Deliver us from this vision
Tony Blair used the word shortly after the election, since when
no self-respecting government minister has been able to appear on
television without sounding like the Prime Minister’s echo. The
word is, of course, “delivery” and health secretary Alan Milburn is
quite as keen on it as his colleagues are.
The paper published last week setting out the Department of
Health’s future shape and direction is subtitled – surprise,
surprise – Focusing on Delivery. In case anyone misses the point,
the message is reinforced in the text: “We have to change from a
department that is focused on policy to one that is focused on
delivery,” it says before setting out detailed proposals for an
overhaul of the rusty machinery of health governance.
By maintaining separate bunkers for health and social care, the
DoH had begun to look hypocritical as it preached the virtues of
integration and partnership to everyone else.
That charge, at least, will no longer stick.
The department’s change programme promises a radical shift in
the balance of power from the centre to the regions, demolition of
the internal structures that have enforced artificial distinctions
between the NHS Executive, the public health group and the social
care group within the DoH, and a system of national and regional
directors of health and social care.
So far, so good.
What is less certain is the vision of social care which
accompanies the change agenda. It is difficult to detect any
conception of social care which sees it as more than an adjunct of
a health service preoccupied with its set of all-important clinical
Unlike delivery, words such as advocacy, empowerment, and
anti-oppressive practice are missing from the departmental lexicon.
A new peace may have dawned for health and social care but, make no
mistake, the battle is on for social work values.
It is surprising – given workloads in social services generally,
the impact of the recruitment crisis, and the realities of child
protection in deprived and excluded communities – to learn that
Haringey social workers were not overworked at the time of the
appalling death of Victoria Climbie.
But according to their director, this is the case.
Her view cannot truly be judged until the statutory inquiry has
heard both her evidence and that of her staff. But whatever the
truth there can be no question of blame falling solely on
We must not see a return to the 1980s, when individual social
workers were blamed for the deaths of abused children and the
context was routinely ignored.
There must be no attempts by Haringey Council – or any other
agency – to shift attention from the failure of systems onto the
failure of individuals.
When the inquiry reports next year, the way its findings are
presented, and the reactions of the agencies concerned, will be
crucial to the message that reaches the public. Those agencies have
a responsibility to do everything they can to make sure no