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The recent comprehensive spending review confirms social care as the cinderella of front-line services. While a sma...
The recent comprehensive spending review confirms social care as the cinderella of front-line services. While a small sum of hypothecated funding has been included for joint working with the NHS, the financial deficits in many local health economies make it unlikely new money will be released for joint developments over the next five to 10 years.

Social care faces constant pressure, and is in clear danger. More children are coming into care. A high proportion require expensive placements. A 15 year old in my own council, one of a number, is in a placement costing£3,500 per week. Staff tried 55 potential placements before finding one who would take this young person. Like many such establishments, it was the best available, but far from ideal.

More people with complex disabilities need specialist placements, spend that is usually not budgeted for. And the ageing population, means a greater number of older people are needing support for longer periods, a level of demand enhanced by new longevity projections.

Older people's services are benefiting from the modernisation of social care services. Promoting independence programmes, such as an expansion of therapy services, and shifts to rehabilitation-focused home care services, can lead to substantial increases in performance and effectiveness. Pooled budgets for older peoples services, and care trusts for older people, are well worth exploring.

Children's services are a different ball game. Unlike frail older people, desperate children cannot stay in their own homes while services are developed. Breakdown is frequently immediate, even if it has been a long time coming. Delay in delivering services for older people, while appalling in human terms, is more manageable, as budgets can be successfully capped. The£3,500 a week placement would buy hundreds of hours of care and rehab for older people. Unavoidable overspends in children's services are the main reason why many councils cannot devote the extra funding received from government to supporting NHS Plan targets.

The reasons for the financial hole in children's services are threefold. First, the number of children in the care system continues to rise beyond the funded level and beyond the capacity level of the nation's stock of foster carers. As a result, expensive independent fostering agencies are providing a disproportionate number of the newly required placements.

Second, the threshold for statutory intervention has changed, as courts and agency decision makers are no longer prepared to tolerate the intolerable in family situations.

While Quality Protects funding has helped to raise standards, it is no substitute for a boost to mainstream funding, which could be announced in terms of freeing up more cash for NHS Plan targets such as reducing the national numbers of delayed transfers of care. This would be a popular move, as chronic delays in older people receiving care cannot be justified. Cinderella herself is baulking at that.

Anthony Douglas

Director of heath and social care in Suffolk CC

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