Hunter: infrastructure boosted
Tony Hunter, president of the Association of Directors of Social Services:
"The government has undoubtedly improved the professional infrastructure within which social work is practised, and has rationalised the management environment in which it is led. In many respects the building blocks of these changes were laid down during Labour’s first administration, from 1997 to 2001.
So what have been some of the highlights? The General Social Care Council – the systematic registration of what eventually will be the entire social care workforce was a move that ADSS and other organisations had long called for. Also, the setting up of the Social Care Institute for Excellence. This, as we have seen over past weeks, is a tectonic plate which is still settling down. Eventually it should act as a major catalyst for disseminating good practice throughout social care. Other achievements are the creation of the Commission for Social Care Inspection, and then the declared merger of its functions with those of the Healthcare Commission and Ofsted, although as yet it is too soon to say whether this will work for the best. The CSCI had made an excellent start in developing performance assessment systems based unambiguously on the experiences and outcomes of service users. The new arrangements must retain this focus.
We should also welcome the introduction of the three-year social work degree. This is further evidence of the government’s determination to bolster social work’s academic and professional identity.
Nor should we forget the voice the government has helped to provide for carers and people with learning difficulties: there is more to be done, but some excellent building blocks have been laid.
However, the under-funding of social care services compared with the NHS has not allowed us to keep up with NHS colleagues, successful though we have been in reducing delayed discharges across the whole system.
The recent ADSS/local health alliances/Treasurers’ Society survey of social services budgets has shown there simply isn’t enough cash in the system to allow us to carry out the creative, preventive tasks to which we are committed.
We remain seriously concerned, too, over what feels like an over-punitive approach to people with mental health problems.
On the children’s side, engagement of all local bodies and agencies is essential to delivering the five outcomes of the Children Act 2004. As for adults, refocusing our professional and managerial practice towards the person-centred approaches in the green paper will be challenging, but it is also an unrivalled opportunity to deliver in-depth, council-wide community care services based on people’s choices.
A great deal has been achieved but the next government still has a lot to do."
Gunn: More hassle for public sector staff
Sheila Gunn, political commentator and Conservative councillor in the London Borough of Camden:
"On 2 May 1997, those working in social services must surely have been among the most excited as the Blairs walked into 10 Downing Street. Less than 24 hours beforehand, I had heard the cheers against the background of the song "Things can only get better" as the golden couple arrived at the celebratory party on London’s South Bank.
I believe that Britain regained her standing and self-confidence during the Conservative years. But, as a "one-nation Tory", I hoped that a change of government would tackle issues we had not resolved. Nagging worries included the catalogue of tragedies involving children in care and the less-than-successful care in the community policy. Maybe New Labour would touch the parts that Conservatives had not quite reached.
From day one there were surprises. The most obvious was the adoption of Conservative spending plans for the first two years: skewing the benefit scheme to "encourage" single mothers to take paid work; the parsimonious approach to pensioners; and an almost manic faith in the private sector to deliver public sector projects.
Perhaps it would be wise to write off New Labour’s first parliament as a trial run. The second parliament would be different, we were told. Absolutely right it has been.
The key change, apart from a propensity for committing our troops to dubious wars, has been chancellor Gordon Brown’s loosening of the purse strings. There is no doubting New Labour’s self-belief in distributing public money for the greater good of our communities. Yet far too little appears to filter through to those who really matter. These fall into two categories: firstly, the intended recipients – those who are not able to care adequately for themselves or their loved ones.
The second is those working on the front line, face-to-face with the users of social and health services.
At the same time, all those I meet who are working in a public service seem to be working harder, experiencing more hassle – and gaining less satisfaction.
And that is without mentioning severe outbreaks of "crick-in-the-neck syndrome". You know what causes that? It’s perpetually glancing over your shoulder to see if you’re meeting some target, or absorbing the latest badly written, acronym-strewn directive.
One day – and I hope it is soon – many more people will connect this with the way we are being governed."
Adebowale: ‘Intractable problems’
Victor Adebowale, chief executive of social care organisation Turning Point:
"The first thing to say in judging the government’s performance is that there has at least been a performance to judge. There is a creeping interest in what could be done through social care, and the impact it could have on a host of society’s toughest issues. However, we’re at the beginning of that journey rather than at the end. There are huge challenges for how, as a society, we perceive social care, measure it and invest in it.
After two full terms of New Labour government and sizeable investment, we’re still faced with apparently intractable problems. What that tells me is that government hasn’t done enough to understand and overturn the inverse care law. This states that those who need the most support are the least likely to receive it. Look at poverty and employment programmes, for example. The government is to be commended on the effort and investment put into this area, but so far it has focused on the margins. Some of the most excluded groups still face little chance of employment and face severe poverty.
In the green paper on adult social care, the government has at last started to build on the link between regeneration and social care. I believe this is an area overlooked to date, and that we have to focus on investing in individuals as much as we invest in their physical surroundings.
There has been progress across mental health, substance misuse and learning disability, but there is still so much more to be done. In relation to the first two, the focus needs to rest firmly on building services that people can quickly access at the point of need rather than following the criminal justice agenda.
Finally, a word on the role of the not-for-profit sector in all of this. Government isstarting to understand the full role that voluntary and community services can play. But the big challenge for the general election winner will be to put a commissioning and capacity-building framework in place to enable not-for-profit agencies to play a full role in tackling the challenges discussed above."
