A cross-party group of MPs that has been scrutinising the draft care and support bill is warning of trouble ahead. (Guardian 19/3/2013)
In particular the group cautions that:
- ‘We are not confident that ministers have yet fully thought through the implications for local authorities of these changes.’ [Colour me unsurprised!]
- The proposed greater roll-out of capped Personal Budgets (aka ‘cash for care’) will result in a ‘deluge of disputes and legal challenges’. [About time too that people started waking up to the harsh reality of social care delivered according to assessed need being turned into a means-tested welfare benefit.]
- There doesn’t appear to be sufficient funding or resources to make the transition to a new system of working and then to deliver that system over the longer term. [Willing the end but not the means perhaps Whitehall’s most besetting sin over many a decade.]
- Without greater integration between health, social care and social housing the whole system is unsustainable. [Given that everyone has been saying just this for at least the last twenty-five years two questions arise: if it hasn’t happened by now will it ever; if it hasn’t happened by now and the system survives is the proposition true?]
- Improved and strengthened safeguarding measures are needed to protect adults at risk of harm or exploitation, including ‘explicit responsibilities’ for local authorities to prevent abuse or neglect. [Anyone who has raged and railed about the increased risks of ‘hate’ or ‘mate’ crime cheerfully and willfully ignored by proponents of personal budgets is entitled to scream very, very loudly in impotent frustration. As for Councils having ‘explicit responsibilities’ for safeguarding – that is the law as it stands; not implemented maybe, but such statutory duties and powers do exist already.]
So far so ordinary I fear. Any commercial venture that tried to run its business with the strategic ineptitude of the Department of Health would be dead in the water ‘ere Michaelmas. What particularly strikes though are the comments by Paul Burstow, the chucked out ex-Care Minister and now chair of the joint scrutinising committee. Bear with the extended quotation. Old hands will find so many hoary old friends in my italics:
“We need care and support to be more focused on prevention and more joined up with health and housing. There is much in the government’s draft bill to welcome – it cuts through a complex web of arcane legislation that people struggle with. But there is room for improvement.
The government must take stock of its funding for adult care and support and think seriously about whether the transformation we all want to see can truly be delivered without greater resources.
There is a growing imperative to join up services so they fit around people’s lives and make the best use of resources. The whole system must shift its emphasis away from crises and towards prevention and early intervention. The draft bill helps, but we believe it could do more.”
Listen also to Stephen Dorrell, chair of the Health Select Committee speaking in a similar vein:
“It’s unlikely that public expenditure on health and social care services will increase significantly in the foreseeable future. This means that the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration.
They need to respond to individuals rather than expecting individuals to find their way round a bewildering range of specialist departments. To make this ambition a reality, we need to develop a much more joined up approach to commissioning health and care services; we propose that responsibility for this process in a given area should be vested in the health and wellbeing board.
Joined-up commissioning would ensure that resources are no longer treated as ‘belonging’ to a particular part of the system, but become shared resources to use more efficiently to develop and deliver a more flexible and responsive local health and care services.”
Is there really anything to argue against in what Messrs Burstow and Dorrell are advocating? In detail perhaps yes, but in principle no. Sound thinking, sound reasoning. But the yikes! moment, the for heck’s sake let’s get down pub imperative, is that these are precisely the same sentiments, wishes and intentions that successive governments have been trumpeting for year upon year upon national policy framework upon new strategic direction upon Great Bloody Leap Forward.
Any sentient, visiting alien reading that would have to ask: “If it’s all so necessary, if it’s all so obvious, if it’s all so agreed, if it’s all been proposed for decades – why then hasn’t it happened? And if it hasn’t happened by now, will it ever or will it always be ‘jam tomorrow’?”