Stains on the record

Labour’s social care record: a conspiracy, or a cock-up? This
government has made an unprecedented commitment to social care and
has overseen some of the most significant investment and sweeping
changes of the past 30 years. Yet all this furious activity has so
far failed to halt the recruitment crisis, eliminate the barriers
between health and social care and meet targets for improving the
lot of children living in poverty.

Mental health services – particularly those for children – are
still poor, older people are going to court in droves to prevent
the closure of their care homes, parts of the child protection
system are in chaos, and vulnerable children are still being
killed, injured or committing suicide in prisons and young
offenders institutions.

For all its grand initiatives, is Labour presiding over a social
care disaster?

Measuring standards
Perhaps the least popular and most contested government
initiative to date has been the star-ratings system for social
services, launched last May and refreshed in November. There have
already been many convincing arguments that the way stars are
awarded is deeply flawed and the system itself divisive. There
seems little point in informing service users who cannot shop
around for services of the relative merits of social services
departments in different areas.

More worryingly, there is concern that the system is gradually
warping the way social services departments work, forcing
authorities to jump through inflexible nationally set hoops in
pursuit of stars, rather than concentrating on providing good,
locally appropriate services.

Much of this criticism also applies to star ratings’ bigger
brother, comprehensive performance assessment. This is a similar
system of rating for overall local authority performance – but the
performance of social services and education is given added weight.
Reducing the complex and diverse functions of local authorities to
a single statement has been widely criticised. To a lesser degree,
individual services can be dragged down by the rest of the
authority (Kingston upon Hull has a good social services rating but
a low overall one) or failing social services can be blamed for the
poor overall result of an otherwise excellent local authority (as
in Coventry).

Mental health
The government’s controversial proposals to detain people
who may be a risk to the public because of untreatable mental
disorders and to impose treatment on people living in the community
have been around since 2001.

The main opposition to the draft Mental Health Bill comes from the
apparent emphasis on public protection, over and above the needs
and rights of individuals with mental health problems.

Mental health pressure groups and survivors’ organisations have
warned that the proposals will mean almost anyone could be detained
indefinitely without having committed any offence, and might see
vulnerable people being dragged from their homes to be forcibly
medicated. But the government stuck by its guns and included the
proposals in the draft bill, published in June. Despite the
proposals’ absence from the Queen’s speech, health secretary Alan
Milburn has since declared the government’s commitment to pass the
bill in this parliamentary session, potentially making 2003 the
flashpoint everyone has been anticipating.

Criminal record checks
Despite widespread support for the creation of a central
body to co-ordinate checks on people who work with children and
vulnerable adults, the Criminal Records Bureau has been an
embarrassment to the government since its launch in March (by which
point it was already eight months late). Someone, somewhere didn’t
do their sums right. The CRB was not prepared for the scale of its
task, with the result that staff and organisations have had to wait
months for clearance. The delays have threatened to close
residential homes, care providers have bemoaned massive extra
costs, and social care workers have claimed thousands in
compensation after being prevented from working for months by the
inefficient bureau.

The government finally admitted a kind of defeat late last year by
moving the goalposts, demanding that checks on care home staff must
be completed “during the course of 2004” rather than by the
original deadline of March 2003. The deadline for existing
domiciliary care and nursing staff supplied by agencies was
extended indefinitely. Whether this messy and expensive paperchase
has harmed service users remains to be seen.

National Care Standards Commission
Another grand plan that looked sensible on paper, the NCSC
started in April amid controversy and conflict about the way the
new minimum standards – particularly those for older people’s
residential care homes – were going to be implemented. Mixed
messages from the commission about exactly how non-negotiable the
standards were did nothing to scale down the rate of care home
closures, panicking the government in July into downgrading what
had been mandatory “minimum” standards to little more than good
practice guidelines. The move infuriated care providers, who had
struggled to meet the standards, and older people’s groups in equal
measure.

To add insult to injury, just three weeks after the commission
finally lumbered into life in April, the government announced that
it was to be scrapped and most of its functions merged with the
Social Services Inspectorate, much to the concern of the staff who
had been transferred from local authorities and health authorities
to the commission.

Adoption
Late last year the long-awaited Adoption and Children Bill managed
to steer a course through troubled waters in the House of Lords
over the proposals to allow unmarried couples – including gay
couples – to adopt. But this success is still being overshadowed by
disquiet within children’s services about the government’s
unshakeable and perhaps unfounded belief that thousands of children
are “languishing” unnecessarily in the care system.

