Imagine yourself for a moment as a consumer of The relevance of all this to care in the community is public services, rather than someone with a profes- now very real, after a relatively quiet period. With the sional interest. What is your view on the so-called implementation of the NHS Plan the annexation of ‘postcode lottery’? Are you broadly in favour of stan- social care by the (nationally controlled) NHS is start- dards of provision being assured nationally in the ing. The Secretary of State sees social care mainly as a context of specialist lobbying on your behalf? Or way of securing effective performance for the NHS, would you prefer to have more of a say by them and local variation in social care policy cannot, there- being set locally (the price of which is that the avail- fore, be allowed to exist. Setting aside for a moment ability or quality of a service might vary considerably that this is a very narrow view of social and commu- between localities)? nity affairs, is this an act of courage on behalf of the vulnerable hitherto failed by local authorities, or is it Our current Government believes that it is its duty to a danger sign of an over-centralising state? the electorate to ensure basic fair play across the nation, even though local factors will inevitably bring It has been amusing to observe the initial amazement some variations. This is a plausible case. However, of NHS people to the news that half of the £900 mil- conventional wisdom would have it that the distrib- lion extra funding for intermediate care earmarked in ution of power in any state is necessary to prevent the NHS Plan is being allocated to cash-strapped local abuses. The development of local government has authorities ‘with no ring-fencing’. Their fear is that been one of the means by which a democratic balance the money will disappear to plug the gaps in current has been achieved in this country, probably to the budgets. They shouldn’t worry. The accountability of great beneﬁt of our people. We have not suffered from SSDs to deliver intermediate care through partner- the abuse of state power like some other places. ships is not going to diminish. Neither will the bud- Having said that, our processes of governance have get pressure. What will have to go, therefore, is the historically been more centralised than those of many discretion to spend money on the social care that local of our neighbours in Europe. It is hard to know for people created in the past or want to create for the sure where the balance of beneﬁt might lie. future. Local priorities are being replaced by national priorities through the use of ﬁnancial leverage. Our current Government is unusual for wanting to control public services more directly than its prede- There is no objective measure of whether this is a cessors of any colour. It could have reversed the good thing or not. However, as a consumer I would weakening of local education authorities initiated in like to be enabled to have a real say in what is hap- the Thatcher/Major years, but it has taken more con- pening locally. The ways of doing this are critically trol of policy and use of resources, and strengthened undeveloped, and local bureaucrats are too busy inspection. League tables and similar devices empow- ensuring compliance with national performance er parents and create a force for improvement, or so requirements to be able to do better. This inevitably the rhetoric goes. Parents are probably more empow- limits the scope of user and carer participation at the ered now than in the past – but that is not to say that local level. It is likely to be a bad thing in the long run. they could not be so empowered in a more decen- tralised environment. These are political matters par Peter Thistlethwaite excellence. Editor 2 Managing Community Care Volume 9 • Issue 2 • April 2001 © Pavilion Publishing (Brighton) Ltd
Journal of Integrated Care – Emerald Publishing
Published: Apr 1, 2001
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