How to protect vulnerable services

Cuts are coming and, with an end to ring-fencing, services are at risk. A “whole area” approach  may help them survive

In a headline-grabbing speech earlier this month David Cameron warned that the UK’s “whole way of life” will have to change as we face the most drastic cuts in a generation.

He intends to put cabinet members before a “star chamber” to justify their budgets to a group of ministers and senior civil servants at regular intervals.

In the Queen’s Speech, the government said it would ring-fence NHS and school budgets.

This can only mean that the design and delivery of social care will therefore have to be framed in a new and necessarily more austere environment.

It will put intense pressure on existing partnerships. It will force local authorities to take money away from early intervention programmes for children and prevention work for older people.

There are also fears that a move to the Canadian model, where services are forced to compete with each other for funding, could lead to cost shunting between the very agencies that should be providing joined up services.

Many economists, and even Nick Clegg before the election, have called for an end to protecting “loved” services, such as hospitals and schools at the expense of “unloved” services such as social care.

Nevertheless, a cautious welcome should be extended to government moves to dismantle ring fences around more than £1.7bn of grants to local authorities which should give councils greater flexibility locally.

But there is a danger that this too will mean that funds could be diverted from the most vulnerable, such as children in care and those reliant on youth services.

Local decisions will remain crucial in this new environment. Councils need to resist the temptation to chip away at each service, imposing general staff freezes and so on.

So far the government has been silent about the operational aspects of children’s social care. But it cannot ignore the figures that are coming out. Last month the Children and Family Court Advisory and Support Service (Cafcass) reported the highest care demand figures ever recorded for a single month.

Comparing the whole of 2009-10 to last year’s figures, care demand was up by 34%.

However, if we reject ring fencing, salami slicing and the Canadian model, it really only leaves one solution: we need more efficiency. We need a radical shift of focus and resources in the NHS from acute care to preventing ill health in the first place and a shift from taking children into care to supporting families to take better care of them earlier on.

The key performance issue is about doing more with a lot less money. One answer is to make local decision-making more effective by giving councils the responsibility for all local public spending by using a Total Place model.

Currently being piloted in 13 areas, it looks at how a “whole area” approach to public services can lead to better services at less cost. It seeks to identify and avoid overlap and duplication between organisations – delivering a step change in both service improvement and efficiency at the local level, as well as across Whitehall.

Eric Pickles, the communities and local government secretary, has confirmed his support for this work, but has renamed it Place Based Budgeting. There will not be a roll out – instead the message is “get on with it!” It is to be hoped that this proves an effective way of making radical reductions in spending – whilst continuing to protect the most vulnerable children and adults.

Jasmine Ali is head of the Children’s Services Network at the Local Government Information Unit

This article is published in the 17 June 2010 edition of Community Care magazine under the headline Greater Efficiency is the Way to Protect the Vulnerable