12 January 2007
The social care inspectorate has called for an urgent national debate into whether or not the state should continue to provide preventative social care to disabled and frail adults.
The call comes as the Commission for Social Care Inspection confirmed that two-thirds of councils in England now provide care services only to those whose needs have been assessed as 'critical' – typically the bed-bound.
Funding constraints and rising demand mean that the majority of councils no longer provide, whether free or for a charge, services designed to stop vulnerable people's conditions deteriorating further, such as help with meals, washing and dressing, the CSCI has found.
'That means we're seeing a shift away from services funded and arranged by the statutory sector to more responsibilities being placed on individuals and families,' said commission chair Dame Denise Platt. 'That's happening by default, it's not being debated.'
At £30,000 a year for an average care home placement, the financial consequences for individuals were huge, but people turned away by councils were often just handed a list of private providers, with no formal infrastructure in place to advise them of their needs and best options.
If councils were to continue restricting care to only the most critical cases – as Local Government Association projections envisage – then they should at least improve the information and support they give to informal carers, said Platt.
But she denied this meant the CSCI was letting the government off the hook by implying the recent tightening of eligibility criteria should be made permanent.
Speaking on January 10 at the launch of The state of social care in England 2005/06, she told Public Finance: 'We are drawing attention to what is currently happening in the hope that those things can be more openly discussed rather than just happen.'
She added: 'It may mean councils need more money, but there needs to be a debate now.'
She echoed Sir Derek Wanless in his care funding report last year when she said that one option might be the development of 'a new partnership with the people who use those services about how those costs can be shared'.
She added: 'This isn't just about looking at the system as it is. We need to have a debate about what are the individual's responsibilities for their own care, the state's responsibility and how councils organise that, and what are we expecting people to pay for.'
The Liberal Democrats, Age Concern, the LGA and the Association of Directors of Social Services added to the call – which ADSS president John Coughlan said could be a 'turning point' for the sector.
A spokeswoman for the Conservative Party said it would not yet call for a debate in Parliament as it had not costed the various options and so did not know what its policy would be.
A Department of Health spokesman said it was 'concerned' about rising eligibility criteria. 'Local authorities need to put a greater emphasis on preventative services – helping people with lower needs to avoid admission to hospital or residential care,' he said.
But Coughlan told a CSCI conference to launch the report that there was now an 'intolerable strain' on care services. He hoped that the message would be picked up by the Treasury as it prepared its Comprehensive Spending Review.
Platt was less hopeful, however, and set her sights for change further ahead. 'If this CSR is going to be as difficult as people say, then we need to put in place plans now for the next Spending Review,' she said.
She added a plea to the chancellor that he give as much attention to social care for older people as he had to lifting children out of poverty. There was a 7% real-terms increase in spending on children's service in 2005/06 but only a 4% increase in adult services. That reflected political priorities but meant that resources invested in children were then 'dissipated' when they moved into adulthood, she said.
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