Last chance saloon

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.

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