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Although the Financial Times had what turned out to be a very authentic leak, the proposal to 'incentivise' dischar...
Although the Financial Times had what turned out to be a very authentic leak, the proposal to 'incentivise' discharge of people medically fit for discharge from hospital was nevertheless something of a surprise.

The Association of Directors of Social Services welcomes the additional 6% increase announced in the budget although, as the Local Government Association has pointed out, 4% of that had already been signalled in the forecast spending plans released by

the Treasury.

The LGA/ADSS treasurer's survey of February 2002 indicated a shortfall in social services budgets of around£1bn. The actual increase year-on-year totals£1bn. It is however not as straightforward as that. This headline figure includes inflation and money which was 'expected' in 2003/04, following on from previous announcements. Nevertheless, a 6% real terms increase is good news.

The government's major priority is very clearly the NHS and this means achieving targets on waiting times.

Nevertheless, there are key questions to be asked and answered if the proposal to introduce legislation to fine councils for failing to discharge is going to be implemented without perverse incentives.

First, there must be sufficient money in the system. A worst-case scenario could be where councils are fined thereby reducing the cash available to spend on services. In this scenario it would be a case of local government financially supporting the NHS - this is surely not what is intended.

Second, we need answers to questions regarding what happens if there are simply no residential or nursing home places available, or staff to provide home care packages. What happens if extensive house alterations are needed and the person is a homeowner? Or the council's housing department has a backlog of adaptations and shortage of resources?

What happens if there are maverick consultants who make inappropriate decisions to discharge people early as a way of meeting their targets? This occurs now, so, surely, the introduction of fines makes this more rather than less likely to occur. We are therefore interested in how the government plans to make sure that inappropriate early discharges do not occur.

We are still awaiting guidance on precisely how the increased resources are to be split between children's services - the side of our budgets

which February's survey showed was under most pressure - and services to adults.

What is of overriding concern is not so much the way in which proper resources are targeted to groups and individuals most in need, important though that issue is. More important overall is to ensure that, however the cake is cut, it is of sufficient size to cater for those most

in need.

What we perhaps need in this case is a debate about the general principles, even though holding to general principles when there is so much political capital resting on the success or failure of the NHS is probably a bridge too far.

Michael Leadbetter

President, Association of Directors of Social Services

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