepted by the Mayor as he takes the scheme forward (with implementation planned for August this year).

My letter therefore reiterates this concern, and raises the question as to why the proposed ULEZ border does not match that of the Air Quality Management Areas in London. It also makes clear that we will not continue works to install warning signage on our road network unless and until we see these concerns addressed.

In taking this stance, KCC is representing the concerns and interests of our many residents who may be affected by the ULEZ extension in its current form, and joining the growing concern and opposition expressed by outer London boroughs and authorities who border London. We are considering further steps. You can find KCC's media release about this here.