:01:17. > :01:27.reform, plus who cares and who pays? Will the integration of our councils
:01:27. > :01:27.
:01:27. > :37:30.Apology for the loss of subtitles for 2163 seconds
:37:30. > :37:37.and health services put patients on I am Arif Ansari. Coming up in the
:37:37. > :37:45.North West... Who cares and who pays? Will the integration of our
:37:45. > :37:50.councils and health services put patients on a firmer footing?
:37:50. > :37:54.anybody came here, they are genuine, genuinely interested in the
:37:54. > :37:57.patients, and that is what it's about, isn't it, really?
:37:57. > :37:59.And joining us this week the Labour leader of Rossendale Council and
:37:59. > :38:05.Lancashire County Council Alyson Barnes. And Michael Jones, the
:38:05. > :38:09.Conservative councillor in charge of Cheshire East. Michael, we had the
:38:09. > :38:15.Spending Review, have you had a chance to see what the likely impact
:38:15. > :38:20.will be on your counsel? We think it will have a big impact, about seven
:38:20. > :38:25.or 8%, and we are looking to absorb that, and I am hopeful services will
:38:25. > :38:35.not be affected. Deeper than you hoped? You'll macro what we thought
:38:35. > :38:42.
:38:42. > :38:46.we would get. Alyson? We thought we would sustain a big cut. We had a
:38:46. > :38:54.51% cut in real terms. And we know, moving forward, that will get
:38:54. > :39:00.washed, -- worse, possibly by 70%. Difficult times for local
:39:00. > :39:05.authorities. One area of spending that affect councils is what
:39:05. > :39:10.opponents call the Bedroom Tax, the reduction in housing benefit for any
:39:10. > :39:13.spare bedrooms. A new report by the National Housing Federation into its
:39:13. > :39:18.impact on Merseyside paints a miserable picture of vulnerable
:39:18. > :39:23.people being put under financial pressure.
:39:23. > :39:27.The Hoile family did not expect to be cut up in a logical drama. Darren
:39:27. > :39:31.and Angelina own their own business. They moved to a
:39:31. > :39:37.four-bedroom social housing property so they are sons could have a room
:39:37. > :39:41.each. Each of the boys have been diagnosed with ADHD. They are also
:39:41. > :39:47.on the autism spectrum disorder. There is no way they could share
:39:47. > :39:50.bedrooms. They do not sleep, up half the night. Knowing their children's
:39:50. > :39:58.conditions, they never thought they would be affected by benefit
:39:58. > :40:04.changes, no paying 40% more in rent. We cannot move. There are schools.
:40:04. > :40:08.Those meet with the boys needs. 26,000 properties on Merseyside are
:40:08. > :40:12.affected by what has been colder Bedroom Tax. Many people live in
:40:12. > :40:16.overcrowded conditions, but nearly four times as many are under
:40:16. > :40:23.occupied. The problem for housing associations is that are not enough
:40:23. > :40:26.properties for them to move into. So have the wrong type of properties
:40:26. > :40:32.being built? If we think about 21st century contemporary living, and the
:40:32. > :40:35.space is needed to live and work in, that points away from very small
:40:35. > :40:39.cramped accommodation. The report from the National Housing Federation
:40:39. > :40:46.reports that exposing families have gone into arrears for the first
:40:46. > :40:51.time. It could cost �23 million over the next year. That is said could
:40:51. > :40:57.build -- it is said that could build many more homes. The council says
:40:57. > :41:00.the policy is disrupting community cohesion. Some areas of the city,
:41:01. > :41:05.there are only three bedroom properties available and nowhere for
:41:05. > :41:08.those families to downsize. Dumb families are handing the keys back
:41:09. > :41:18.to landlords and seeing they can no longer afford to live there. -- some
:41:19. > :41:29.
:41:29. > :41:34.welfare reform driving housing policy and not the housing needs of
:41:34. > :41:38.the population. What has been the impact for your
:41:38. > :41:44.counsel, Alyson Barnes, and for people living there? We have not
:41:44. > :41:48.done a formal evaluation, like Liverpool, and it has been adjusting
:41:48. > :41:55.looking at their document, because they are demonstrating some of the
:41:55. > :41:59.concerns we have all had about this Bedroom Tax. But locally in
:41:59. > :42:08.Rossendale, we are seeing arrears rising and we are also seeing
:42:08. > :42:12.three-bedroom properties becoming empty and staying that way. One of
:42:12. > :42:18.the Liverpool Housing associations have seen a doubling of its empty
:42:18. > :42:25.stock for three-bedroom accommodation. Michael, why support
:42:25. > :42:30.the principle of this? It is about fairness. But that is the problem.
