NICE mark II

The Government is considering removing care for elderly, infirm and disabled people from local authority control, because of the existence of "patchy" service standards across the country, - a post code lottery of different standards. Social Service departments have been warned that they must improve their supervision over the next three years, or else lose their responsibility.

This is despite, or because of, activities by the Commission for Social Care Inspection (CSCI), who are charged with inspecting and rating care homes. Of the 10,000 or so homes in the private sector and others in the public sector, 370 have been given a "no star" rating after an inspection, and 31 have been sent legal notices of plans to cancel their registration and be closed.

The threat seems to be to remove badly performing local authorities, but if necessary a new commissioning authority will be created.

In either event we shall have national bureaucratic control in place of local and accountable control, in some districts at least.

In part the problem is one of finance. There is insufficient good care at affordable prices. The Government is to be blamed for this, in part, because homes have closed down through over regulation and sometimes when local councils have insisted that private homes have higher specifications than their own homes. If there were more care provision and the elderly and infirm had more choice, standards would be driven up. The question should be, "What can we do to make more people consider offering social care?" The answer would not be, "Tighten the red tape even more tightly."

It is ironic that NICE, about which there is so much criticism, was intended to drive up health standards nationally and remove the "post code lottery" but has led to enormous differences between areas. It is doubtful if whether some new national social care quango is any more likely to produce uniformity.

And why should it? The object ought to be to maintain minimum standards, and to allow local and informed discretion to set the rest. We wish to weed out the poor homes and encourage greater provision. Over-zealous central diktat is likely to weed out poor and good, without promoting extra accommodation to compensate.

This is another example of well meaning people who can see nothing but centralisation and greater control. Will they never learn?