News

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 Association
"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 structure."

Martin Green, chief executive, Counsel and Care for the Elderly
"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 Agency
"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 care."