04 February 2005
The Wanless franchise keeps on growing. Not content with producing two influential reports on future NHS funding and public health, the former NatWest chief executive this week announced he is turning his attention to the oft-neglected area of social care for older people.
Sir Derek Wanless's third review, launched on January 31, will again take the long view, engaging in the uncertain business of predicting what social care demand will look like in 20 years' time, what funding will be needed to match it and how that care might be paid for.
'Demand and expectations for social care services will increase and this growth may well outstrip growth in spending,' Wanless says. 'So thinking about social care policy needs to be integrated with thinking about health care policy.'
The difference with Wanless Three is the conspicuous absence of Whitehall backing. Rather than being Treasury-commissioned, the money is being put up by health think-tank the King's Fund and the work will be undertaken in collaboration with the Personal Social Services Research Unit at the London School of Economics.
The government is taking a polite interest. Social care minister Stephen Ladyman admits there are problems to be addressed and says all contributions to the social care debate are welcome.
'Meeting the care and support needs of a wide and varied population is complex. We have to find better ways to deliver care and to give people more choice and control over the care they receive,' he says. 'The government is currently carrying out a review of efficiency in social care services and the King's Fund study will complement this work.'
Wanless acknowledges that some progress has already been made in instituting a more joined-up approach to the two fields. Some of the pressures on the health service triggered by failures in social care, chiefly bed-blocking and emergency admissions, have been lifted, he says, but there is much more to be done.
Although £2.5bn was spent on adult social care in 2003/04, finances continue to be stretched. According to the Association of Directors of Social Services, the fact that people are living longer, the rise in care home fees and the costs of separating children's services from adults' have put budgets under considerable strain. The Local Government Association is predicting an additional £1.4bn funding pressure on adult social care by 2007/08 and is continuing its call for a rise in spending.
But no answers to the big funding questions are likely to emerge from Richmond House in the near future. The long-awaited green paper on adult social care is expected to confine itself more to the organisation of services rather than who pays.
King's Fund chief executive Niall Dickson believes there is a nervousness in Whitehall about tackling the issue head on and is critical of the lack of long-term policies. 'What they have done in the past few years is little more than a sticking plaster,' he says.
According to Dickson, the long overdue social care review should help to fill this gap and promises to be one of the most significant inquiries in the King's Fund's distinguished history.
'It was the missing piece in the original Wanless jigsaw and it remains one of the big unanswered policy questions. We believe this review should have a major impact on the way care and support for older people is delivered in this country.'
Wanless himself is confident that his recommendations will be taken seriously, adding that this review's independence from government is a bonus.
'I think this report could be very influential. We have no constraints on the scenarios we can look at,' he says. 'We will be opening up all kinds of questions.'
He adds that ministers cannot ignore the vexed question of social care funding forever. 'Along with pensions, these are huge issues and I think this review is timely.'
Social services directors have praised the review as a 'bold and imaginative' step. ADSS president Tony Hunter says: 'This review, with its potential to cost emerging models of care planning and provision, might help expose some of the weaknesses in our budgetary position and encourage central government to help us overcome them.'
PFfeb2005
