See below for Jacqui Smith’s answers to your questions.

This week’s Have your say debate centres on the Victoria
Climbie inquiry.

What do you think should be done to restore the public’s
confidence in child protection services? Do you think another case
like Victoria Climbie could happen again? Or do you have a view on
the way the Climbie Inquiry is working?

Have your say and join the online debate by clicking here

All the responses will be posted here

Health minister Jacqui Smith has answered questions from
visitors to
and readers of Community Care magazine. Questions
are grouped in different subject areas.

Pay, morale, recruitment and retention

Question: Is the government going to put more
resources into social work? If salaries are not increased, social
workers will leave to join the private sector. Kathleen

Answer from Jacqui Smith: We increased spending
on social services by 6.2% this year. This is well above inflation.
As you know, pay for individual staff is decided by their employer
– we do not set pay levels for social workers or social care

Q: When will the government substantially
increase pay for social workers to recompense for years of
effective pay restraint, and to reward in a way that reflects the
nature of the work and helps to retain staff? Tony

A: As I said in answer to the question by
Kathleen Webberley, we have increased resources for social
services. But we don’t control social workers’ pay – which is
decided by employers. We can only encourage employers to have
effective recruitment and retention policies that look at all the
issues, including pay.

Currently the starting salaries for social workers, teachers and
nurses are on average the same which is an important start in our
bid to recruit more people into the profession.

Q: The problems in retaining staff in social
care are well documented. Is there a role for performance related
pay? Anonymous

A: Again, pay is an issue for individual
employers. But I personally think that innovative schemes, such as
paying more to duty teams working out of hours or promoting more
flexible working patterns, definitely have a major role to play not
only in retaining staff, but in recruiting them.

Q: With the current shortage of qualified
social workers, why isn’t more being done by the government to
encourage/demand local authorities to retain the experienced
qualified staff they already have? I am a senior social work
practitioner working in child care, there is no option within my
department for me to reduce my hours or to work flexitime, which,
in accordance with the government’s work-life-balance guidance
policy is essential in the recruitment and retention of staff, and
is line with good staff care policies and a healthy productive

Many of my colleagues and myself have all suffered from stress
and paperwork orientated high caseloads, particularly with the
introduction of the new doh core assessment requirements. This
career is not just about money, although it helps, it’s about
commitment and dedication, and all the retention payments in the
world cannot make up for the feeling of being valued, supported and
cared for within the workplace. There seems so much government
energy and public sympathy being focused on the shortages and work
pressures of teachers and nurses, but little media coverage of the
desperate shortage and work pressures of social workers.

In light of the recent tragedies involving children, why isn’t
the government looking into the disparity that exists within local
authority social services departments in relation to working pay
and conditions to retain existing experienced staff, instead of
just focusing its attention on the recruitment and training of new
social workers? Carol Groves

A: We are encouraging councils to look at the
best ways of retaining their staff. The social work recruitment
campaign, which the Secretary of State for Health launched on 19
October, is not just about recruiting new staff. Its wider aim is
to improve the image of people who work in social care. I
appreciate that social work staff feel very much under attack by
the media, and so one of the purposes of the campaign is to raise
the level of public and media awareness about the brilliant work
that social workers do.

I entirely agree with the point you make that retaining social
workers is not just about money, but is also about flexible working
practices and people feeling valued. I hope that, on a national
level, the campaign will help with this. But on a local level, it
has to be up to the individual employer. We are encouraging
employers to have good human resources policies – the report ‘Care
to stay’ by the Local Government Association shows that acting on
these can be very effective in retaining and recruiting staff. So
does ‘People need people’, a report by the Joint Review
Inspectorate that shows that councils which have good human
resources policies tend to have good outcomes for service users,
too. But in the end, it is about individual employers making a
conscious decision to invest in their staff.

Q: If you were employed as a social worker,
morale was low and you did not know whom you would be working for
i.e. health, education or police (in the child protection team) in
a year’s time, what would you do? Len O’Connor

A: I think that I, like anyone else, would be a
bit anxious about the changes. But I would welcome anything that
would let me provide a better service for children and families –
and I think that working more closely with health, education and
the police will help to do that. I would want to make sure my voice
was heard before all the decisions were taken, and that I took
every opportunity to have some input into what the changes would be
and how they would be implemented. It’s very important that people,
like you, who work on the front-line get a big say, because you are
the people who know best what service users want and need. And, if
I was a team leader, I would want to look at ways of improving
morale, perhaps by having a look at innovative schemes that other
councils have used to retain staff and seeing if they would work

I really hope that you stay and are part of the changes.

