Speaking exclusively to Holmes on his first day at the helm at the ADASS Spring Seminar in Bedford last month, I began by asking for his views on local government secretary of state Steve Reed's recent letter to councils on partnering with ICBs on neighbourhood health centres (NHCs).

Neighbourhood health

While welcoming the secretary of state's call to help establish NHCs, Holmes highlighted the need to avoid ‘rushing to tick boxes'.

‘Neighbourhood health centres are there to serve neighbourhoods, to authentically be places where people might want to go and to host outreach to support those places, but they are dependent on people working well together,' Holmes said.

The ADASS president said plenty of community buildings had been set up with good intentions only to become ‘white elephants'.

‘We have to support Government to make sure that they're seen as just a starting point, not some kind of an end point,' Holmes added.

With Health and Wellbeing Boards (HWBs) having been identified as key to setting out neighbourhood health plan strategies, Holmes noted there was service quality variation across the country. He described the less effective HWBs as like a ‘a dusty old council committee looking at long papers full of complicated concepts'.

The ADASS president added: ‘I think it's about local government recognising the HWB is the place for democratic, open discussion about the health and care needs of the local population and how best to meet that.'

Holmes said there was a dual onus on local governments and partners to ‘really grasp the fundamental democratic importance of HWBs,' as well as for national government not to see them as a ‘processing house, just for ticking off things that they would like to see happen'.

The ADASS president said HWBs had to be the ‘focal point' of driving the prevention/public health agenda through being ‘visible to local people', adding they had to be something people can participate in.

‘There is no other place in health or care where we can have effective public conversations, so the HWB is the be all and end all and that's a great opportunity for us to take but we must grab it locally as well as people respecting it nationally,' he emphasised.

Holmes added local care and support providers ‘needed to be around the table', commenting: ‘Holding them at arm's length and just managing them through a contract is not the answer.'

ICBs

The ADASS president noted the ‘disruption' to effective integration between local government and ICBs caused by the latter's restructuring.

‘The NHS will need to own it's not supported the organisational development of its commissioners for a large number of years in a systematic way,' he added.

‘They have been kicked about like a football but not had much support about the clarity or the capability required to do their jobs.'

Holmes added that NHS England appeared to be addressing this, commenting ‘that needs to happen or these people will be set up to fail again'.

The ADASS head identified the removal of ICBs from the convening space in local partnerships as another key change.

‘It feels logical that people would expect their hospital, community health provider and their council to be able to convene good quality, productive, honest conversations without having their ICB to be there,' he said.

Holmes also highlighted the need for NHS England to ‘follow through' by resisting the need for ICBs to ‘rush in' to the convening space as soon as there was pressure on urgent and emergency services.

He commented: ‘We need to support our ICBs to be strategic commissioners alongside councils and also to make sure we get our health providers alongside our other social care, council and voluntary community sector working together as a vibrant partnership without the ICB having to do all that.'

When asked if ICBs and local government should work towards joint health and social care commissioning, Holmes stressed ‘there should always be jointness about commissioning'.

‘Any council will have a relationship with the local hospital and local health providers that might well include some contractual elements,' he observed.

‘Similarly, the ICB has significant relationships with adult social care providers through people that the ICB might place with CHC arrangements or mental health aftercare arrangements.'

Holmes said people were witnessing a contraction in CHC eligibility and an ‘increase in adversarial behaviours where you might expect to see more joined up activity between councils and ICBs'.

‘There's always a need for jointness,' he noted. ‘Whether there's a need for a formal integrated arrangement, I think form follows function.

‘If you can get the relationships right and if there's a logical structural development that comes out of that, then by all means, but don't lead with governance and structure charts because if you lead it organisationally you lose the authenticity about what needs to work well.'

Holmes said less NHS CHC commissioning was a financial problem for councils but also a problem for people with very complex care and support needs.

‘You have also got the issue of free point of need care being means tested by the council,' he added.

‘It's not about public sector bodies fighting over who pays, although it is an existential issue for councils due to the degree of increased pressure that they are experiencing, but the most important impact is on local people and local care providers who are again stuck in the middle of this.'

Holmes said a lot of people end up receiving CHC after coming out of hospital who needn't have gone into hospital, noting there was a ‘virtual cycle here that we could get into'.

Casey Commission

The ADASS president said Baroness Casey had made a ‘really strong start' in her review of social care.

‘People know that adult social care needs to be sustainably funded and understood as quickly as possible so we're not going to wait until 2028,' he said.

‘There's a reason our campaign is called "Care Can't Wait".

‘There's no-one we could have better than Baroness Casey but the quicker we see these things coming to a head in an admittedly really difficult financial climate, the better.'

Holmes added it was really important to support the Fair Pay Agreement in principle, adding the ‘amount of money national Government can put into this will determine the degree and speed of implementation'.

The ADASS chief added it was also ‘very clear that local government cannot bear hidden costs of this implementation'.

He commented: ‘We need to make sure that we're very in lock step alongside central Government around sustainable, well-targeted funding so that the principles aren't defeated by the implementation.'

National Care Service

Turning to plans for a National Care Service, Holmes said: ‘I think we can all relate to the idea there should be a well-funded adult social care approach nationally and standards need to feel consistent but there needs to be much work done about what that means.

‘We don't want a vanilla approach that doesn't recognise the strengths and the national variations that we are proud of in our different places up and down the country.

‘The National Health Service isn't the most consistent nationally either so there will be an irony if we are holding the National Care Service up to a standard the NHS is not reaching.'

When looking at the prospects for social care funding reform, Holmes noted the ‘difficult climate' while concluding: ‘The Government will be aware that we are missing opportunities both for adults of all ages to make contributions to their society they could make if they had the support to do that.

‘And we're missing opportunities around growth in our economy through supporting older people, disabled people and the workforce that they depend on.

‘It's a pretty big mission and we're aware that national Government have got a lot on but we don't think they'll want to duck it.'