Elderly need to be protected from cuts
As local authorities prepare for the deepest budget cuts for decades, we have heard much about increasing efficiencies, joint working and rationalisation.
These are necessary moves to extract as much value as possible from every penny the public purse provides but they will not be sufficient to deliver the £3.3bn to be cut from the public services budget over the next four years.
Directors of social work must make many of the decisions that turn budget cuts from bald figures into the removal or reduction of services which directly affect individuals.
That cannot be achieved without a strategic policy, something that is alarmingly absent from the internal survey by the Association of Directors of Social Work (ADSW), details of which are revealed by The Herald today. There are proposals to close council-run facilities, including homes for the elderly and day centres, but also to reduce services contracted from external providers without any indication of how the gap will be filled.
Elderly people who need more care than can be provided at home will have to wait longer for respite care or for a residential place. Patients who should be discharged from hospital but are too frail to go home will “block” beds, lengthening the logjam in the care system. This will be further exacerbated by the growing numbers of older people, including those with dementia.
Local authorities faced with severe cuts will be tempted to ensure that as many people as possible become the responsibility of the NHS, even if that is at the cost of quality of life. This sort of pass-the-parcel approach, however, risks destroying joint working between the NHS and social work designed to improve services as well as make them more cost-effective.
Another short-term saving likely to increase expenditure in the long term is intervention work with young children to prevent family breakdown and the need to take children into care. This too often leads to other problems, including offending, with a further cost to the taxpayer.
One council suggests it is important not to waste the opportunity presented by the financial crisis for a radical policy rethink. Given the range of options suggested by different councils, from capping the cost of individual care packages and increasing charges to closing homes and relying on the voluntary sector to provide more services, there is a danger of provision varying widely across local authorities.
This is something the commission on public services set up under the chairmanship of Campbell Christie, a former general secretary of the STUC, must examine.
As the number of very elderly increases, people with profound disabilities live longer and the downturn takes its toll on mental health, difficult decisions will have to be made on how to fund services for vulnerable people from a shrinking pot of money. Simply culling the most costly will do no more than provide short-term gain with long-term pain. A policy-based, objective approach will be essential.