Debate: care trusts

Care
trusts will succeed as long as local needs are catered for and
there is an existing culture of integration.

Liam Hughes is social services director in Bradford. He is
moving shortly to become chief executive of Leeds East primary care
trust.
In Bradford we are consulting on the creation of a care trust which
will be formed by merging services from three local agencies,
Airedale NHS Trust, Bradford Community Health NHS Trust, and the
council. The proposal already has considerable local support, yet
it is clearly controversial.

If it
gets the go-ahead, the care trust will take responsibility for
mental health and learning difficulty services previously provided
separately by the three bodies, including social services. It will
have to pass some tough tests, but I believe that it is the right
thing to do.

The
benefits to service users and carers will have to be demonstrated
in terms of improvements in quality. Person-centred care will have
to be reinforced. Equal respect within the trust for both learning
difficulties and mental health will be important. Staff will need
to feel that the merger is not a takeover, that arrangements are
fair, and that they are valued. Governance, finance and human
resources will require effective project management if the care
trust is to be in place by April. None of this will be simple to
achieve. So why bother?

The
simple answer is because this form of organisation will fit the
local circumstances. Good joint working relationships have been
built up over several years, and the groundwork has been done. It
is far better to involve social services from the start of the new
organisation and for them to shape its future, rather than stand
outside being critical.

The
council will nominate board members, it will run the scrutiny
process, and it will provide the money, along with the primary care
trusts. It will have power and influence in commissioning and
procurement. This approach is in line with the “challenge” required
under Best Value to find the most appropriate provider, and with
the movement towards arm’s-length and independent provider
organisations. The local authority’s role as leader of the learning
difficulty partnership will keep open communications with other
agencies such as the Benefits Agency, employment services and
further education, leisure and housing. Similar links are in place
for mental health.

There
are risks. It would be unwise to proceed so quickly in situations
where integrated working is poorly developed, or professional
values are at odds, or there is financial instability. For
Bradford, structure follows function, and the proposal builds on
our particular history. It is a local solution.

The danger of the care trust model is that it is presented as a one
size fits all approach.

Rita Stringfellow is chairperson of the Local Government
Association social affairs and health executive.
While in areas like Bradford it is clear that the care trust model
may have much to offer, it is equally clear that in other parts of
the country it will not be the best fit. What works for local
communities must guide us, and there are real issues to be
clarified about the impact of front-line integration; encouraging
both health and local government partners to establish care trusts
is difficult without that clarification.

The
Local Government Association believes that what must inform the
national debate about the development of care trusts is an analysis
of what communities actually need and are asking for. The danger of
the present debate about care trusts is its focus on structural
solutions, rather than meeting the particular needs of specific
communities.

As local
government and social services have evolved over the past 20 years,
we have seen a movement away from “one size fits all” global
solutions to tailored responses to individuals and to the specific
needs of communities.

The
range of solutions will not only differ across the country on the
basis of geography but also according to the services to be
included in new arrangements. Solutions that work well for older
people’s services may not work for children’s services.

Local
communities and local partners need freedom to develop local
solutions. The LGA believes that care trusts are a useful addition
to a range of freedoms and flexibilities which may create new ways
of delivering high quality services for local people.

Across
the country we see local authorities and other partner
organisations coming together to develop a wide range of models to
meet the needs of local communities, some of which will include
care trusts.

The
essential criterion that needs to be satisfied is that whatever the
choice of organisational structure, it must be focused on the
outcomes that will be achieved for the individual and community.
These outcomes must be in harmony with the culture and expectations
of local people. Local government and the NHS must continue to
improve services and develop and maintain close connections to
their local communities. Favouring one organisational solution will
undermine this work.