Echoes of a decade ago

When the care in the community policy was
introduced 10 years ago, it was accompanied by the useful fiction
that services would be “needs-led” rather than “cash-limited”. It
turned out to be little more than a pious hope, as the thousands of
social care workers who pursued the ideal of full implementation
found to their cost.

Although the government has studiously avoided
the jargon of needs-led services in its current proposals on paying
for long-term care, some of them have the same hollow ring.

The Scottish executive has certainly made a
better fist of the proposals than its counterpart in Westminster.
The maximum of £90 a week that older people in Scotland will
receive to pay for personal care will cover 15 or more hours of
support, and go a long way towards meeting people’s needs. What’s
more, it will be £90 more than older people in England and
Wales receive for personal care.

But the £65 that the Scots will get for
the other crucial component of care – nursing care – is nowhere
near enough and will actually be £20 less than the average
south of the border. These figures should be seen in the context of
a survey by the Registered Nursing Home Association which indicated
that nursing costs for very dependent patients could be as high as

There is an important difference, however,
between the Scottish and Westminster governments. The Scots have
promised to put £125 million towards the expense of long-term
care without making an unfair distinction between nursing and
personal care.

The Westminster government’s cynical
insistence on that distinction, such that one should be financed
centrally and the other not, raises the question of how much the
resulting extra layer of nursing assessments in England and Wales
will cost. £125 million, perhaps?

– See news story page 7

Death threat

Dire warnings of a crisis in social services
due to a lack of resources filled the press last week. The
government heard that a phenomenal increase in care orders has
placed unbearable pressure on departments with the result that
children at risk could die.

Calls for increased resources are a regular
event. But this time the Association of Directors of Social
Services president Moira Gibb went straight for the worst case
scenario by warning children might die in the week before the start
of the Climbie inquiry, and succeeded in grabbing the

At last, social services leaders are speaking
out about the pressures their staff face in a way that attracts
media attention. And the public is getting the true story on child

Cynics might argue this approach is an attempt
to deflect likely criticism arising from the inquiry. But social
services cannot be expected to cope with staggering increases in
demand without a substantial boost to their resources. Another
cynical view might be that social services directors have nothing
left to lose so can resort to plain speaking.

The only question is: will the government


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