Stability up in smoke

It is ironic that the government should have published its vision
of the future of adult social care only days after it had torpedoed
one of the sector’s principal agencies, the Commission for Social
Care Inspection. By the time the smoke had cleared from the
Budget’s “bonfire of the quangos” just four super-regulators were
left, replacing the CSCI, the prisons inspectorate and nine other
public service inspectorates reduced to embers. For a government
intent on re-election the CSCI was a convenient sacrifice, helping
to answer Conservative jibes about excessive bureaucracy and waste.
But for social care it was a singularly ill-timed manoeuvre that
owed much more to expediency than the interests of the
sector.

Much will now depend on the way in which the dismantling of the
CSCI and the division of spoils between the Healthcare Commission
and Ofsted is managed. If the Healthcare Commission is allowed to
call the shots where adult social care is concerned, it is hard to
see how the government’s vision of the future, contained in this
week’s green paper, can be realised. The green paper, Independence,
Wellbeing and Choice, talks of giving users much more control over
their care, pooling the whole breadth of public sector resources
and the strengths of communities in more effective prevention, and
a change of role for social workers from “gatekeepers” to
“navigators”, where the emphasis will supposedly be on opening
rather than barring the way to services. As the title implies, it
draws together many of the values traditionally associated with
social work: independence, choice, inclusion and empowerment. They
are values that the CSCI would have been ready to promote, but the
same can hardly be said of the Healthcare Commission in its current
form.

Almost as soon as the chancellor sat down after his Budget speech
CSCI chair Denise Platt, barely able to conceal her fury, issued a
statement lamenting “a further period of instability” in social
care regulation. And well she might: the commission itself is less
than a year old and one of its predecessors, the National Care
Standards Commission, had existed for a mere 17 days when its
abolition was announced. The prospect of more instability, coming
at such a crucial time, explains why the CSCI’s chief executive,
David Behan, has been keen to sound more conciliatory than his
boss. He insists that it is a merger not a takeover, implying that
social care will be a prominent partner in the new regulatory
enterprise.

But it is difficult to share Behan’s optimism that social care is
“still on the pitch”. If the new super-regulator emerges as a
genuine Health and Social Care Commission, with social care more
than an afterthought as it assesses the delivery of NHS priorities,
all well and good. Behan has pinned his hopes on such an outcome.
The danger is, however, that the Health Commission will continue to
view social care as it now does, a satellite of the NHS servicing
its requirements but without any independent status to call its
own. True, more people will be cared for outside hospital. The
question is, how will they be cared for?

It is here that the high flown ambitions of the green paper begin
to sound hollow. If direct payments and individual budgets become
as widespread as the consultation document intends, professionals
and the institutions they represent will have to cede power to
service users as never before. Directors of adult social services
and their local authorities may be coaxed and bullied into doing
it, but will the Healthcare Commission insist on it? And what of
social care’s dwindling voice inside the Department of Health? The
somewhat tokenistic role of the social care tsar, Kathryn Hudson,
does not inspire much hope. Despite the absence of new money to pay
for it, the green paper is a worthy document. But this was not an
auspicious beginning.