Geoff Ettridge: how to manage cuts by redesigning services

Councils must not wait for the inevitable cuts that will filter through this year but look now for less costly systems, writes Geoff Ettridge

Despite last week’s emergency Budget, we will have to wait until October’s spending review before we know the full scale of the cuts to be delivered by local government. But we know they will be significant.

It is therefore essential that local authorities and private and voluntary sector organisations do not wait for government-sanctioned cuts. They need to be working now on radical service redesign, community empowerment programmes and on identifying the flexibilities and, perhaps, statutory changes they may require to deliver their programmes.

It is also essential that local authorities remain commercially savvy but most systems underpinning care relate to contracting, reducing risk, demonstrating probity, and monitoring budgets and performance. As a consequence, considerable resources and management time are consumed and tied up in processes that are secondary to enabling someone to retain or regain their independence.

Our care systems are also largely focused on matching services with people’s physical needs. But there is credible research evidence that older people can over-present their needs in order to attract and maintain the attention of carers, and that loneliness and social isolation in later life can accelerate their decline.

At a time of crisis, practical support needs to be put in place but this is perhaps also the time for low-level casework to support clients while they make social and emotional adaptations in their lives.

The running of a commercialised care system has helped to hold down unit prices. But is it possible that a simpler, less costly system could deliver savings and enable more to be invested in casework and in paying better rates for reablement services?

Over many years reorganisations, reviews, inspections, new regulations and initiatives have brought incremental changes and adornments that have increased the cost of service provision; perhaps no better demonstrated than in child protection.

As the old is seldom removed as the new is introduced, a zero-based review of services and operational procedures could lead to operational efficiencies and service redesign. Although this should have been undertaken as part of the best value review process, it became highly bureaucratised and was not undertaken within a financial climate that needed seismic changes.

There are significant costs associated with removing all annoyances and risks from society and perhaps we will need to become more tolerant of them and local authorities a little braver.

If we are to expect communities to do more we may need to look at the responsibilities and contractual burdens we place on them. As the chair of a voluntary group, I needed to be appraised of the risks and consequences associated with health and safety, risk assessments, personal liability for the organisation’s finances, no-win-no-fee litigators, Criminal Records Bureau and Protection of Vulnerable Adults schemes. Although each body responsible for enforcing these matters claim only reasonable steps need be taken, when something goes wrong hindsight is always 20/20. This is enough to deter many from volunteering.

All of these issues show the need to introduce less complex systems and to return the focus to helping people and helping communities to help themselves. Perhaps local authorities should facilitate debates on how government could free them to more effectively deliver services and savings, and to reduce the inevitable pain. In this way the emphasis can be shifted from “destruction”, through “deconstruction” and then on to “reconstruction” – a wholly more positive mindset.

Geoff Ettridge is an independent adviser on care services

This article is published in the 1 July issue of Community Care magazine under the heading Act now to redesign services and offset impact of cuts