Social
services told now is the time to challenge health service

It
is time those working in local authorities took on the health service and
challenged the NHS to take them seriously, Rita Stringfellow of the Local Government
Association told the conference, writes Rachel Downey.

She
called for wider recognition by the health service that those involved in
social care had valuable expertise and experience to bring to the table.

But
she added: "My real challenge to health, to the department of health and
to ministers, is that we have a dialogue, an honest dialogue about what
integrated services mean and not just a repetition of the usual rhetoric."

Stringfellow,
chair of social affairs, health and housing at the LGA, questioned the role of
the new four regional directors of health and social care and asked why people
had been appointed to the posts before the role had been properly defined.

"Do
they anticipate drawing powers from local government or the Social Services
Inspectorate? Otherwise why should this layer exist?"

She
said she "struggled with" the fact that there are now eight
government office regions, seven SSI regions, the new strategic health
authorities and the four health and social care regions. "What is the
added value of the latter?" she asked.

She
said it was important that there was a balance of power, and local government
should not be viewed as the junior partner.

"It
might be tempting for some directors of social services to see themselves as
part of the health establishment – but it is more complicated than that,"
she declared, adding that perhaps it should be chief executives who sit on
health bodies as they have more clout than social services directors.

The
LGA has set up a task force to look at the interface between health and social
care and work has so far focused on the setting up of the new care trusts. But
what was clear was that the key to future improvements to services is
maintaining a dialogue with those in health.
"Now is the time to draw a line in the sand and say to the NHS at the
centre ‘Talk with us not at us,’" she said.

Care trusts hide lack of resources

Structural
change in the shape of care trusts was a way of avoiding the under resourcing
of social services, Evan Harris, Liberal Democrat health spokesperson, told
delegates, writes Rachel
Downey.

Harris
said the government was hiding behind constant structural changes in the health
service to avoid tackling the poor levels of service delivery and the same
would happen in social services. Any government which cannot deliver the
improvements it has pledged will seek to distract the debate away from service
delivery towards structural change.

Because
the government has pledged increased spending on social services but also cuts
in income tax, social services departments were being left to take the blame
for reducing services as well as increases in council tax, he said. “With
social services, the dangers are even greater. It’s a double centralisation of
praise and a double decentralisation of blame.”

The
government’s approach to health and social care was “to centralise praise and
decentralise blame”. Democratic accountability in local government meant the
risks of a blame culture were greater, he added.

The Liberal Democrat solution was an increase
in income tax and Harris welcomed the Prime Minister’s apparent realisation
that improved public services would require significant investment.

He argued that the government’s new
recruitment campaign for social care workers was not enough. “Social services
relies, more than any other workforce, on the quality and quantity of its
workforce.  It requires long-term
investment in the recruitment, training and retention of staff.  That’s the message for politicians who say
they care about care.”

Commission to focus on
outcomes and not close homes

Work
in the first operational year of the National Care Standards Commission will
focus on finding out how people achieve outcomes, not closing down homes,
chairperson Anne Parker told conference delegates, writes Lauren Revans.

Parker
said there were too many “unrealistic fears” in the care home sector about the
NCSC, which is due to come into force in April 2002 to inspect and regulate
social care and private and voluntary health care in England.

She
said that the NCSC had decided not to comment on the minimum standards set by
the government this year, but would make recommendations for changes next year
once they had gathered all the information.

“In
year one, we are going out there and finding out,” she said. “We have standards
and we will record standards. And we will be in discussion about what the
shortfalls are.”

Parker
said that, by gathering information from providers about outcomes being
achieved despite standards not being met, the NCSC would, where appropriate, be
able to feed new ideas into the second round of standards.

The
GSCC officially came into being on 1 October, and will eventually be
responsible for registering the whole social care sector workforce.

Scie set to help staff promote the social care model

The
new Social Care Institute for Excellence will help social care staff have the
confidence to promote the social care model in new working arrangements, a
department of health official told delegates, writes Lauren Revans.

Amanda
Edwards, head of quality strategy for social care, said that Scie had a role in
“preparing people for working in new ways”.

“In
order to promote the social care model in new situations we have to have a bit
of background,” she said. “We need to know why we are doing what we are doing.
Using Scie to develop confidence is very important.”

Part
of Scie’s dissemination role will be to work with the General Social Care
Council, the National Care Standards Commission, the Social Services Inspectorate,
and others to make sure that findings were actually being drawn on and used by
educators and trainees, she added.

Ray
Jones, Scie’s chief executive designate and out-going director of services for
Wiltshire, said it was essential to recognise the realities of the real world
and the complexities of changing it, as well as the opportunities.

“What
I’m recognising is that Scie is going to be working with all of you in
different ways in a world that is messy,” he said. “We mustn’t kid ourselves.”

Scie
chairperson Jane Campbell added that the organisation’s goal to involve all
partners in the development and dissemination of knowledge must extend to the
independent sector.

“Scie
recognises the majority of social care provision is in the private sector, and
two thirds of the workforce is employed there,” Campbell said. “We are keen to
discuss with private sector staff and employers how Scie’s work can help them
improve quality and outcomes.

