Care for elderly, infirm and disabled people could be stripped from local authority control under radical new government plans in an effort to end the so-called "postcode lottery" that sees wildly different standards of care across the country.
Social services chiefs have been warned they will lose their responsibility for care unless they step up improvements in their performance over the next three years.
More than 370 nursing and care homes have been given "no star" ratings after the independent Commission for Social Care Inspection (CSCI) assessed their services as "poor". A further 31 have been sent legal notices stating the CSCI plans to cancel their registration and move their residents elsewhere.
Last week it obtained a court order to cancel the registration of a residential nursing home in Brackley, Northamptonshire, after a random check found the safety and welfare of its elderly residents were "at serious risk". Several residents of the home were taken to hospital for treatment. Two subsequently died after inspectors shut the home.
The reputation of the sector has also been damaged by repeated revelations of abuse and neglect of residents in some of the 10,000-plus private homes across the country. Some 150 local authorities across England spent £14.2bn on social care for all adults last year including elderly people, residents with dementia and young people with learning difficulties. Their role is already under threat, however, from reforms designed to give individuals "personalised" control over their own care, including control of a personal budget under the Government's Putting People First programme.
The health minister Ivan Lewis has warned that the Government is prepared to go further, and remove local councils from the system if their performance does not improve. He said: "If at the end of three years, local government has not delivered on those building blocks, I think there will be some really big questions to be asked about its capacity to commission these services in the future."
Department of Health insiders said the warning could mean the worst-performing councils being stripped of their powers – or, in extreme circumstances, the power over commissioning care being handed to a new body altogether. In an interview with Community Care magazine, Mr Lewis said the postcode lottery was one of the "big, big concerns".
Age Concern gave a cautious welcome to the Government's proposals. A spokesman said: "We have been concerned about councils being in charge of assessing people's needs and then deciding how much should be spent on them. There have been concerns about the quality of care offered to older people, in particular. At least threatening local authorities with sanctions if they do not improve can be of benefit."
But the Local Government Association (LGA), a cross-party organisation representing councils in England, insisted that local authorities still had a vital contribution to make. "Councils are best placed to make decisions on providing care and support to local people, thanks to their knowledge of what's available in each area and how best it can be managed," a spokeswoman said.
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