CP Snow famously wrote about the “two cultures” of science and literature, each in its own bubble. There is an analogous case in social care: the culture of those who make policies and the culture of those who implement them. The health and social care white paper hopes to usher in a golden age of community-based, preventive services, where people’s needs are met or better still forestalled close to home. That, at least, is the policymakers’ dream. The reality on the ground is rather different: cuts and more cuts.
Our survey this week tells of a budget crisis that is probably among the worst ever, particularly when put together with the NHS’s continuing struggle to make ends meet. Most of the adult social services departments in our sample were cutting services, raising thresholds, increasing charges or making redundancies. More than half had been forced to plug the gaps left by health service cuts. One council said it had had to bail out the NHS to the tune of £6m, an experience that is likely to be replicated elsewhere as health runs up a deficit that could reach £1bn.
It would be easy to blame profligate public services that have enjoyed yearon- year spending increases of 4 per cent or more – much more in the case of the NHS – through this decade. But it would be unfair. Rising expectations, longer lifespans, more sophisticated treatments, the vagaries of council budget allocations and the costs of restructuring are all part of the picture. In consequence, services integral to the white paper’s vision – such as respite care for disabled people in Northamptonshire – are threatened with closure.
One symptom of the budget crisis is the renewed pressure to purchase services on the cheap. Internet auctions, in which the bids are public and the lowest wins, are the latest wheeze for driving down prices. The emphasis purely on cost, rather than cost-effectiveness, revives memories of compulsory competitive tendering with all its attendant evils. It favours corporate providers able to offer loss leaders over smaller rivals, a trend that is likely to continue as government spending on social care slows over the next two years.
Care services minister Liam Byrne says he wants the NHS to invest in social care – surely a vain hope in the current climate. Someone should tell him what’s really happening before his policymaker’s bubble floats off into the stratosphere.