:42:30. > :42:33.But has Liverpool built the right houses? I do not think so. You need
:42:34. > :42:38.to have the right housing stock available, the right offer, the
:42:38. > :42:44.right structure. As a country, we cannot afford to have housing
:42:44. > :42:49.benefit doubling to �21 billion. That is a startling figure. We have
:42:49. > :42:53.to make sure we support those in work, those who can work, those who
:42:53. > :42:59.cannot work, making sure people go out to work. These are good for
:42:59. > :43:02.everybody, for the many, and we should support those who cannot.
:43:02. > :43:06.they are not being supported. We saw them in the film they are talking
:43:06. > :43:11.about people and vulnerable positions, otherwise they would not
:43:11. > :43:14.be in housing benefit, being forced out of homes, or having to find more
:43:14. > :43:17.money they do not have. We want to encourage people into
:43:17. > :43:23.work, which is the key message behind this, people who can work
:43:23. > :43:27.should work. In Cheshire East, no one vulnerable should be affected.
:43:27. > :43:31.If they are, we will pick up the figures. Macro we will pick up the
:43:31. > :43:41.pieces. Could it be about better skills, could it be about better
:43:41. > :43:46.interaction? Jobs are on the way. Michael, in the
:43:46. > :43:51.peace we saw, there was a family in which the parents were both working.
:43:51. > :43:56.They had three children, a bedroom each and they were being told they
:43:56. > :44:03.had to effectively downsize. That is not the case of not working, but
:44:03. > :44:05.this policy hitting them. And we know 66% of people affected by this
:44:06. > :44:15.Bedroom Tax and actually people living with disability, and
:44:16. > :44:16.
:44:16. > :44:20.925,000 people stopped claiming disability. That tells you what is
:44:20. > :44:26.wrong with the system. You cannot have a system giving free benefit
:44:26. > :44:30.for all. It is not good for the morale of the country. We need a
:44:30. > :44:34.system rejecting those who truly needed, not just wanted.
:44:34. > :44:40.understand that principle, but suggest it is not happening and that
:44:40. > :44:47.people who are vulnerable are being hit, being as to move, downsize into
:44:47. > :44:51.flats, one-bedroom flats, that do not exist. But we need to build
:44:51. > :44:56.them. In Cheshire East, we have housing for people, and community
:44:56. > :45:00.driven housing. We will get them built. All that takes time.
:45:00. > :45:07.Merseyside speaks about six or seven years. We are looking at similar
:45:07. > :45:14.timescales. Why have they not been built in the past? You had the money
:45:14. > :45:18.to build. At the most fantastic time. My information is it is not
:45:18. > :45:22.economically viable for housing associations to build one bedroom
:45:22. > :45:25.accommodation at the moment. We clearly need to look at the
:45:25. > :45:31.financial framework. But maybe feel years under the previous Labour
:45:31. > :45:35.government? If you look at what is being built under this current
:45:35. > :45:42.government... I am talking about the previous Labour government. You'll
:45:42. > :45:46.macro all governments have played their part in this.
:45:46. > :45:47.all-conference have played their part in this, but housing
:45:47. > :45:56.associations also building economically viable and bigger
:45:57. > :46:00.houses. Will Labour repeal the Bedroom Tax? It is unclear what will
:46:00. > :46:05.be done at the moment. This grassroots pressure to do that. I
:46:05. > :46:09.would like them to do that. I know many Labour activists would like to
:46:09. > :46:15.see them do that. The working man and women know that benefit culture
:46:15. > :46:20.is bad for them. I think you have to be realistic and see what is the
:46:20. > :46:24.right way. This may not be having the better effect, but it can be
:46:24. > :46:28.changed and targeted properly. To put it back to the way it was let
:46:28. > :46:34.people down. Build the right houses, help the needy and those in work
:46:34. > :46:40.first. But that does not address the issues here and now. We shall leave
:46:40. > :46:43.that. Among the plans for the Spending review, the Chancellor
:46:43. > :46:49.promised �3 billion to better integrate health and social care.