Harding: ‘Essential care pared to the bone’
Tessa Harding, senior policy adviser, Help the Aged:
"Since 1997, this government has promised an elephant on health and social care for older people, and delivered a moderately sized mouse.
Early in its life, the government asked Sir Stuart Sutherland to head a Royal Commission on long-term care – an encouraging sign. After all, Royal Commissions are not every day events and long-term care is not a popular subject, and here was a new government setting out to take the bull by the horns. But it didn’t. In particular, it failed to address the key issue of funding for personal and social care.
The national service framework for older people published in March 2001 was a high point. It brought older people out of the shadows of the NHS and social care, where they habitually reside, and into the limelight – wonderful. What is more, it involved older people directly in developing its recommendations, and that showed.
Age discrimination was to be rooted out, services were to be individually tailored and take account of the views of the person concerned, and attention was to be paid to helping people stay healthy, as well as treating them when they were ill. But, while recent extra investment in the NHS has certainly benefited older people, again social care has been the poor relation and "who pays for what?" has continued to be the dominant theme.
Now we have the new vision for adult social care to raise our hopes again. And yes, the principles sound wonderful: helping people stay healthy, affirming their personal dignity, enabling them to have a decent quality of life and more control over their own affairs – all laudable aims. But there is no promise of new funding.
Eligibility criteria have already been squeezed till their pips squeak. Essential low-level care has been pared to the bone. Carers in their eighties are left unsupported to look after spouses who would otherwise be in care homes. People in their nineties who urgently need adaptations to their home are told they must wait for many months. These things are surely shameful.
How can people be assured of dignity in old age when the services that are supposed to support them are so thinly spread and so discriminatory? And how do we as a society expect the needs of the rapidly growing cohort of those in advanced old age to be met if we are not prepared to spend more?"
McCulloch: ‘They’ve taken on the doubters’
Andrew McCulloch, chief executive of the Mental Health Foundation:
"The past eight years have seen major change and achievements in mental health policy and services. Labour has grasped the nettle of service change and taken on the doubters in the medical establishment by radically shifting community care for people with severe mental health problems. This has been done by massively accelerating the rate at which intensive community care has developed. Specifically, NHS Plan targets for assertive outreach have been achieved. And while progress has been slower on crisis intervention and early intervention, growth has been significant. There has also been major investment in secure services.
While this change has been the crowning achievement, there have been helpful broader policy developments including a fairly comprehensive national service framework for adult mental health, and significant investment in children and young people’s mental health. Suicide rates have declined and there is an emerging, albeit barely resourced, emphasis on public mental health. The philosophy of recovery has also helped to drive attitude and service change. Most recently we have a welcome emphasis on social exclusion and employment although, as yet, only limited signs of practical progress.
Despite some of these landmark changes, Labour’s achievements have been tainted by its abortive and muddled attempts to reform mental health legislation. This sorry saga has undermined relationships between the sector and government and has added to the stigma and fear experienced by service users. In misconceiving and mishandling its attempts to reform the 1983 Mental Health Act Labour has worked against the social inclusion agenda it has advocated elsewhere, and public fears about people with severe mental health problems have increased rather than declined.
Other areas where Labour has struggled to deliver include older people’s mental health, the needs of people from black and ethnic minorities (where the emphasis has been on rhetoric and fudge), the needs of carers, and improving primary mental health care. We also need a fundamental rethink of child and adolescent mental health services – not just more of the same. If re-elected, Labour’s key challenge will be to put the mental health legislation debacle behind it and free up the logjam which now exists in mental health services.
Further progress and further investment in service modernisation will be impossible without tackling acute inpatient care. Unless we turn our attention to this key policy issue we will not be able to complete the modernisation of mental health services."
Tickell: Joint-working worries
Clare Tickell, chief executive, the children’s charity NCH:
"It is too early to judge definitively this government’s impact on social care when it comes to children because Every Child Matters is a 10-year programme. At NCH we strongly support the government’s vision of integrated, child-centred children’s services, with social care having a central role alongside health, education and the voluntary sector, among others – as it already does in Sure Start.
Social care’s contribution is crucial if children are to be effectively safeguarded. Social care’s values of working alongside children, young people and families must also be given full expression; otherwise we will not maximise the potential of the system as a whole.
But questions arise over the extent to which this balanced integration of children’s services will really happen. This is particularly important following the decision to integrate arrangements for children’s inspections.
Every Child Matters spells the end of social services departments that span children and adults. At NCH we worry that this may weaken joint working with families in which there are child welfare concerns, and where the parents have mental health or substance abuse problems. Similar issues arise over disabled young people’s transition to adult services. Local protocols are needed to support effective joint working within the new structures.
This government accepts that most looked-after children are not fulfilling their potential. Some of its responses helpfully recognise that looked-after children are a corporate responsibility, not just a job for social care – such as the new duty to promote the education of looked-after children in the Children Act 2004. However, government targets for the looked-after system should have been much bolder and resources should have been allocated to ensure they are achieved.
It is disappointing that there is still no youth green paper, as this is an important part of the jigsaw.
Since social care is a "people business", a critical element of government policy is the workforce. We applaud the government for recognising the need to praise social workers for the difficult job they do, rather than just blaming them when things go wrong. Tackling social care recruitment and retention difficulties, including those among foster carers, is hugely challenging, and how the government addresses this may be the most important test of all of its approach to social care. We await the publication of the children’s workforce strategy with interest."
