I know I was not alone in my astonishment last week at the leaked letter from the Prime Minister criticising Oxfordshire council for cutting front line services. What exactly did he think would happen if the council faced year on year cuts in funding combined with a year on year increase in needs? The story bears out the concerns expressed by the National Audit Office last year that central government has "limited understanding of authorities' financial sustainability and the impact of funding cuts on services."
In the last few months the evidence of an impending crisis in social care has been mounting: figures for NHS delayed discharges caused by lack of social care have risen 33%; 77% of local authorities have experienced social care provider failure in the last year; warnings of the imminent collapse of a significant care home provider could cost the NHS £3 billion per year. The question is no longer how much people will have to pay for their care but will there be any care to buy.
In case we still believe that those who really need care still get it, Scope's report last week showed the end result of this crisis - people sitting in soiled incontinence pads for 14 hours, unable to wash, sleeping in their clothes. That's happening now, before the predicted further cuts to be announced in the spending review next week.
Why exactly does the Prime Minister think his authority is cutting front line services if there are other ways to make savings? In the course of my work I meet many of those who have to make these decisions. People with a wealth of experience, with integrity, with commitment to what social care at its best can do and with a very keen understanding of what happens when that support is less than good. More than once in recent weeks I have been faced with someone saying "I don't want to do it, Sue, but I just don't see I have any choice."
If I have one criticism of social care leaders it is that they have taken too long to sound the warning. There has been a natural tendency to put a brave face on it, to stand up for local authorities and play down the impact of what they have been forced to do. Privately many will admit they can no longer deliver even their basic legal duties. Publicly they can't do this.
But the warning is now being sounded loud and clear across the sector. I am amazed that in the face of these cuts there are still so many in social care with commitment and enthusiasm for delivering change and improvements. If you give the sector the funds it needs it is capable of delivering extraordinary things.
So, Mr Cameron, you and your Government have some tough decisions to make in the next week. As you put the finishing touches to the spending review, heed the warning signs in social care and remember the benefits that excellent social care brings to the NHS, the economy and the people who need it.
Above all, remember that your actions will have consequences.