Despite the absence of robust research and evaluation supporting
such a policy, the government holds that more children should be
adopted, and adopted quickly. As well as new adoption standards and
a spectacularly unsuccessful National Adoption Register, local
authorities have been set targets to increase the number of
children adopted by at least 40 per cent by 2004-5.

They are also expected to find adoptive parents for 95 per cent of
children for whom adoption is the plan within 12 months of that
decision. There are early signs that many local authorities will
fail to meet these targets in 2003 amid concern that the
government’s adoption drive is pushing children – and prospective
adoptive parents – into ill-fated matches, when fostering or even
residential care could be more appropriate and successful.

The Nationality, Immigration and Asylum Act
The government can look forward to a year of sustained
criticism during 2003 as it pursues its controversial asylum
policies. The act was finally passed by parliament in November, and
will eventually allow asylum seekers and their children to be held
and educated in large detention centres in rural areas, as well as
removing the support for asylum seekers who do not make their claim
at their port of entry.

The government argues that its asylum seeker policies, including
the now defunct voucher scheme and the dispersal system, and a bar
to asylum seekers claiming benefits, are simply designed to bring
the UK into line with the rest of Europe.

Its opponents argue that the measures are an inhumane, knee-jerk
reaction by a government which has been panicked by the right-wing
press.

Youth justice
The government has also faced a difficult year within the
youth justice field. Despite evidence that suggests giving young
offenders penal sentences is one of the best ways of guaranteeing
that they will re-offend – 72 per cent of 18 to 20-year-olds were
reconvicted within two years – the government remains wedded to its
“lock ’em up” approach to young people.

The conditions within which children and young people are held in
young offenders institutions and prisons were described during 2002
as “unacceptable in a civilised society” and “institutionalised
child abuse”.

In September, a damning review of the government’s treatment of
children by the United Nations said the UK had made little progress
in tackling juvenile justice over the past five years.

The report, by the United Nations Committee on the Rights of the
Child, also expressed deep concerns that between April 2000 and
February 2002, 296 children sustained physical injuries while being
detained.

Children Act 1989
For children in the criminal justice system, the
government faces a thorny problem for 2003.

In November the High Court ruled that the Children Act 1989 does
apply to children in young offenders institutions. The onus is now
on local authority social services departments to ensure children
in YOIs are protected, begging the questions of how that
responsibility should be divided between departments and how social
workers can be expected to protect children from a regime which
many believe is inherently damaging to them.

The government has not yet issued guidance clarifying what this
ruling means for social services departments, but some
clarification will be necessary during 2003.

Bed-blocking
After years of banging on about the importance of
co-operative joint working between health and social care agencies,
the government scored an impressive own goal during 2002 with the
Community Care (Delayed Discharges) Bill, which included proposals
to charge social services for the cost of keeping older people in
hospital unnecessarily.

Matching incentive charges will be imposed on hospitals for
emergency re-admissions, on the assumption that this indicates
patients had been discharged too soon – thus pitting social
services against health providers in a never-ending financial
struggle.

The proposals, suggested originally in the Wanless Report on the
future of NHS funding, undoubtedly looked attractive to a
government keen to cut intractable waiting times. But several
months on, numerous questions remain about how it will work in
practice and what the impact will be. More than three-quarters of
the 268 organisations and agencies that responded to the
consultation document outlining these proposals in September warned
that the reimbursement proposals could damage partnerships. Almost
a third raised the issues of funding and capacity in health and
social care, and a quarter believed that this April was too soon
for implementation.

The verdict
Does this amount to a social care disaster? Does Alan
Milburn really want to help the social care sector do a better job
or is he more interested in reforming the public sector, bit by
bit?

Many in social care feel the government is dismantling conventional
social services and the “monolithic” local authorities that contain
them. But others feel the government’s heart is in the right place,
even if its actions are at times misguided, ill-informed or poorly
thought-out.

Owen Davies, senior national officer for local government at public
sector union, Unison, says: “I don’t think there’s any doubt that
Alan Milburn wants to help social services do a better job and
improve services. But the problem is that he seems obsessed with
big-bang, structural, top-down solutions, which may sound good in
parliament and in the press, but which don’t fit local needs. He’s
got to learn to trust the people who are on the ground, doing the
job.” CC