news analysis of local authority warning that NHS reforms will fail without extra cash

Social services and local authority chiefs said last week that
without substantial new government investment in social care the
planned NHS reforms will fail. Janet Snell

Prime Minister Tony Blair and health secretary Alan Milburn
hinted last week that the NHS is set for another big cash boost in
April’s budget. This came two days after senior local
government figures called a press conference to warn that social
care services will be in “jeopardy” unless substantial and
immediate investment is made.

The press conference announced the findings of a survey by the
Association of Directors of Social Services and the Local
Government Association, which found a £1.2bn shortfall between
what the government makes available and what local authorities
need. Some two-thirds of this financial black hole lies within
children’s services where there is a projected overspend of
69 per cent, while learning difficulty services and older
people’s services face overspends of 19 per cent and 12 per
cent respectively.

Given the current focus on the Victoria Climbie case and the
apparent failings in the child protection system, a £700m
shortfall in funding for children’s services – driven by the
“remorseless rise” in the number of children in care – ought to
have prompted some sort of reaction from government. But Milburn
and his health colleagues do not appear to have shifted their
attention from trolley waits, “bed-blocking” and NHS waiting

ADSS president Mike Leadbetter believes, however, that the
government has not fully grasped the fact that unless it stumps up
the cash for adequate funding of social care its plans to reform
the NHS will fail.

He says: “It’s true that social services have had
increases, but compared to the huge sums poured into health they
have suffered. Unless funding in social care matches health you
just can’t provide a service.”

Rob Hutchinson, ADSS children’s services spokesman, adds
that it is not just a question of NHS services relying on a
properly funded social care sector. “New initiatives like Sure
Start and the Children’s Fund will suffer too if other parts
of the system that provide services to children are under-funded.
It threatens the integrity of so many of these new preventive

The survey also found that 68 per cent of local authorities are
restricting eligibility criteria for services in an attempt to
contain demand. Only people in the most acute need are now
receiving a service.

It also highlights concern over “unrealistic” assumptions about
the preserved rights transfer (funding of higher rate income
support for pre-1993 care home residents) to local authorities.
Councils are predicting a £56m funding shortfall – equivalent
to 15 per cent of the preserved rights allocation for 2002-3,
excluding care management.

Another issue is that councils lost £36m more than they
expected when the National Care Standards Commission took over
inspection and registration.

So the financial picture for local authorities in general and
social care in particular is a grim one, and the local authority
sector comes out very much the poor relation to health.

Even when the government has come up with more money for social
care in the shape of the £300m “cash for change” funding –
announced last autumn to ease so-called “bed-blocking” – there was
no indication whether it was a one-off payment or a regular

This made it very hard to plan during the current round of
setting local authority budgets. Many councils have proceeded on
the basis that more cash for change will be forthcoming, but if it
is not they will be in even deeper trouble.

No one denies that the health service needs more cash too, but
if the government is serious about its pledge to engage in
“joined-up” thinking it needs to do more to promote joined-up
public services. And unless there is a more balanced approach to
funding health and social care, the NHS Plan will go out the window
and the whole system could grind to a halt.

Councils’ WISH-LIST

In June’s comprehensive spending review, the ADSS and the
LGA want:

– More cash for children’s services.

– An urgent review of preserved rights funding.

– A review of the funding assumptions around the National Care
Standards Commission.

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