Magazine article Public Finance

Taking the Longer View

Magazine article Public Finance

Taking the Longer View

Article excerpt

For Sir Derek Wanless, social care represents unfinished business. When he conducted his review of the NHS for the Treasury, he gave every appearance of regretting not being able to analyse the demand for, and cost of, care in the future.

'While the review considered it vital to extend its terms of reference to begin to consider social care, it has had neither the information nor the resources to be able to develop a "whole systems" model, nor indeed to build up projections for social care in the same level of detail as for health care,' Wanless wrote in his Treasury report.

But not only did Wanless recommend that sueh a detailed report should be produced, he gave a stark warning not to underestimate the costs likely to hit the state and service users in coming years. 'The projections show that population changes and the ageing of the population are a much greater cost pressure for social than for health care,' Wanless pointed out in his report.

Excluding children's and family services, and ignoring expectations of higher quality and more professionalised social care, Wanless still found that baseline personal social services expenditure will rise from £6.4bn in 2002/03 to £10bn0 -£llbn in 2022/23 'as a result of the impact of demography and health status changes', representing a real-terms increase of 2.3% to 2.8% per year. If Wanless gave off a sense of frustration that he had neither the powers nor the facilities to properly consider social care alongside health care in that earlier, government-commissioned, report, his pleas have now been answered.

Health think-tank the King's Fund, in line with calls from many other interested parties, including the Local Government Association, the NHS Confederation and the Association of Directors of Social Services, has commissioned Wanless to lead a review. This is due to report in spring next year on the 'long-term demand for and supply of social care for older people in England'.

The project will be led on the ground by Julien Forder, senior research fellow and deputy director of the London School of Economies' Personal Social Services Research Unit, which provided the data on social services for the Wanless Treasury review.

Although there has been speculation that social care minister Stephen Ladyman is irritated by the setting up of a review which might be expected to try to bounce the government into much higher expenditure on social care, the signs are that Ladyman is relaxed about the project. He says he 'welcomes' the review, and Forder told Public Finance that this sentiment was genuine. 'We have had nothing but positive comments from him about doing this,' says Forder.

In any case, Ladyman is preoccupied with one of the most difficult tasks in government - overseeing publication of the green paper on social care, now expected to be published in the second week of March, and likely to be central to Labour's election manifesto. It will probably be published at the same time as a green paper on youth policy and, in electoral terms, may become integrated into a wider debate on the treatment of elderly people, including pensions reform.

But the green paper was to have been published late last year. Ladyman has implied the delay is enabling the prime minister to be involved personally and to associate himself with its launch. But one person close to the process says the original version produced by Ladyman's small team of social care civil servants and advisers disappointed the minister by not being radical enough.

Policy disagreements have been another factor delaying publication. Some proposals expected in the green paper are not especially contentious. We are likely to see a move towards what is being termed the 'virtual care trust', involving even greater partnership and joint procurement between social services and primary care trusts.

PCTs will be pushed into further consolidation, becoming co-terminus with local authorities. …

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