Social services told now is the time to challenge health service

It is time those working in local authorities took on the health service and challenged the NHS to take them seriously, Rita Stringfellow of the Local Government Association told the conference, writes Rachel Downey.

She called for wider recognition by the health service that those involved in social care had valuable expertise and experience to bring to the table.

But she added: "My real challenge to health, to the department of health and to ministers, is that we have a dialogue, an honest dialogue about what integrated services mean and not just a repetition of the usual rhetoric."

Stringfellow, chair of social affairs, health and housing at the LGA, questioned the role of the new four regional directors of health and social care and asked why people had been appointed to the posts before the role had been properly defined.

"Do they anticipate drawing powers from local government or the Social Services Inspectorate? Otherwise why should this layer exist?"

She said she "struggled with" the fact that there are now eight government office regions, seven SSI regions, the new strategic health authorities and the four health and social care regions. "What is the added value of the latter?" she asked.

She said it was important that there was a balance of power, and local government should not be viewed as the junior partner.

"It might be tempting for some directors of social services to see themselves as part of the health establishment - but it is more complicated than that," she declared, adding that perhaps it should be chief executives who sit on health bodies as they have more clout than social services directors.

The LGA has set up a task force to look at the interface between health and social care and work has so far focused on the setting up of the new care trusts. But what was clear was that the key to future improvements to services is maintaining a dialogue with those in health.
"Now is the time to draw a line in the sand and say to the NHS at the centre 'Talk with us not at us,'" she said.

Care trusts hide lack of resources

Structural change in the shape of care trusts was a way of avoiding the under resourcing of social services, Evan Harris, Liberal Democrat health spokesperson, told delegates, writes Rachel Downey.

Harris said the government was hiding behind constant structural changes in the health service to avoid tackling the poor levels of service delivery and the same would happen in social services. Any government which cannot deliver the improvements it has pledged will seek to distract the debate away from service delivery towards structural change.

Because the government has pledged increased spending on social services but also cuts in income tax, social services departments were being left to take the blame for reducing services as well as increases in council tax, he said. “With social services, the dangers are even greater. It’s a double centralisation of praise and a double decentralisation of blame.”

The government’s approach to health and social care was “to centralise praise and decentralise blame”. Democratic accountability in local government meant the risks of a blame culture were greater, he added.

The Liberal Democrat solution was an increase in income tax and Harris welcomed the Prime Minister’s apparent realisation that improved public services would require significant investment.

He argued that the government’s new recruitment campaign for social care workers was not enough. “Social services relies, more than any other workforce, on the quality and quantity of its workforce.  It requires long-term investment in the recruitment, training and retention of staff.  That’s the message for politicians who say they care about care.”

Commission to focus on outcomes and not close homes

Work in the first operational year of the National Care Standards Commission will focus on finding out how people achieve outcomes, not closing down homes, chairperson Anne Parker told conference delegates, writes Lauren Revans.

Parker said there were too many “unrealistic fears” in the care home sector about the NCSC, which is due to come into force in April 2002 to inspect and regulate social care and private and voluntary health care in England.

She said that the NCSC had decided not to comment on the minimum standards set by the government this year, but would make recommendations for changes next year once they had gathered all the information.

“In year one, we are going out there and finding out,” she said. “We have standards and we will record standards. And we will be in discussion about what the shortfalls are.”

Parker said that, by gathering information from providers about outcomes being achieved despite standards not being met, the NCSC would, where appropriate, be able to feed new ideas into the second round of standards.

The GSCC officially came into being on 1 October, and will eventually be responsible for registering the whole social care sector workforce.

Scie set to help staff promote the social care model

The new Social Care Institute for Excellence will help social care staff have the confidence to promote the social care model in new working arrangements, a department of health official told delegates, writes Lauren Revans.

Amanda Edwards, head of quality strategy for social care, said that Scie had a role in “preparing people for working in new ways”.

“In order to promote the social care model in new situations we have to have a bit of background,” she said. “We need to know why we are doing what we are doing. Using Scie to develop confidence is very important.”

Part of Scie’s dissemination role will be to work with the General Social Care Council, the National Care Standards Commission, the Social Services Inspectorate, and others to make sure that findings were actually being drawn on and used by educators and trainees, she added.

Ray Jones, Scie’s chief executive designate and out-going director of services for Wiltshire, said it was essential to recognise the realities of the real world and the complexities of changing it, as well as the opportunities.

“What I’m recognising is that Scie is going to be working with all of you in different ways in a world that is messy,” he said. “We mustn’t kid ourselves.”

Scie chairperson Jane Campbell added that the organisation’s goal to involve all partners in the development and dissemination of knowledge must extend to the independent sector.

“Scie recognises the majority of social care provision is in the private sector, and two thirds of the workforce is employed there,” Campbell said. “We are keen to discuss with private sector staff and employers how Scie’s work can help them improve quality and outcomes.

