Margot James: How to deliver more for less in health and social care
I met the head of Adult Learning Disabilities and mental health at Dudley Council for a briefing on services and current issues the other day.
With the economy in a state of near ruin it is especially important that we protect what the media call ‘front line services’ for such vulnerable groups of people. Sadly if we are not very careful, such groups will suffer a disproportionate share of the cuts that are now being discussed by all political parties.
In just over an hour with the excellent head of service, Mr Richard Carter, I identified four areas where we could make substantial savings without affecting either the quality or the extent of the service received by those with learning disabilities and mental health needs.
Firstly, Dudley Council employ 70 social services staff ‘seconded’ to the Walsall & Dudley Mental Health Trust. Such large scale secondments are always problematic. Who are such staff accountable to? We have three bodies, the Local Authority, the Walsall and Dudley Mental Health Trust and the Primary Care Trust all trying to manage parts of a service that clients and carers assume is coming from one source.
Try being the carer going between all these organisations – I’ve done it myself with older people and its almost a full time job! We should consider merging all three groups under one management structure and budget. Definite savings at no detriment to service – in fact in my view such a move would enhance service.
Secondly, out of a total budget of some £24m for learning disabilities within the Local Authority, some £10m is spent on residential care. The cost of caring for some of the clients with more complex needs can reach £3,000 per week. These are private homes charging the taxpayer a great deal of money and their books should be scrutinized. Local Authorities account for almost 100% of their income. The Councils should work together to drive down costs whilst maintaining standards.
Now here's another idea which is doing the rounds. And it came up in another context when I visited the Worcester Street GP Practice in Stourbridge the other day. What is it that Primary Care Trusts do that cannot be done either by Local Authorities or GP Practices? If these two arms of government were merged, when it comes to health and social care, there would be tremendous savings on back office costs.
And so is this idea (doing the rounds that is), but it is interesting when you see the potential of an idea in practice. David Cameron talks a lot about releasing the power of voluntary, not for profit and private sector groups in to the provision of public services. We have an excellent voluntary sector in our borough. Mind, Rethink, the Alzheimer’s Society and the Family Care Trust all provide excellent services to people with learning disabilities and/or mental health problems. My interviewee acknowledged that services contracted out to independent groups or companies are almost invariably delivered at a lower cost. I promised not to quote him on the subject of the difference in quality!
But if we go down this route in a big way we must keep a steady hand on the tiller. Transferring services should not be seen purely as a cost cutting measure. You only have to look at the residential care sector for older people to see that Local Authorities pay significantly below the cost of providing good quality care in so many cases. That is wrong. As important as the legitimate savings that do exist is the harnessing of the passion and dedication of many of the people who run and work in these organisations.
These policy decisions will of course be made by the Shadow Secretary of State for Health, Andrew Lansley, and his team, not by me. But I will certainly feed ideas in from the grassroots.
The sheer incompetence of this Government, and the byzantine systems of public service management that they have introduced, changed and re-introduced in a different way and at such huge cost to the taxpayer proves that every cloud does, indeed, have a silver lining. At least with proper government, we might be able to deliver the same, or even a better standard, of care to many groups of vulnerable people in the health and social care areas for less money.