The improvement in the economy and GDP will still be insufficient to meet the rising costs of health and care, a seminar heard last month.

David Behan, chief executive of the Care Quality Commission told an audience of senior social services managers: ‘This is an unprecedented recession. In previous ones growth returned and this kicked into the public sector but it hasn’t happened this time in social care.’

Another speaker, Lord Bob Kerslake, chair of Kings College Hospital and former head of the civil service, concurred, saying: ‘We face unprecedented financial pressures with 25% to 40% spending cuts in local government likely during this Parliament. I‘d say it will be in the upper end of that range.’

Mr Behan told the seminar, organized by executive recruitment firm Penna, and supported by iMPOWER, BT and The MJ, by that high turnover and shortages of care staff were due to dissatisfaction rather than pay, adding: ‘We have a 20% vacancy rate in social care plus a 25% turnover rate plus 28% turnover in nursing. But the evidence is that people are moving not for money but because of their level of satisfaction.’

He also rejected arguments that poor performing social care departments were down to lack of funds, saying: ‘There is little correlation between money and quality. Lots of local authorities have very good services with not much money. Well run organisations run their money better and have stable staff.’ But he did warn that the high use of agency staff to plug gaps ‘contributes to instability.’

Lord Kerslake said: ‘There’s a big difference between the view from the ground and from Whitehall. The capacity for self-delusion at the centre is almost infinite. We also face significant issues of morale. I’ve had junior doctors in tears. We can see the way forward but we haven’t got there yet. There are some brilliant examples of health and care reduction but we haven’t seen any reduction in demand.’

Among other speakers Anthony Douglas, chief executive of the Children and Family Court Advisory and Support Service pointed out that ‘child protection and support for vulnerable adults will still be here even in a smaller, shrunken state.’

Jo Cleary, former chair of the College of Social Work which was scrapped recently by the Government, said: ‘It only took a few months to dismantle the College of Social Work which took six years to set up.’

Maggie Hennessy, local government director, executive recruitment, at Penna, cited spending cuts, a climate of blame and even pension changes as reasons for the shortage of directors of children’s and adult services but added ‘the jobs still need to be done.’

She said stable councils find it easier to recruit staff and that every local authority needs a pipeline of managers ready to move upwards. She added: ‘My heart sinks when I am handling a senior appointment and the council says no one internally is applying for the post.’

She also said there was little movement from health to local government ‘perhaps because health directors prefer a letter from the Department of Health in far away Whitehall rather than a word from the leader in an office next door.’

This feature first appeared in Health MJ, a new supplement appearing inside each copy of The MJ every month. Visit www.themj.co.uk/order to subscribe to your own copy.