:46:49. > :46:53.Adult social care is a council's single biggest area of expenditure.
:46:53. > :47:00.Councils are due to spend about �11 billion on at this year. That is
:47:00. > :47:05.down from �14.6 billion in the year to 2011. The aim is to get councils
:47:05. > :47:09.and the NHS working more closely to allow people to be looked after at
:47:09. > :47:13.home, improved patient care and reduce bed blocking in hospital.
:47:13. > :47:17.Part of the region, including Liverpool, have already started
:47:17. > :47:27.integrating services. Stuart Pollitt visited one rehabilitation centre
:47:27. > :47:27.
:47:27. > :47:34.which has just had a make over. You are probably thinking what does
:47:34. > :47:40.the Berlin Wall have to do with this? Put your right hand on your
:47:40. > :47:44.left leg... This is an exercise rehabilitation class and an example
:47:44. > :47:49.of how the imaginary Berlin wall between the health service and local
:47:49. > :47:53.councils is being broken down. A patient used to be discharged from
:47:53. > :47:56.hospital, sent home meaning they were now under council care, but the
:47:56. > :48:00.council may not know much about it, so the patient would probably
:48:00. > :48:04.struggle and may end up back in hospital, falling between the cracks
:48:04. > :48:10.of different agencies. People could be Leopard days waiting for
:48:10. > :48:20.equipment, for the right health care, before the GP got involved. --
:48:20. > :48:25.
:48:25. > :48:28.could be left for days. It was just jointed in the past. -- disjointed.
:48:28. > :48:33.John Lennon spoke about being signed by Brian Eckstein. I said what do
:48:33. > :48:42.you have to lose? June has been part of the Liverpool scene since the
:48:42. > :48:49.days of the -- the Beatles. Now she is one of many using the Granby hub
:48:49. > :48:53.in Toxteth. It is a halfway house between hospital and home. I have
:48:53. > :49:00.been an host, costing a lot of money, not half as good as theirs. I
:49:00. > :49:04.would give it 100%. They are genuine, genuinely interested in the
:49:05. > :49:09.patients. It is run by Liverpool community health trust, the link
:49:09. > :49:13.between council, GP and hospital. Instead of patients begin to several
:49:13. > :49:18.people, they will speak to one person, to medication going between
:49:18. > :49:24.both agencies. This thought of tight up is something the Chancellor wants
:49:24. > :49:29.to see more of. This will help relieve pressures on accident and
:49:29. > :49:33.emergency, the local government deliver obligations, and save the
:49:33. > :49:36.NHS at least �1 billion. integration began with a pilot in
:49:36. > :49:40.Cumbria four years ago. The government now wants all councils to
:49:40. > :49:44.do the same, so they have pulled budgets and Knowsley and joined
:49:44. > :49:48.forces in Wigan. Stockport has linked up IT projects. There are
:49:48. > :49:55.concerns this will not work. worry about the new integrated care
:49:55. > :50:00.money is that it might not create anything, but create whole new
:50:00. > :50:04.structures and systems which will come and go, instead of creating and
:50:04. > :50:08.building on what we know works, which is general practice. That word
:50:08. > :50:14.integration has been high on the agenda at this week's LGA conference
:50:14. > :50:18.in Manchester. It is Conservative and Labour Party policy. Partnership
:50:18. > :50:24.has to be the key thing. If you do not work with other organisations,
:50:24. > :50:34.you will go under. Is heading home after five weeks at
:50:34. > :50:43.Bambi. -- is heading home after five weeks at Granby.