“We
want private sector managers and staff, often working in isolation and with
limited access to training opportunities, to access through Scie’s services
knowledge that will improve their practice.”

WEDNESDAY 17 OCTOBER

Deputy mayor of New York speaks to conference

An
interview with the deputy mayor of New York in which he talked about the
aftermath of the September 11 tragedy was relayed to delegates at the National
Social Services Conference, writes David Callaghan.

The
Local Government Association’s head of social affairs John Ransford travelled
to New York to talk to Anthony Coles about the efforts made by the city’s
leadership to return it to some normality and revive the morale of citizens.

Coles
apologised for not being able to attend the conference in person, but explained
how the terrorist attack had been the preoccupation of everyone in New York.

He
said the city had been forced to ‘peg back’ budgets by 15 per cent because a
downturn in the city’s economy will reduce civic revenues by an estimated $1
billion in this financial year. Tax rises have been ruled out, he said, and
there may even be tax cuts to stimulate the economy.

Video
clips of New York’s mayor Rudolph Giuliani giving a briefing on the financial
implications of the attacks were also shown.

Ransford
said: ‘The most encouraging thing we found was the absolute absence of rancour.
But there is a search for understanding for why this happened and not a thirst
for revenge.’

He
said this country could learn from the Americans’ resolve, and use their
experience to address problems such as inequality.

Closer working
arrangements delayed six months

Progress
towards closer working between health and social services will be delayed by at
least six months as a result of internal restructuring within the NHS, local
authorities warned, writes Lauren Revans.

Delegates
attending a policy session on the way forward for health and social care heard
that the changes outlined in government’s document published this summer, Shifting the Balance of Power in the NHS,
would leave health organisations with no choice but to focus on internal
changes rather than partnership arrangements.

The
document proposes replacing the 95 health authorities in England with around 30
strategic health authorities from April 2002, and making primary care trusts
the lead NHS organisations with responsibility for assessing need, planning and
securing all health services, and improving health in their localities.

Richard
Humphries, chief executive of Herefordshire health authority and director of
health, housing and social care at Herefordshire Council, said: “The NHS will
be looking at its own internal structures instead of outwards at the
partnerships. That will set the process back. It’s going to need six months
from April to settle down.”

Dave
Martin, acting chief executive of Sandwell health authority and executive
director for social exclusion and health at Sandwell Council, urged local
authorities to be patient with their health colleagues.

“It’s
about having confidence,” he said. “We need to do everything we can to keep key
players doing pretty much what they were doing before. If they turn up in a
different structure it doesn’t matter – they won’t change their spots.

Martin
predicted that “re-engagement” with health partners post restructuring would be
gradual, with several phases. “Everyone has a very complicated set of changes
ahead of them, and at the same time we are trying to turn round and modernise
services,” he said.

*
Youth offending teams or community mental health groups are good templates for
care trust structures, the conference was told.

David
Browning, who is associate director of public services research for the Audit
Commission, said multi-disciplinary teams such as YOTs and mental health teams
form an effective model to follow.

He
also said a ‘network manager’ can help to co-ordinate the partnership working
between agencies essential if care trusts are to be successful.

Brian
Dornan, who is director of social services for Southern Health and Social
Services Board in Northern Ireland, explained how Down and Lisburn Health Trust
combined health and social services into one organisation.

Primary
care teams were created, including social services, based in GP practices.
"There is no wall between health and social care staff," he said.

He
said 90 per cent of staff preferred the new integrated working arrangements,
and believed it led to improved services.

Dornan
said it was important to avoid nominal integration and domination of one
profession.

Tories
promise improved professional standing for social work

Tim
Loughton, the new Conservative social services spokesperson, provided a
pastiche of recent briefings from social services chiefs on the current crisis
facing social care, writes Rachel Downey.

“Many
social services departments are no longer able adequately to carry out their
statutory responsibilities,” he told delegates. 

He
outlined staff shortages, increases in demand, an unfair distribution of
resources between the NHS and social care and initiative overload “where
central government gets all the kudos, but local government departments will
get all the flak when it all goes wrong”.

Last
week’s announcement of an additional £300 million to combat bed blocking this
winter was “a drop in the ocean”, he added, warning the government “would not
be forgiven a second time” if it failed to meet its targets on care of older
people.

His
solutions were limited. He suggested examining “not just independent treatment
episodes but the whole system of care holistically”, and looking at the transfer
of funds from acute hospital sector to care in the community to give a better
balance.

The
only new proposal was a national independent assessment forum, which would
devise a standard for assessing care needs to cover the whole country. 

Loughton
said he hoped the forthcoming government recruitment campaign would not just
focus on raising qualifications but the public perception of the profession. He
claimed the Conservative party would raise the professional standing of social
workers and all those who work in social services to that anticipated for
nurses, doctors and teachers. “The Conservative approach is to trust
professionals to get on with their job with minimum interference from central
government.”

He
criticised the government for setting “targets for everyone but priorities for
none” and when it goes wrong, blaming local authorities.