“We want private sector managers and staff, often working in isolation and with limited access to training opportunities, to access through Scie’s services knowledge that will improve their practice.”

WEDNESDAY 17 OCTOBER

Deputy mayor of New York speaks to conference

An interview with the deputy mayor of New York in which he talked about the aftermath of the September 11 tragedy was relayed to delegates at the National Social Services Conference, writes David Callaghan.

The Local Government Association's head of social affairs John Ransford travelled to New York to talk to Anthony Coles about the efforts made by the city's leadership to return it to some normality and revive the morale of citizens.

Coles apologised for not being able to attend the conference in person, but explained how the terrorist attack had been the preoccupation of everyone in New York.

He said the city had been forced to 'peg back' budgets by 15 per cent because a downturn in the city's economy will reduce civic revenues by an estimated $1 billion in this financial year. Tax rises have been ruled out, he said, and there may even be tax cuts to stimulate the economy.

Video clips of New York's mayor Rudolph Giuliani giving a briefing on the financial implications of the attacks were also shown.

Ransford said: 'The most encouraging thing we found was the absolute absence of rancour. But there is a search for understanding for why this happened and not a thirst for revenge.'

He said this country could learn from the Americans' resolve, and use their experience to address problems such as inequality.

Closer working arrangements delayed six months

Progress towards closer working between health and social services will be delayed by at least six months as a result of internal restructuring within the NHS, local authorities warned, writes Lauren Revans.

Delegates attending a policy session on the way forward for health and social care heard that the changes outlined in government’s document published this summer, Shifting the Balance of Power in the NHS, would leave health organisations with no choice but to focus on internal changes rather than partnership arrangements.

The document proposes replacing the 95 health authorities in England with around 30 strategic health authorities from April 2002, and making primary care trusts the lead NHS organisations with responsibility for assessing need, planning and securing all health services, and improving health in their localities.

Richard Humphries, chief executive of Herefordshire health authority and director of health, housing and social care at Herefordshire Council, said: “The NHS will be looking at its own internal structures instead of outwards at the partnerships. That will set the process back. It’s going to need six months from April to settle down.”

Dave Martin, acting chief executive of Sandwell health authority and executive director for social exclusion and health at Sandwell Council, urged local authorities to be patient with their health colleagues.

“It’s about having confidence,” he said. “We need to do everything we can to keep key players doing pretty much what they were doing before. If they turn up in a different structure it doesn’t matter – they won’t change their spots.

Martin predicted that “re-engagement” with health partners post restructuring would be gradual, with several phases. “Everyone has a very complicated set of changes ahead of them, and at the same time we are trying to turn round and modernise services,” he said.

* Youth offending teams or community mental health groups are good templates for care trust structures, the conference was told.

David Browning, who is associate director of public services research for the Audit Commission, said multi-disciplinary teams such as YOTs and mental health teams form an effective model to follow.

He also said a 'network manager' can help to co-ordinate the partnership working between agencies essential if care trusts are to be successful.

Brian Dornan, who is director of social services for Southern Health and Social Services Board in Northern Ireland, explained how Down and Lisburn Health Trust combined health and social services into one organisation.

Primary care teams were created, including social services, based in GP practices. "There is no wall between health and social care staff," he said.

He said 90 per cent of staff preferred the new integrated working arrangements, and believed it led to improved services.

Dornan said it was important to avoid nominal integration and domination of one profession.

Tories promise improved professional standing for social work

Tim Loughton, the new Conservative social services spokesperson, provided a pastiche of recent briefings from social services chiefs on the current crisis facing social care, writes Rachel Downey.

“Many social services departments are no longer able adequately to carry out their statutory responsibilities,” he told delegates. 

He outlined staff shortages, increases in demand, an unfair distribution of resources between the NHS and social care and initiative overload “where central government gets all the kudos, but local government departments will get all the flak when it all goes wrong”.

Last week’s announcement of an additional £300 million to combat bed blocking this winter was “a drop in the ocean”, he added, warning the government “would not be forgiven a second time” if it failed to meet its targets on care of older people.

His solutions were limited. He suggested examining “not just independent treatment episodes but the whole system of care holistically”, and looking at the transfer of funds from acute hospital sector to care in the community to give a better balance.

The only new proposal was a national independent assessment forum, which would devise a standard for assessing care needs to cover the whole country. 

Loughton said he hoped the forthcoming government recruitment campaign would not just focus on raising qualifications but the public perception of the profession. He claimed the Conservative party would raise the professional standing of social workers and all those who work in social services to that anticipated for nurses, doctors and teachers. “The Conservative approach is to trust professionals to get on with their job with minimum interference from central government.”

He criticised the government for setting “targets for everyone but priorities for none” and when it goes wrong, blaming local authorities.