National service framework for children

Q: Will the ‘NSF for children’ promote the
integration of community based child health services with social
and education services to ensure seamlessness and single case
management for those children that are vulnerable especially for
children with disabilities? If it doesn’t how will the government
ensure that services do breakdown professional boundaries and pool
resources? The flexibilities of the partnership legislation allow
for joint investment plans and pooled budgets, but how can this be
managed effectively whilst children’s services sit in separate
organisations e.g.: PCT’s, secondary trusts, education, social
services, environment and leisure, Connexions, youth offending
teams etc.? Carol Baker-Longshaw

A: The NSF will set out to tackle inequalities,
raise standards and reduce unacceptable variations by setting clear
national standards and targets. It will provide a coherent and
integrated approach to services for vulnerable children. We want to
build on existing health and social services programmes – such as
the Quality Protects programme and SEN Programme of Action – to
develop an integrated approach to supporting vulnerable children,
especially disabled children. Most disabled children who use social
services also have health and education needs. Disabled children
who need the support of social services, health and education
services should receive these through an integrated system.


Q: Can you confirm that the government will
take very seriously the repeated questions asked in the debate in
the House on 29th October that adoption by unmarried couples should
be included in the Adoption and Children Bill? Mary

A: Yes. Alan Milburn indicated in the House of
Commons he welcomed debate on this issue, and that we would
consider carefully the evidence heard at the Special Standing
Committee. Under the existing Adoption Act 1976 single people may
adopt (regardless of sexual orientation), but only married couples
may adopt jointly. It is open for one unmarried partner to adopt a
child and the other to obtain parental responsibility by applying
for a residence order in respect of the child. The Adoption and
Children Bill makes no change in this area. We believe that these
proposals as they stand are broadly right, but by sending the Bill
to a Special Standing Committee we are providing the opportunity to
hear a wide range of evidence from stakeholders in the field, and
for there to be further debate on this, and other, issues.”

Q: What is being done about revising the court
process in relation to adoption and the new standards? Many of the
delays in placing children are clearly to do with court decisions.
The reasons vary, but often relate to courts losing sight of the
child’s timescale, and by emphasising the need to be fair to birth
parents. Alan Jones

A: I agree that children’s needs should be at
the centre of adoption. Our white paper ‘Adoption: a new approach’
recognised that delays do sometimes occur in the courts and set out
a range of measures to improve the situation.

By the end of the year, we plan to extend the private law
jurisdiction of district judges dealing with cases under the
Children Act 1989, which will increase the numbers of judges
available to deal with disputes over contact or residence with a

This will also free up judges to deal with public law and
adoption work. And from November 1 specialist adoption centres at
county court and high court level came into force across the
country to help reduce delay and improve services.

We plan to consult on ways to encourage and improve inter-agency
communication and co-operation later this year. We want to
encourage consistent recording of information relating to
timescales for children and adoption cases, with a view to setting
target timescales for children’s cases next year.


Q: Does the government’s reluctance to afford
children the protection from assault enjoyed by adults stem from
old adages like “you have to be cruel to be kind”, “spare the rod
and spoil the child” and hypocrisy such as “this hurts me more than
you”? Ian Johnston, Director, British Association of Social

A: There are many areas of social policy where
legislation acts as a point of good practice and principle in
regards to the treatment of children. The Children Act is one of
these. In the case of the Children Act the legislation provides an
expectation that society will treat its children with care and

Q: How can the minister justify the
government’s recent refusal to make such a principled decision in
respect of outlawing the physical chastisement of children?
Nikki Bradley, Adoption manager

Q: I was very disappointed by the government’s
decision not to ban smacking children in England while they managed
to do so in Scotland. How do you justify this? Liz

A: We are committed to improving safeguards for
children to protect them from harm, violence and abuse and to
improve their life chances. The ‘common sense’ approach we recently
set out in response to the difficult and sensitive issue of the
physical punishment of children was informed by our consultation on
this issue. We received a large number of responses which revealed
that this was a subject about which people have deeply held and
strong opinions.

We need to balance the needs of children with the reality of the
difficulties of parenting. And recent developments in the law
answered some of the key concerns that led to the consultation
exercise in the first place.

We do not believe any further changes to the law would either be
enforceable nor have widespread public support. We will however be
keeping the use of the ‘reasonable chastisement’ defence under
review to ensure that the Human Rights Act 1998 serves to provide
children with adequate safeguards from violence that should not be
capable of being justified as reasonable chastisement.

We have put forward proposals which meet the needs of parents
and children in England and Wales, and under devolution the
Scottish Executive is free to put forward their own proposals.

Domiciliary care

Q: I would be most interested to know what
plans there are to help self-funding older people who wish to
remain in their own homes, but who need a high level of care, which
agencies choose to call nursing care. Packages of this nature cost
vulnerable people huge amounts of money (day care around
£1,000 per week for nine hours a day, sometimes with only 10
minutes in the hour hands on.) There appears to be no ombudsman to
protect their interests, and no help other than attendance
allowance. Since they are self-funding, they are not open to social
workers, and since they are at home, they are not entitled to
nursing costs being reimbursed, as with those going in care homes.

A: By introducing free nursing care, we have
ended the anomaly of people having to pay for the care they receive
from a registered nurse in a nursing home, care that would be
provided free through the NHS in any other setting – either in
residential care or at home.

Anyone can have access to NHS community nursing services in
their own home through a district nurse, regardless of their means.
People may choose, if they wish, to pay privately for care that
they receive in their own home.

Currently, anyone who receives social care, which is not
provided by or contracted out by the local council, and who is
unsatisfied with the service provided, should contact the
Department of Trade and Industry.

