The price of efficiency

“Cost-neutral” was how the government described funding for the
ambitious proposals set out in the adult green paper. “On the
cheap” was the phrase preferred by many commentators. Liam Byrne,
the new health minister, has belatedly promised to lobby for more
money during next year’s comprehensive spending review, admitting
that there are all manner of cost pressures in need of

It is questionable whether these cost pressures will be eased by
the Gershon savings now being implemented across the country.
Three-quarters of the “efficiency and effectiveness gains” made
this year will be straightforward cash savings and some £260m
of the £1.1bn total will come from social services, according
to a new report from the Institute of Public Finance. It is
encouraging that the IPF finds local authorities taking a strategic
approach to efficiency savings, particularly as this includes a
more positive attitude to independent living and direct payments,
both of which are often honoured in the breach rather than the
observance. The fact that, a decade after the first direct payments
legislation was introduced, fewer than 20,000 service users receive
them testifies to the lack of enthusiasm in local authorities.

Two other trends picked up by the IPF will require more careful
handling. Many councils, including some of the old refuseniks, are
talking about re-commissioning services from the private sector, in
line with developments in the health service. But they will have to
ensure that the long-term costs of more private sector involvement
do not outweigh the short-term gains, a factor which has begun to
complicate the pursuit of “choice” in the NHS.

Second, local authorities have begun to review the skill mix of
their workforces, once again following the example of the health
service where nurses have been skilled up to relieve pressure on
junior doctors and health care assistants likewise to perform some
nursing tasks. If the result is that qualified social care
practitioners are freed to spend more time with clients, there is
much to be said for it. But it must not be an excuse to dilute the
social work skills base of the workforce.

Just as important, the cashable portion of the £180m
efficiency savings which have been scraped together from adult
social care must be put back into front-line services. That will
begin to replace the government’s cost-neutral dreams with the
sober realism that implementing the green paper will require.


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