:50:43. > :50:48.You have made a future husband? Maybe. I suppose it is fitting that
:50:48. > :50:54.are centred built with greater integration in mind has resulted in
:50:54. > :50:58.just that for some residents. We are also joined now by Professor
:50:58. > :51:03.Mark Gabbay, a professor in general practice at the University of
:51:03. > :51:10.Liverpool. Welcome. What is your assessment of this idea? It has been
:51:10. > :51:14.tested before in several ways. I remember the times when, because of
:51:14. > :51:18.bed blocking, health services were giving social services money to be
:51:18. > :51:23.able to move people back home. What we now have is a slightly more
:51:23. > :51:28.structured way of doing that by having a wraparound approach to
:51:28. > :51:34.providing holistic care within a primary care setting. So the same
:51:34. > :51:42.eye they year already been trialled? Yes about 15 or 20 pilots. Including
:51:42. > :51:46.Cumbria? And the assessment of that scene soon suggest that the patients
:51:47. > :51:53.did not seem to notice a difference. -- the assessment of that seemed to
:51:53. > :51:58.suggest. It seemed to help the service providers more. But they did
:51:58. > :52:02.not seem to carry it on. I think it has only been reporting last year,
:52:02. > :52:07.so it is a relatively new idea. Evaluation showed that more work
:52:07. > :52:12.needed to be done to find better ways to do it. The anxiety for the
:52:13. > :52:15.health services where the money will come from, whether that reduces the
:52:15. > :52:20.spend in the National Health Service by more effective social care, or
:52:20. > :52:24.whether in fact effect on the health services such by the transfer of
:52:24. > :52:31.funds that the health service struggles to meet cost. Michael,
:52:31. > :52:35.what is your take on this, good idea? Inevitable, it has to happen.
:52:35. > :52:39.Health is a big part of improvements. We want people to have
:52:39. > :52:45.helped in the home. A good idea, an essential way to take the pressure
:52:45. > :52:51.off. The money will come from both sides. NHS has to put money into the
:52:51. > :52:56.community, driver that way. All of the technology helping as well. I
:52:56. > :53:02.think it is good. We should go local, community driven, the way to
:53:03. > :53:08.interact health for people's needs. One are the benefits, do you think?
:53:08. > :53:13.It is about the person. We have heard about services focused on the
:53:13. > :53:18.individual needs. I think this will go some way to give us that. And
:53:18. > :53:24.clearly, the recipient of care, the person at the centre of this, needs
:53:24. > :53:29.to feel the difference. Andy Burnham announced this week that some Labour
:53:29. > :53:33.local authorities would go ahead with this whole person pilot.
:53:33. > :53:38.Lancashire County Council being one of them. How broadly will that work?
:53:38. > :53:41.I think they will build on work already being done. They have worked
:53:41. > :53:48.closely with health over a number of years one intermediate care
:53:48. > :53:52.measures. This is part of building on that. Not looking at completely
:53:52. > :53:58.changing what they are doing and how they are doing it, but building on
:53:58. > :54:02.work done already, because that will then help them save on costs. And it
:54:02. > :54:07.will not incur massive additional new costs in terms of this work.
:54:07. > :54:12.you have the cash for this? As I said, it is building on what we are
:54:12. > :54:18.already doing, so we will take this forward naturally. Some of these
:54:18. > :54:24.measures will save money from both budgets. Michael, the budget has
:54:24. > :54:28.gone down by about 25%, hasn't it? It is actually going up in my
:54:28. > :54:35.county, which you would expect in one dominated by an elderly
:54:35. > :54:39.population. We like that, but it is a pressure. It is a fact of life
:54:39. > :54:42.people are living longer. The pressure on the NHS, on councils,
:54:42. > :54:49.will continue. We need to work differently. Pool resources
:54:49. > :54:55.together, move together, work with GPs. GPs could work with adult care
:54:55. > :55:00.services. The councils, NHS, GPs, commissioning groups, have to get
:55:00. > :55:06.together to make this work. It has to go ahead, we have no choice.
:55:06. > :55:09.do you think will be the financial issues? I do not think this is a
:55:09. > :55:14.particularly political argument, but about how we cost effectively
:55:14. > :55:19.provide care for people in their own homes. Liverpool, for example, has
:55:19. > :55:24.the independent project, part of the Dallas pilot, so they are testing
:55:24. > :55:30.out the best way to use technology to help people stay in their own
:55:30. > :55:35.home. It is not a bad idea that we integrate social and health care. I
:55:35. > :55:39.believe the divide should go. The argument will be how -- who is in
:55:39. > :55:45.charge of how that money is spent. And maybe the money could be used
:55:45. > :55:54.for other things, which could cause some problems. Who is in charge? No
:55:54. > :55:59.always a good question. - always a good question. We have many people
:55:59. > :56:03.already under trial on telly care. Many are already having a better
:56:03. > :56:06.quality of life. If we can work with providers to go through and continue
:56:07. > :56:12.to do that and move to private landlords, it will make things
:56:12. > :56:17.easier. There are enormous savings we can have to make services better.
