As the first care trusts came into being last week, the evaluation of the first merger of social care and health services was timely.
The appraisal of the de facto care trust running mental health services in Somerset provides some loud warnings for those leading the way. It concludes service users benefited but staff, particularly those who transferred from the social services department, did not. Increased workloads, more bureaucracy, less therapeutic time with clients, decreased job satisfaction, and rising pressure on team managers were all reported.
Evaluators also found that the cultural differences between social care and health staff remained entrenched. Social workers' fears that the social model of care would lose out to the medical model were vindicated, as were their fears about the different languages used by each professional group.
More worrying was the fact that social workers felt clients no longer perceived them as "independent enough". When working with people with mental health problems it is crucial that service users view their social workers as their advocates, not as part of the state mechanism. If social care staff are seen as part of the health bureaucracy, clients could disengage from services and they and their families could resort to trying to cope alone, most likely unsuccessfully.
But as the evaluation heralds good news in other respects for its care trust project the government will probably not be losing much sleep on account of social workers' feelings. User satisfaction levels in Somerset rose to very high levels by 2001 despite a fall in the year after the setting up of the trust. So the project appears to be working.
But high quality services cannot be delivered without motivated, contented staff. Given that social workers are already in short supply and many agencies are having great difficulties in recruiting and retaining staff, it is not possible for the government to miss the message coming out of this study.
Staff self-esteem, security, and self-respect are crucial not only to the quality of social care services but also to the government's plan to modernise the health service. Social care workers need assurances that their model of care, their expertise, and their holistic approach to service users will be protected within the new structures.
Justice comes at a price
There is no simple answer to the question whether some of those residential workers convicted of abusing children in their care were victims of a miscarriage of justice. Successive inquiries in areas such as north Wales, Cheshire, Merseyside and Northumberland have resulted in hundreds of convictions for crimes mostly committed 20 or more years ago. It is notoriously difficult to gather evidence in such cases without calling for corroboration from a great many witnesses whose motives may occasionally be dubious and, on the law of averages alone, there must be at least a small chance that, for a few of those found guilty, justice failed.
But none of this shows that a single one of the police forces involved was wrong to carry out an inquiry. The lapse of time does not lessen guilt, nor do the difficulties in collecting evidence make establishing the truth any less important. Those who lobby on behalf of convicted care staff cannot have it both ways. If the truth of the allegations against them is worth investigating now, it was worth investigating then. Residential workers, like many others, hold positions of public trust. When this trust is seriously called into question, they must be willing to answer for their actions.
