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What's wrong in Wales? Quite a lot, if recent reports, joint reviews and inspections are to be believed.

It started with Learning the Lessons, a summary of the key issues from the first six joint reviews in Wales, which concluded that none of the councils involved were serving most people well.¹ In July, an Audit Commission review of all public services in Wales found that social services provision was "worrying".² Last month, Pathways to Improved Social Services in Wales, an overview of eight joint reviews, concluded that most were "struggling to put in place consistently good social services" and worse, that "prospects were judged as less than promising in six of the eight councils reviewed".³

In between, Cardiff had been named as one of the worst three social services departments in the country, lambasted for failing in its statutory obligations to children and vulnerable adults in its care and exposing them to "unacceptable risk". The joint review team said that there was "a widely held view that a macho management culture had prevailed for many years" which was contributing to the council's difficulties, and concluded that there were poor prospects for improvement. Cardiff has been given six months to improve. If the inspection team sent in next spring is unimpressed with progress, the Welsh assembly may take the drastic and unprecedented step of taking over the running of the department under the powers introduced by the Local Government Act 1999. The prospect is remote, but real.

In response to the crisis, minister for health and social services in Wales Jane Hutt took the opportunity at October's National Social Services Conference in Cardiff to launch what looked like significant increases in social services spending. She announced that the Welsh assembly had, as part of its draft budget, agreed to increase Welsh authorities' "ability to spend" on social services by £230m a year in cash terms by 2005-6. Listening directors were initially hopeful that this increase would address some of the underfunding of social services that has plagued Wales and meet some of the impending budget crises they were predicting.

But as always with government budget announcements, the reality is a little more complex. Colin Berg, corporate director of social and housing services for Monmouthshire and chairperson of the Association of Directors of Social Services resource group in Wales, says: "When we put together the expenditure bids with the Welsh Local Government Association we wanted to reflect the fact that social services in Wales were overspending by about £9m a year. We identified a number of real pressures on services, mostly related to children's services and services for people with learning difficulties. In fact we found that the overspends would have been higher but for the fact that there were a number of long-standing vacancies because of the recruitment crisis."

He says that the initial response to the budget was that it looked very hopeful. It contained figures that seemed to be similar to those of the ADSS and Welsh LGA. But the money is weighted to the second and third year."The announcement of a 6.2 per cent increase in funding for next year is all very well but, when you work out all the things like preserved rights that we are having to take on, that increase works out to be 3.3 per cent next year - which will not meet our inflation and pay increase costs.

"The bottom line for next year is disappointing - it doesn't address the specific pressures that we raised with the assembly. Also there are a number of funds included in the assessment that are simply special grants that have been made permanent - that's not new money. It does leave us with anxieties in relation to things like funding residential and nursing home fees. For those it's a standstill budget-line."

Berg says that the increased funding in years two and three will help. But he adds: "There are dedicated funds in year three for children's services, but they are coming on line at the same time as the Adoption and Children Act, new child and adolescent mental health responsibilities and new services for disabled children. A lot of things have to be delivered with that new money."

He also points out that Hutt committed herself only to "increase social services' ability to spend" by £230m a year. This, he says, suggests that little of the extra money will be hypothecated funding, so councils will receive the money but they will not necessarily have to spend it on social services. Unfortunately successive inspections and reviews have highlighted the fact that council leaders and elected members in Wales have historically regarded social care as a low priority and as a cost, not an investment. Social services may still have a political fight on their hands to ensure the money comes to them, rather than being swallowed by other priorities.


But it is too easy to write off Welsh social services as a pitiful failure. Bruce McLernon, director of housing and social care for Carmarthenshire, says: "In some ways the joint reviews have been putting down Wales unfairly - there's a lot of really excellent innovative work going on, particularly around learning difficulties and children. There is a lot of good practice and some really committed staff. I think other areas which haven't performed so well have dragged the whole lot down with them."

Although inspectors are highly critical of services, the people who actually use them think they are great. According to Pathways to Improved Social Services in Wales, "most users rate services as excellent or good". McLernon agrees: "We had an inspection which found that 87 per cent of our service users felt the service they received was excellent. But I think a lot of it comes down to low expectations - for years we've had a lack of investment and people have been very happy with whatever they have been given. That's not a good enough benchmark."

But McLernon and others are proud of the direction in which Welsh social care is moving. For instance, rather than the English star-ratings system with its "naming and shaming", Wales is setting up an alternative performance evaluation system based on self-assessment and backed by external evaluation.

In contrast to English councils, Welsh social services will not be subject to fines for bed-blocking, and are not subject to the Best Value regime. The 22 new health boards being set up in Wales will have a key seat reserved for the director of social services. And these boards will be expected to co-operate closely with local authorities in the drawing up of new "well-being strategies" for health and social care - local plans within which health and social care will be commissioned and delivered by 2005.

In the shorter term, Derek Wanless - who conducted an influential report into long-term health care provision in England⁴ - has been drafted in to conduct a similar review in Wales. No timescale for the review has been announced, but it is to the Welsh assembly's credit that it has learned from England's mistake and asked him to look not just at the future of health care, but at the crucial relationship between social services and health. Perhaps there's hope for Wales yet.

¹ Audit Commission, Learning the Lessons of Joint Reviews of Social Services in Wales 1999-2000, Audit Commission, October 2000.

² Audit Commission, Delivering a Better Wales, Audit Commission, July 2002.

³ Joint Reviews, Pathways to Improved Social Services in Wales, Audit Commission and Social Services Inspectorate for Wales, October 2002.

⁴ D Wanless, Securing our Future Health: Taking a Long-term View, Department of Health, March 2002.