Editorial Comment: Running out of options

The final report from the Lyons Inquiry calls for the government to lead a “clear national debate about how we want to manage social care for older people”. It argues that councils have much of the responsibility for managing funding pressures but with limited means to cope with them. The report recommends, for example, reducing specific and ring-fenced grants to give councils more flexibility to respond.

Further evidence comes in the shape of an unrelated report on the rising cost of social care for adults and older people in London.

It estimates that, by the next spending review in 2010-11, the total cost will be £3bn if services are maintained at current levels. In 2005-6, it was £2.3bn.

Average unit costs of care in London are 18 per cent higher than the national average, and social services departments already face an average budget deficit of 5.7 per cent.

The report also predicts that costs will rise by 5.5 per cent a year due to further demographic change, rises in assessments and home care, and more expensive staff and property. And this is after efficiency savings have been accounted for. There’s also more risk of cost-shunting in London.

But when it comes to social care, the councils concerned have little capacity to respond. Education budgets are now ring-fenced and council tax is capped. Inevitably, the one realistic option is to tighten eligibility criteria and restrict access.

Improved commissioning by councils and PCTs could go some way to ­easing cost pressures, but it’s unlikely to be enough on its own.

While political reaction to the Lyons report has been lukewarm, we need to force the agenda and raise the profile of the debate. Social care is likely to receive a tight settlement in this year’s comprehensive spending review and, if we’re not careful, we could find ourselves working in a system for adults and older people that only accommodates those with acute needs. CC

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