Is more spending the answer to poor quality home care?

The consumer group Which? have produced a survey detailing poor quality home care for the elderly. Those producing the home care have predictably said that increased spending is the answer. This is message the Local Government Association has been putting out. But if you look at the examples of failings documented by the elderly people who are being "cared" for they are not really about lack of resources but mismanagement, inconsideration and incompetence. Visits would take place but on the wrong day. Medicine would be left but out of reach. A carer would leave without turning the lights on so an old lady was in the drak and unable to see her food.

What is actually needed is for the carers doing a poor job to be sacked. In Hammersmith and Fulham we have brought in robust quality assurance to check the staff are up to the job. This has improved efficiency and thus reduced costs and driven up standards.

Personalisation, giving care users a personal budget which allows them to decide the priorities, was a good reform introduced by the Labour Government which is proving increasingly beneficial. Caring for elderly neighbours is an obvious aspect of the Big Society and initiatives to encourage charities to do more are welcome.

So it is not all gloom. But there is such extraordinary bureaucracy in adult social care. Endless different social workers from the NHS and the Town Hall, all turning up to ask the same questions.

On Wednesday I was at a meeting discussing adult social care at Hammersmith Town Hall with a group of Kosovan executive mayors. We talked about how the system worked, some of the challenges involved, the immense costs, the merits of personalised budgets, the alternatives of residential and non residential care. How for every three pounds spent, one goes on working out what to do with the other two.

The Kosovan listened politely as the Albanian interpreter repeated everything. Then they said: "In Kosovo old people are looked after by their families."