Milburn names worst authorities

Health secretary Alan Milburn named and shamed the country’s 14
worst performing social services departments during his keynote
speech to the National Social Services Conference,
writes David Callaghan.

He also named the 15 best performers during a hard-hitting
speech in which he admitted social services staff face a “Herculean
task”, but insisted improvements depend on management and
organisation and not money.

Milburn warned councils that fail to improve quickly will face
government intervention with outside ‘experts’ being brought in to
take over the running of services. A new star rating system is to
be introduced to grade departments from one to three stars, which
will be introduced next summer.

He also officially launched a government campaign to recruit
5,000 more social workers within three years. “We do believe the
shortages can be turned around,” he said

Milburn told delegates it was unacceptable that a quarter of
local authorities do not review child protection cases on time, and
that six out of 10 children leaving care do so without any formal

He also highlighted the failure to meet government targets to
reduce delayed discharge.

To the best performing councils though he promised ‘light touch’
inspections, inspections of non-children’s services every five
years, and more freedom to spend cash from the £50 million
performance fund on locally agreed priorities such as staff
bonuses.He said he was disappointed in the take-up of legal powers
enabling pooled budgets, but said 15 care trusts would be
established next year.

New performance indicators show that the 14 worst councils

Blackpool, Bracknell Forest, Buckinghamshire, Croydon, Isles of
Scilly, Kirklees, Lambeth, Richmond Upon Thames, Southend on Sea,
Stockport, Torbay, Warwickshire, West Berkshire and Windsor and

And the 15 best are:

Camden, Cornwall, Derby, Derbyshire, Dudley, Kensington and
Chelsea, Leicestershire, Medway, Middlesbrough, Rotherham,
Redbridge, Salford, South Tyneside and Sunderland.


Social services told now is the time to challenge health

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

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.

As 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

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

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

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

“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

“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


Deputy mayor of New York speaks to

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

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

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

Closer working arrangements delayed six

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

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

“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

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

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

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

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

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

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

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







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