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The price of efficiency

Posted: 02 June 2005 | Subscribe Online


"Cost-neutral" was how the government described funding for the ambitious proposals set out in the adult green paper. "On the cheap" was the phrase preferred by many commentators. Liam Byrne, the new health minister, has belatedly promised to lobby for more money during next year's comprehensive spending review, admitting that there are all manner of cost pressures in need of attention.

It is questionable whether these cost pressures will be eased by the Gershon savings now being implemented across the country. Three-quarters of the "efficiency and effectiveness gains" made this year will be straightforward cash savings and some £260m of the £1.1bn total will come from social services, according to a new report from the Institute of Public Finance. It is encouraging that the IPF finds local authorities taking a strategic approach to efficiency savings, particularly as this includes a more positive attitude to independent living and direct payments, both of which are often honoured in the breach rather than the observance. The fact that, a decade after the first direct payments legislation was introduced, fewer than 20,000 service users receive them testifies to the lack of enthusiasm in local authorities.

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Two other trends picked up by the IPF will require more careful handling. Many councils, including some of the old refuseniks, are talking about re-commissioning services from the private sector, in line with developments in the health service. But they will have to ensure that the long-term costs of more private sector involvement do not outweigh the short-term gains, a factor which has begun to complicate the pursuit of "choice" in the NHS.

Second, local authorities have begun to review the skill mix of their workforces, once again following the example of the health service where nurses have been skilled up to relieve pressure on junior doctors and health care assistants likewise to perform some nursing tasks. If the result is that qualified social care practitioners are freed to spend more time with clients, there is much to be said for it. But it must not be an excuse to dilute the social work skills base of the workforce.

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Just as important, the cashable portion of the £180m efficiency savings which have been scraped together from adult social care must be put back into front-line services. That will begin to replace the government's cost-neutral dreams with the sober realism that implementing the green paper will require.

 



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