Ideals do not end crises

Two
of the landmark social care white papers of the last decade – Caring for
People, published in 1990, and Modernising Social Services, in 1998
– were in broad agreement on the principles that should underpin the care of older
people. In the words of the latter, setting out the vision of the new Labour
government, services for adults should aim for "independence, consistency,
meeting people’s needs". These objectives neatly summarised the governing
ideals of the community care reforms introduced in the early 1990s.

Yet even nine years after local authorities
first took charge of community care funding, these objectives remain a mere
speck on the horizon. Just how far there is to go is shown by this week’s Nothing
Personal report from Help the Aged: a disproportionate share of resources
continues to go into hospital care, overstretched local authorities cannot cope
with demand, services are inconsistent between one part of the country and
another, and only those older people in the greatest need can expect any
support.

The problems have been exacerbated by the
continuing heavy dependence on residential care and nursing home services. The
enormous upward pressure on fee levels has caught councils in a bind – either
they keep the lid on them, resulting in an ever poorer quality of service to
clients, or the cooker explodes, as it has done in the Isle of Wight. There the
council was taken to court for failing to pay a home owner at the commercial
rate. The court ruled in the home owner’s favour, a decision that is likely to
open the floodgates elsewhere in the country.

However, it would be wrong to blame
independent sector care homes for the current crisis. Their desire for higher
fees is largely a just one and not a sign that they are universally on the
make. Help the Aged rightly points to the chronic inadequacy of funding for
community care – this is as true of this government’s failure to fund the
aspirations contained in Modernising Social Services as it was of the
Conservative government’s failure to fund those in Caring for People.
Local authorities must certainly be more imaginative about the range and choice
of services they offer to older clients, but it is also imperative that the
chancellor of the exchequer puts community care funding at the top of his
priority list in the forthcoming comprehensive spending review.

No need for revolution

A
powerful coalition involving all the main agencies involved in child protection
has spelt out ideas for improving services, which should form the core
recommendations of the inquiry into the death of Victoria Climbie.

It would be easy to recommend a radical
solution, such as a new national child protection agency, but we must hope this
influential statement will make structural overhaul easier to resist.
Widespread organisational change would be a disaster. It destroys crucial
networks between organisations and individuals. Reorganisation decreases staff
morale and therefore intensifies recruitment problems and damages practice. The
current system, with its separate lines of professional accountability, works.
It needs improving, however, and the coalition has clearly outlined where and
how.

Community Care fully supports the coalition’s proposals: a
set of agreed outcomes in child protection work covering all agencies,
inspections of joint agency work, and the closest possible joint working of
front-line professionals without merger. We also support its call for area
child protection committees to be strengthened and given statutory force.

It may not suit a soundbite, but it can work.
Importantly, it builds on the best work that now exists, with no need to go
back to the drawing board.