Parliament & Politics: Watchdog gives warning over care funding

RADICAL changes in the provision of community care for the elderly, disabled and mentally handicapped will demand a revolution in the operation of social services departments, the Audit Commission, the local authority watchdog, says in a report published today.

But the commission warned that the changes could be threatened if funding, being negotiated in Whitehall, was not properly protected. At present there are no guarantees that local authorities will pass the money on to social services departments.

'There is a genuine concern that some authorities, particularly those in the greatest financial difficulties, may use the funds to reduce the financial pressure within other departments,' it says.

One solution would be to 'ring fence' the funds initially, a precaution which could eventually be dropped once the services had been developed.

The shift of responsibility to local authorities, which will co-ordinate the services from April next year, is aimed at meeting the needs of users and those who care for them.

The other major plank of the change is that funds for the care of the elderly in residential and nursing homes, currently paid direct to those using the service, will go to social services departments so that provision can be tailored to best suit the individual.

To achieve these goals the report, The Community Revolution: Personal Social Services and Community Care, says that everyone involved must come to terms with the change in emphasis.

But the report, the result of an 18-month study, cites several major obstacles facing the changes under the National Health Service and Community Care Act 1990. Focusing on the needs of the individual, rather than the provision of a service, will present a challenge to the culture of social services departments.

Power structures and vested interests will be undermined leading, the commission fears, to 'significant resistance' to the fundamental changes.

Further, as social services departments take on the role of both assessor of the individual's needs and the commissioner of the service, it will be essential that the authorities develop clear management systems.

'A lack of financial and management information,' the report says, 'is the rock on which community care will founder if devolved budgets and a split between the commissioner and provider functions are implemented ahead of the necessary support systems.'

Finally, the commission believes there is a real danger that key agencies, particularly social services and health, will not be able to work well together, a vital ingredient in the success of changes.

In order to surmount these difficulties, the commission says the first priority is that authorities have an assessment procedure in place by 1993.

Roger Tristem, the commission's director of health studies, said the research revealed that authorities differed widely in the progress they have made. 'Local authorities face major difficulties in implementing the changes,' he said. 'If community care is to be delivered successfully, authorities must face up to the challenge.'

The Community Revolution: Personal Social Services and Community Care; HMSO Publications, price pounds 9.50.