Behind the headlines

If structures are any guide to the government’s intentions, the
writing is on the wall for social care’s voice in the Department of
Health. The blueprint for a radical overhaul of the DoH gives
rather less prominence to social care than it enjoys within
government. At present, the social services chief inspector advises
ministers directly and is on a par with the chief medical officer
and the chief nursing officer. But under the new plans, the social
care lead will report to the chief medical officer rather than to
ministers, signalling a marked reduction in status for social care.
The Association of Directors of Social Services is so concerned
that social care will lack a credible voice within the corridors of
power that it is asking for a meeting with NHS chief executive
Nigel Crisp to discuss the issue. Unison has also expressed
concern. The public sector union’s senior national officer for
local government, Owen Davies, said of the changes: “Social care is
already marginalised within the Department of Health and this will
push it further to the edge.”   

Phil Frampton, national chairperson, Care Leavers

“The Association of Directors of Social Services is correct to
express its fears. It remains to be seen whether the government
will dumb down social care. If it does it will make a huge blunder.
However, big bums on big seats is not really the issue. More policy
needs to be dictated by the staff on the ground and by service
users. Policy can then be oriented to dealing with the reality of
underfunding and poverty in this sector.”

Julia Ross, executive director for health and social care,
London Borough of Barking and Dagenham
“Social care appears to remain a largely invisible partner
in the new NHS, although social services are of course still very
much a local government responsibility. I think this lies at the
heart of the government’s apparent difficulty in recognising our
unique function and contribution to health and well-being. The
dominance of the NHS agenda in all debates reflects this as the
highest government priority. I think our best way forward is to
focus strongly on the community-based elements of the NHS and whole
systems working with much closer alliances with primary care
trusts, as well as arguing for a national place in the future

Martin Green, chief executive, Counsel and Care for the

“The fact that social care is being downgraded in the Department of
Health’s restructuring plans is worrying, but no real surprise.
Social care is not high on this government’s list of priorities and
is increasingly irritated by the inability of social services
departments to deliver on the government’s agenda. The fact that
the social services chief inspector is no longer at the DoH’s top
table is another signal of the diminishing importance of current
social services structures.”

Bill Badham, development officer, National Youth

“Merger or takeover? That is the question facing health and social
care. Structures might seem boring but they do indicate intent; and
the relegation of social care from the top table at the DoH may
well be the most honest government announcement yet of its
intentions. Mergers happen between partners of similar clout.
Takeovers are often linked to asset-stripping at a local level.
Social services watch out!”

Bob Hudson, principal research fellow, Nuffield Institute
for Health, University of Leeds

“There is a striking dissonance between the rhetoric in the Change
Programme of a ‘health and social care system’, and the detail of
the proposals. Essentially this paper is a vision for the NHS, with
social care dragged along in its wake. The new Standards and
Quality Group, for example, will be responsible for huge swathes of
social care, but be led by the chief medical officer. He in turn
will be supported by six senior managers, only one of whom will
have social care expertise. This is not good news for social

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