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Two decades lost waiting for Dilnot

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Much has been said in recent weeks of the ‘graph of doom’.

It took me back to 1989 in East Sussex when I was employed to introduce Community Care legislation which would (from memory) solve the funding crisis in Care of the Elderly … amongst other things. What was abundantly clear is that one could utterly predict the future trajectory of demand and the need for a national solution. At local levels, local government was pretty efficient at reducing runaway budgets which had featured in the system we inherited from the then DHSS. We did well. 

What did not go well was the ownership at a national level of finding a permanent solution for an absolutely predictable demand curve. So, 23 years later when presented with the ‘graph of doom’ which anticipates the possibility that by the end of this decade, top tier local government will be spending over 80% of its service activity on social care and the environment … we should not be surprised. All the other services may be squeezed some into priority oblivion. 

When looking at the national Government ‘efficiency’ agenda, the political rhetoric is focussing on the squeezed minority of services. Indeed, statements around the eradication of unnecessary costs by taking out back office activity and central services when one looks at the graph, demonstrates how little is understood as to where the big solutions really must be found.

Or is it avoidance?

If Dilnot won’t do, something else must be done to tackle these pressures. We appear to have lost at least two decades of possible action to address demand. I sit reflecting this with my mother in her nursing home where it is patently obvious that costs are being depressed to a minimum. We’ve been good in local government at keeping purchased care costs down … perhaps too good as we deflect the urgency with which the overall system needs addressing. 

I think about my expectations for what I might require in the future and whether this graph might finally shed light on the fact that doing nothing is now no longer an option.

Jim Graham, chief executive, Warwickshire CC

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Readers' comments (1)

  • Jim, I totally agree with your reflective comments. Delay on this issue not only increases the cost of the solution but heaps misery and distress on older people, their families and the workforce.
    However I wonder if the point you raise in your last paragraph - what we might all require for our futures - is currently excluded from the policy debate about funding and organisational forms. The sector and government are focussing onh the real and immediate problems of increased need and decreased funding rather than the broader question of what kind of life do we want for ourselves and our relatives and friends.
    Local government - particularly now it is inheriting new responsibilities for health and wellbeing can be in the forefront of this wider and longer term debate.

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