:56:17. > :56:24.To some extent, because some councils have certainly lost a lot
:56:24. > :56:30.of money in terms of adult social care, is the NHS budget sort of
:56:30. > :56:36.almost being graded to fill that gap? I think it is much simpler. The
:56:36. > :56:40.NHS is threatened by people being in there. With an operation, people
:56:40. > :56:45.stay in hospital far too long. If we can bring them into the community
:56:45. > :56:50.quicker, get them home quicker, that saves billions. A simple example of
:56:50. > :56:54.how this can work and should work. And people want to remain in the
:56:54. > :57:00.Rhone homes. I think this does contribute to the work that we're
:57:00. > :57:06.doing as to try and bring cost down. It surely should make a contribution
:57:06. > :57:12.to that. With everyone thinking it is such a good idea, you wonder why
:57:12. > :57:16.it has not been happening already. My recollection is it used to be the
:57:16. > :57:19.health service looked after these budgets a long time ago, before it
:57:19. > :57:24.moved to the councils when she moved to give budgets came in, probably
:57:24. > :57:31.over 20 years ago, so historically, I think we're just seeing who looks
:57:31. > :57:33.the budget. -- before it moves to the councils and commuter care
:57:33. > :57:39.budgets came in. That is a negotiation between social care
:57:39. > :57:43.staff, health years staff, and cares about the best ways to manage
:57:43. > :57:48.patient, the members of the public, in their own home. We have huge
:57:48. > :57:55.problems with inequalities of health. If this can help, we are all
:57:55. > :58:01.for that. Thank you very much for coming in. Time for the rest of the
:58:01. > :58:05.weeks news in 60 seconds. The government has been urged to
:58:05. > :58:09.take action against Tameside General Hospital. The chief executive and
:58:09. > :58:12.medical director resigned after two critical reviews.
:58:12. > :58:17.An investigation is underway into high death rates. Another Remploy
:58:17. > :58:22.factory is to close, this time in Burnley. Esther McVey says the money
:58:22. > :58:25.is better spent getting equal with disabilities into mainstream work.
:58:25. > :58:29.A petition is calling on Cheshire West and Chester Council to
:58:29. > :58:32.reinstate the head of the planning committee after he was removed
:58:32. > :58:36.following the rejection of plans for a student village on the green
:58:36. > :58:41.belt. It is not needed, it is unnecessary
:58:41. > :58:44.and is also unwanted. Ed Miliband came under fire in Prime Minister's
:58:44. > :58:51.Questions after his aid, the Stalybridge and Hyde MP Jonathan
:58:51. > :58:55.Reynolds, left the Labour leader's notes in a toilet. And also causing
:58:55. > :59:05.a stink, legal action is underway after plans for huge recycling plant
:59:05. > :59:07.
:59:07. > :59:12.in Cheshire were binned. Alyson Barnes, Jonathan Reynolds,
:59:12. > :59:15.often unwelcome guest, but leaving those notes of Ed Miliband for Prime
:59:15. > :59:21.Minister's Questions in which we know he was going to defend Tom
:59:21. > :59:27.Watson, then he did not need to worry, because the following day,
:59:27. > :59:32.Tom Watson goes anyway. So serious is this problem with regards to
:59:32. > :59:37.Unite four Ed Miliband and the Labour Party? It is an interesting
:59:37. > :59:41.distraction, but we all have better things to do. In my view, the Labour
:59:41. > :59:45.Party ought to challenge this government with much of what it is
:59:45. > :59:53.doing and not spending its time arguing in public about things that
:59:53. > :59:59.do not matter to bury people. Michael, a bit of a change to switch
:59:59. > :00:04.from the Tory party to Labour. -- things that do not matter to bury
:00:04. > :00:12.people. They want their man. The unions run the Labour Party.
:00:12. > :00:17.Everyone knows that. I do not think that is true. Unite gave the biggest