Public Services Management: Community careworn: Paul Gosling on how councils will cope with new responsibilities

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The Independent Online
FROM 1 APRIL local authorities take the key responsibility for implementing care in the community. Many people previously in residential care are now being looked after 'in the community' - meaning in their own homes, or looked after by carers, or where they themselves choose to live.

This primarily affects the elderly, people with disabilities, with learning difficulties, with drug or alcohol addiction, or with a terminal illness. Social services authorities will be required to assess the needs of service users and to provide for them, based on that assessment. To pay for community care, local authorities will receive ring- fenced grant, transferred from the Department of Social Security, 85 per cent of which must be spent in the private and voluntary sectors.

Councils have bullishly claimed that all will be well and that legal obligations will be met. But dire warnings have been issued by charities, trade unions and health service professionals. The Institute of Health Services Management (IHSM) last week launched a withering attack on local authorities' state of preparedness. The IHSM, while recognising that some local authorities would take on their new responsibilities efficiently, suggested that others suffered from a failure to prepare properly and a resistance to the new system.

The comments came in a submission to the Commons Health Committee. The IHSM claimed that many local authorities were unprepared, saying 'there is a belief (among health service managers) that the mechanisms are not yet in place to ensure that local authorities have the information necessary nor the organisational framework to implement needs assessment on a borough-wide basis.' Health service managers complain that this is due in part to their exclusion from the formulation of plans.

The report also spoke of a 'language barrier' between health service and local government managers, with some social services staff having an inadequate understanding of continuing care and public service reforms, such as the purchaser / provider split. There was also criticism of the exclusion from consultation by some authorities of GP fundholders and private sector providers. The IHSM further suggested that social services departments had a lack of knowledge of the care market, which, it argued, would lead to expensive errors in the purchasing of care.

Charities are also expressing concern, and are monitoring the situation closely, threatening to publicise local authority failings. The main unhappiness expressed by the charities is that the Government has allocated too little cash for care in the community. John Tizzard of the Spastics Society says charities are being asked to bail out the statutory sector. 'There is an expectation that we will use charitable resources to make up the shortfall in community care, and we have said that we think this would be a misuse of charitable money. We currently subsidise residential places, and we want to move away from that. The pressure will be for cheapness, not the most effective service.'

The Labour-controlled Association of Metropolitan Authorities (AMA) and the Tory-controlled Association of County Councils have agreed a common figure of pounds 135m as the shortfall in England. Welsh and Scottish authorities also complain of too little money. Peter Westland of the AMA says: 'The deficit will not be distributed evenly. Some local authorities will just about cope, others will struggle and will have to screw down criteria.'

Many authorities are making severe cuts to their core social services, which undermine their ability to implement care in the community. There will be many closures of council and private residential homes, which is to be expected. Unhappily some day-care provision is also going, undermining the principle behind care in the community. Charges for home help and meals-on-wheels are increasing. Administration is also being thinned out, with middle- management posts being abolished in many authorities, and social services departments being merged with housing and education authorities, for example. Staff demoralisation in social services is a serious problem, especially when authorities are still struggling with the effects of the Children Act and the Criminal Justice Act.

Brian Roycroft has been director of social services at Newcastle for 20 years, and has, until recently, been proud of both the quality and quantity of social services provision. 'There have been cuts of over 10 per cent in two years, closing homes for the elderly, cutting local day-care and home helps, and it's pretty disastrous. The process has been extremely demoralising for staff who think care in the community is essentially very good, and we have lost a lot of good managers.'

A survey undertaken in January by the Association of Directors of Social Services (ADSS) showed that 81.7 per cent of responding authorities expected to make cuts in their social services budgets in the new financial year. Of 22 London boroughs that replied, 20 expected to make cuts. The ADSS warned that crucial staff needed to implement care in the community would not be appointed.

Both charities and local authorities are worried by the financial implications of needs assessment. The central conflict will be between assessed need and available resources. Some authorities have declared that they will not publish or recognise residents' needs if they cannot afford to meet them. Bromley, for example, has said that the Community Care Act does not stipulate the level of need a local authority must meet, and will set its criteria according to its resources.

The view taken by Bromley and others is in line with a circular issued last December by the Department of Health. This stated that authorities should take into account available resources before needs were assessed. It also warned authorities that users had a right to inspect their records and that a legal obligation could be entered into, if those records showed an assessed need which the council could not meet financially. Authorities were reminded: 'It will not be possible for an authority to use budgeting difficulties as a basis for refusing to provide the service.' Many health care professionals have been angered by these comments, saying that care in the community can only work if care is needs-based rather than finance-led.

According to the AMA the shortfall will grow 'exponentially', because of the method used to calculate grant, the longer life expectancy of people in care, and the increase in numbers of people presenting themselves for assessment.

Some charities say they are already in conflict with local authorities. John Keep, of the disability charity Radar, complains that councils are taking a variable interpretation of what constitutes a disability. One man was told that he had no requirement for a needs assessment as his amputated leg was not a permanent disability, being a temporary handicap until an artifial limb was fitted. Mr Keep says: 'There are already about 100 to 150 interpretations of being disabled. We are working with just under 400 people in discussions with local authorities about their needs. April 1st is an appropriate date for it, but who is trying to fool whom? I don't think disabled people are going to have a better deal come April, or for a few years to come.'

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