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6th May 2025

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News and comment from

Roy Lilley



Numbers...

_____________

Their tails are up…


… that’s for sure…


… and I suspect Nigel is the sort of man who knows how to celebrate.


Reform have had a stonkingly good set of results in the local elections and will be well pleased with their national results. 


To say Labour are shell-shocked is probably an understatement. The Tories look like they’re a party of ghosts. Like it or not, the political landscape has been ploughed up.


Now, the NHS has to deal with the actuality of local authorities, run by a Reform party promising change and common sense and all the usual blah.


What will they actually do? 


A more useful question is, what can they do?


Not a lot.


Councils are legally required to provide certain services, including... adult social care and children's services.


This is a statutory service... end of.


A situation that will get more pressured as demand rises. More-so in Reform areas where levels of social deprivation are high.


Reform’s problem is; since 2010 local authorities have seen cuts of around 25-40% in real terms to central government funding. They rely heavily on council tax, business rates, and grants, most of which are tightly controlled by central government.


Many councils, like Birmingham, are on the verge of, or have declared effective bankruptcy. The upshot, councils have no wriggle room.


The relationship with local government and Whitehall is pivotal. Labour as HMG, will have no inclination to make Reform councils any easier to run or successful.


Reform may be able to make minor changes to planning policy, maybe influence procurement policy to try and favour local providers… but even that’s tricky.


They can fiddle with branding, heritage funding, or local campaigns. Influence local partnerships but council tax rates are capped. 


Winning local control gives Reform a platform and visibility, but not much else.


Reform and radical policy change requires either national power or a reformed local government finance system. 


At best, they can prove competent or stir debate but not transform local government overnight… and they are very inexperienced. Council officers are likely to dominate.


In social care provision Reform councils will find very little room for major policy innovation, because of strict legal duties, financial constraints, and centralised regulation. 


They ‘must-do’, by Law:


  • Provide adult social care, for older people, people with disabilities, mental health conditions.
  • Children’s social services, child protection, fostering, safeguarding.
  • Assessments and care plans under the Care Act 2014.


None of this is an option. 


Failing to meet these standards opens councils to legal action, regulatory intervention and serious reputational damage.


In many Councils social care accounts for, over 60% of local authority spending. 


Costs that are increasing faster than inflation, driven by staffing shortages, rising demand and private care provider fees


Reform could get busy with a Musk-like audit and challenge contracts for better value. Streamline assessments or admin to reduce bureaucracy but gains would be marginal and IT investments to do it, don’t come cheap.


They might try and recruit volunteers and cut non-statutory services like arts, diversity programmes but to be honest, most Councils have already done it. It's obvious.


Councils are legally required (2010/2011 Acts) to eliminate unlawful discrimination, harassment and victimisation... and show how they are complying with the law… not just passively avoiding discrimination. 


Reform’s promise to ‘end woke’ policies will be difficult to deliver.


They can't slash social care services, it's illegal. Privatise or withdraw services? No, that's blocked by national law... and they can't raise substantial new revenue independently… it's heavily capped


They can make some managerial tweaks or value-based choices in social care, but they cannot fundamentally reshape the system without central government backing.


Social care is the big ticket item. 


They might attempt to prioritise ‘Locals First’ in eligibility or access. That would fit their national migration agenda.


They can’t legally deny care based on nationality, but they could politically highlight who is receiving services and campaign for changes to the national rules.


Social care is already mostly privatised, delivering the majority of home and residential care. Reform can’t do much more of that. They might in-source and try to run it cheaper. Perhaps pay relatives to provide care?


More likely; they’ll highlight ‘how broken the system is’... as ammunition for national policies come the election. Around 2m people no longer get the care they once did as eligibility criteria have been hiked to contain costs.


The recent report from the health select committee makes the point;


'The Government does not have a robust understanding of the extent of the current system’s failings to provide people with the care they need.


Nor does it have robust data on the outcomes of delivering high quality care. Without this, it will be unable to make a clear case for reform.'


You can bet the farm it won't be long until Reform has the numbers...

NEW

FREE - PODCAST

Former BBC Health Editor, GMC chief Executive and Confed boss,

Niall Dickson

and

Roy Lilley

In a frank and revealing conversation with

Richard Meddings

Former Chair of

NHS England

'The banker becomes a convert...'

Want to contact Roy Lilley?

Please use this e-address

roy.lilley@nhsmanagers.net 

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News and Other Stuff

---

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>> ‘Profound disappointment’ as ICBs are allowed to cut safety funding - maternity services.

>> Andy Burnham has ”real concerns” - about reorganisation.

>> Pill taken by many - linked to 'weight gain and nightmares'.

>> Reducing intake of one beverage can lower dementia risk - and it’s not coffee

This is today's absolute, cuppa-builder's must read...

NEW EDITION

Now in it's 6th edition, with brand new chapters...

Global sales released on 3rd May, order now for free delivery

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The Lampard Inquiry

Prof Brian Edwards coverage...


'... this full public Inquiry is a restart as an earlier non statutory Inquiry had to be abandoned when only 14 of 14,000 staff agreed to give evidence.'

The Royal Cornwall Hospital Trust...


'... Facilitation of Complex Clinical Risk Decision-Making using the Action/Consequences Model in a Home Treatment Plan'

⬇️ For more news, scroll down








This is what I'm hearing, unless you know different. In which case, tell me, in confidence.

__________


>> I'm hearing - Lab have scrapped the £2 bus fare cap & universal winter fuel allowance, they're targeting disabled people & driving 50,000 more kids into poverty. "Voters have spoken & they've clearly said we don't like what your doing"

Reeves replied: "I know.. we know we need to go further & faster"... this from a reader and Labour supporter...

>> I'm hearing - the keen eye of the 'Future Funding' blog reports; since the Guardian sold the Observer to the Tortoise Media, none of the normal comment pieces were posted over the weekend and Bank Holiday.

More news

-----

>> Trump’s 2026 budget plan - cuts healthcare funds.

>> World may be ‘post-herd immunity’ to measles - US scientist. -

>> Widening gap between health system leadership and health workforce - news from NZ.

>> Draft Single Patient Record (SPR) Requirement - Draft SPR Vision.

>> Suppliers to help design - Streeting’s ‘single patient record’

>> First ICBs to share CEO and chair - makes a mockery of what a board is for, doesn't it?


 
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