‘Dirty hospitals are important, but excuse me!’

Dame Denise Platt is clearly disappointed that The State of Social Care in England, the Commission for Social Care Inspection’s 260-page report on the country’s social services (news, page 8, 15 December 2005), has attracted scarce attention from the national press.

It has been neglected in favour of yet more tales of dirty hospitals, even though it contains some explosive material about risks to vulnerable people and the underfunding of services. “Ministers were very jittery about it,” Platt reveals. “Isn’t this an important issue? Dirty hospitals are important, but excuse me!”

Platt, Denise 3Platt and her colleagues at the commission are shouting about the problems facing social care, yet they and others in the sector face a continuous struggle to prevent it being overshadowed by the NHS and education.

We meet just a day after the Department for Education and Skills confirmed plans to set up an inspectorate covering children’s social care, education and adult learning, but not, as Platt had desired, children’s health services or youth justice.

The CSCI’s ultimately fruitless lobbying on this issue can be seen in the context of a much wider struggle by social care to make its voice heard in central government, which could have major consequences for the forthcoming white paper on social care and health.

Platt is among many in the sector concerned by the lack of social care expertise within the Department of Health, saying only a “handful” of its 2,000 staff have a background in the field. She is well aware of the department’s workings, having been its national director for children, older people and social care services from 2001 to 2003 and chief inspector of the Social Services Inspectorate from 1998 to 2004.

“When I was at the DH and the inspectorate was part of it there were 300 people who had worked in social services,” she says. “Now their understanding of what social care contributes is quite rudimentary.

“Often it’s just seen as administering a package of services and making sure they are delivered. But people who use services also value one social worker they can go to, one social worker who understands their family, one social worker who knows why they get depressed, one who knows what they want to do in life.”

Platt believes the white paper will not contain a separate chapter on social care, and instead will be integrated with health throughout. Although this may satisfy some in social care who see a separate chapter as tantamount to marginalisation, Platt worries that an integrated approach may lead people to think the sectors have identical problems.

She would like to see it “make some of the rhetoric about personalised budgets and choice real”, and says front-line workers need to be given the freedom to use more imagination when delivering services.

She says councils create much of the bureaucracy in the system – “a lot of it is about applying for resources” – and often it can be disproportionate. “We heard from a person receiving direct payments who had got a threatening letter because they couldn’t provide two KFC receipts.”

Councils also need to make better use of the money they receive, says Platt. Although the government has provided a steady trickle of new money in recent years, service quality “has not increased commensurate to the amount going in”, she claims.

But she believes that funding is still inadequate, and The State of Social Care in England told of an under-resourced system where councils set high thresholds for people to access services. She hopes Sir Derek Wanless’s report on the long-term funding of older people’s social care, expected in March, will make a good case for more investment.

“It’s hard to escape the fact that pay and funding needs to have a thorough examination,” she says.

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