Sense and accountability

There is apparent good sense in the draft guidance on
eligibility criteria issued for consultation by the Department of
Health. Nobody would question the underlying principle of fair
access to care services, nor the welcome emphasis on helping
individuals to retain their independence.

The devil, as usual, is in the detail. The guidance avowedly
sets out to achieve national consistency in services for adults of
all ages, but the responsibility for achieving it will lie with
local authorities. If it helps to relieve the public outcry against
the “postcode lottery”, then few will take issue with it, but no
one should forget that there is another principle at stake
here.

That principle is local democracy with services established
according to local priorities for which councillors are
democratically accountable to local people. The guidance says that
the principle must be nurtured. What it does not say is how it is
to be made compatible with national consistency in services.

Local authorities are also encouraged by the guidance to move
away from focusing services on those in the greatest immediate
need. It is the old prevention now rather than emergency
intervention later argument. Does this mean that those in greatest
need should be overlooked for the sake of those in less need?
Presumably not. It means creating services to meet a broader range
of needs. What the guidance does not say is where the money is to
come from.

Many in social care are still prepared to trust this
government’s motives. But this trust will scarcely be deepened by
guidance which so inconsistently recommends consistency to everyone
else.

A ploy to far

The refusal by private care homes in Scotland to accept the
Scottish executive’s emergency funding package is ludicrous and
dangerous.

It places local authorities and older people in an appalling
situation. If the homes carry out their threat to ban new
council-funded placements from the end of the month, then local
authorities will be forced to fall back on their own, limited
provision.

There is no doubt that the private care home owners have a
strong case. Many would agree that they are not adequately funded
for the care they provide to older people. They can rightly argue
that local authorities cost their own residential care provision at
a higher rate. Nobody would argue that it is a level playing field.
However, holding local authorities to ransom when they do not
themselves hold the purse strings is a foolish and dangerous
ploy.

The continuing dispute has already won a small increase in
funding from Malcolm Chisholm, Scotland’s deputy minister for
community care, but this continuing stand-off will fail to gain
further concessions.

Care home owners must accept the funding increase now.