The problems of recruitment and retention in social care are at their most intense in London.
But the fact that London is one city should help its 33 boroughs to work together on strategic solutions, both directly focused on recruitment and retention of staff, and tackling the problems that feed the recruitment crisis, such as the poor media image of social services and the lack of public understanding of their role.
London could and should be a model for the whole country of co-operation between individual local authorities in the common interest. Yet it is far from that. In fact, a spirit of competition between authorities exists that does not merely fail to address the problems: it exacerbates them by driving up costs until poorer authorities automatically lose out, and by generating an unwillingness to share ideas and best practice.
The report Is Anybody Out There?, published by Community Care to launch our Care in the Capital Week campaign, makes many recommendations to help London boroughs avoid a worse crisis, which would inevitably jeopardise the overall improvement in service standards seen in London over the past year.
But elected members must take the lead, and must work across party boundaries. The contribution to quality made by the location of social services within local government is by no means so clear that local politicians can afford to be part of the problem, rather than part of the solution.
But if the power of local government were harnessed in the interests of better social care for everyone in London, it is exciting to contemplate what could happen. Housing schemes for social care workers; managed staff development across boroughs, perhaps including the voluntary sector as well; work with schools to encourage enthusiasm among young people for a career in social care; a pan-London consortium to negotiate with recruitment and locum agencies; a strategic approach to media relations, including London-wide campaigns.
It's time for some joined-up thinking.
Fears need to be
allayed
Unison's local government conference has voted to step up the union's campaign against care trusts, indicating the extent to which absorption of social services by the NHS is still feared at the grass roots. In our view Unison has gone a step too far. In some localities care trusts may be the best way to deliver health and social care effectively, although such judgements should always be made on a case-by-case basis. There will be many other areas where it is better to use the flexibilities of the Health Act 1999 to promote partnership than to bring health and social care together in one organisation.
However, the concerns that give rise to Unison's campaign cannot be ignored. The argument that the NHS is undemocratic looks somewhat forlorn in view of the moribund state of local democracy, although it is undoubtedly true that the health service has a long way to go to improve its own systems of accountability. But the union also argues, with greater justification, that the medical model of care may prevail over the social model if care trusts become widespread.
The Unison vote should be a lesson to the government. Those in government who advocate care trusts as an important part of the future of health and social care must do much more to allay the fears of all those staff whose own futures are tied to them.
