One small victory – but at what price?

Health minister John Hutton told social services directors,
meeting for their annual Spring Seminar near Oxford last week, not
to worry about being taken over by a “Big Brother” NHS. It would
not happen, he said, adding that directors and their colleagues in
social services should feel confident about their future.

As many in social services are all too keenly aware, however,
there is precious little to underpin this confidence other than a
stream of bland assurances from the government that everything will
be alright in the end. The Local Government Association found
solace in a putative concession from the Department of Health,
which would allow councils to select their own representatives on
the forthcoming care trusts rather than have a quango, the new
Independent Appointments Commission, do it for them. But far from
being the significant breakthrough claimed by the LGA, this was a
small victory that merely puts local authorities back where they
were a month ago when the government first mooted the IAC’s
role.

The truth is that social services departments, not to mention
social work itself in a recognisable form, will struggle to
survive. Whatever Hutton says, the odds are stacked against them.
The Health and Social Care Bill establishes care trusts
specifically as NHS bodies, while it is a background assumption of
the NHS Plan that the health service will have the upper hand in
the future arrangements. There is no question of the government’s
financial commitment to social care; what is in doubt is its
commitment to the principles and values that should govern it.

If the government were committed to these principles and values,
the chances are that we would know far more than we do about the
impact of the new regime on social services. Even if local
authorities can choose their own representatives on the care
trusts, we have no idea how much of a voice they will have or
whether it will be drowned out by their more numerous NHS
counterparts.

No steps have been taken to protect the social model of care,
and the accompanying concepts of user involvement and empowerment,
from the inroads that will be made on it by the medical model with
its preference for paternalism and “we know best”. A paternalist
agenda is one that fits in well with the government’s policy of
increasingly prescriptive funding coupled with performance
management that puts the emphasis on achieving centrally-determined
targets. Against this background, notions such as user involvement
and local accountability begin to sound dangerous.

There is much the government could have done to allay suspicion.
It could have drawn up a social services plan to go with the NHS
Plan; it could have promised that care trusts would be “truly joint
organisations” of the kind sought by the LGA rather than NHS
bodies; and it might even have reinvented the DoH as the Department
of Health and Social Care. It has done none of these things. Social
services beware, Big Brother is watching you.