In recent years, the domiciliary care sector has grown in both
size and variety. More and more individuals are choosing care at
home rather than away, and more external agencies have been set up
to help people meet their needs. We want to help people to remain
independent for as long as possible and recognise that the
domiciliary health care sector has an important part to play in
doing this, but we need to ensure that the services these people
experience are of a proper standard.

We are currently consulting on the regulatory framework and
national minimum standards for personal home care services.

The regulations and standards fall into three main areas –
information about an agency, conduct of domiciliary care agencies
and registered persons. Information about an agency regulations and
standards stipulate what information agencies are required to
provide in their service user’s guide. This should include the aims
and objectives of the agency and the nature of the service it
provides. The conduct of domiciliary care agencies covers
arrangements for the provision of care. For example, agencies must
consult users about their care and take account of their wishes and
feelings, religious persuasion, racial origin and cultural and
linguistic background. The final area – registered persons – places
a duty on domiciliary agency to ensure that the people delivering
care and managing the agency are fit to do so.

Day care

Q: Please can you tell me if the
government/councils intend to stop the disabled having to pay a
“day care charge” to attend day centres around England?
Frank Colley

A: We consulted recently on draft guidance to
be issued to local councils on charging policies for day care and
other non-residential social services and we will be publishing
this soon. Councils have had power to levy charges for these
services since at least the beginning of the modern welfare state
in 1948. The power has always been discretionary, meaning that
there is no compulsion on councils to levy charges.

Nursing care

Q: Is it right that very soon people like my
mother who has to pay £700 a week for nursing care and who had
to sell her house to pay for this, will now be able to pay less or
none at all? Would like to know when this is to come into force or
is it now? Annette McCarthy

A: From October 2001, NHS nursing care became
free in all settings. This ended the previously unfair system where
people in nursing homes may have paid for their nursing costs. We
also acted to both ease the burden of residential care costs and
since April 2001 have introduced a number of measures including the
12-week property disregard and deferred payments.

Deferred payments give people an option to meet care home costs
without selling their family home. It also takes further pressure
off people who in the past had to leave their home and sell it at
the same time.

In April this year, a 12-week property disregard was introduced
so that for the first three months following a person’s permanent
admission to residential care the value of their former home is
disregarded from the means-test. This means that people keep more
of their savings and provides breathing space between admission and
deciding how best to meet care fees.

We are aware that where local authorities do not exercise
discretion, some carers can be poorly treated and feel let down by
the State. We are currently considering ways of addressing

Residential care

Q: Why does the government encourage and
collude with local authorities in closing local authority
residential provision, and in so doing pressurise social services
staff to use the private sector? Judi Arnold

A: We think that local councils should be able
to tailor local care provision specifically to local circumstances.
The role of both the independent and public sectors will continue
to be important in the provision of these services. We have an open
mind on whether services should be delivered by the independent
sector or directly by local councils. Decisions should be taken on
the basis of what is best for users and best value. Best Value
service review and Joint Reviews by the Audit Commission and the
Department of Health’s Social Services Inspectorate are used to
ensure that the commissioning of services is undertaken fairly and
that best practice is achieved.

Learning difficulties

Q: Given the emphasis on employment
opportunities for people with learning disabilities in the ‘Valuing
People’ white paper, should not the government set up a national
framework for supported employment services to ensure greater
clarity of objectives and uniform standards which can be monitored
and benchmarked? At present there seems to be a ‘postcode lottery’
as to whether such services exist, who they cater for and what they
do. Steve Porter, Manager, Community Resources, Royal
Borough of Kensington and Chelsea

A: People with learning disabilities can make a
valuable contribution to the world of work. And work, full time or
part time, helps reduce social isolation. Our objective, set out in
Valuing People, is to get more people with learning disabilities
participating in all forms of employment, wherever possible in paid
work, and to make a valued contribution to the world of work. Our
overall aim is to increase the number of people with learning
disabilities in employment, and to work towards their achieving
parity with other disabled people in the workforce.

The Department of Health and the Department for Work and
Pensions will be working together to look at the links between
social care, employment and benefits, and will be establishing a
working group to move policy forward in this area. We are about to
commission research looking at the relationship between day centres
and those local services providing advice, support and employment
opportunities for people with learning disabilities. This will let
us see what helps or hinders day centre clients taking part in work
or work preparation activities and whether any action is

Local Learning Disability Partnership Boards, which should have
been set up by the end of October, have to identify an employment
champion from among their members. Boards should also produce a
local employment strategy for people with learning disabilities by
winter 2002/03. And they should develop local employment
strategies, which should include plans for improving employment
opportunities in the public sector.

Social services departments

Q: Do you think social services departments
will exist in five years? If not, what will replace them?
Nick Johnson

A: Local councils have social services
functions set out in law and they decide how to meet these
functions. As councils try to respond to their local communities in
more innovative ways they are trying new models of organisation –
such as bringing together housing and adult social care, or
education and children’s social services. I think this is good.

We’ve introduced flexibilities in partnership and the
opportunity of new structures such as Care Trusts to respond to
local councils’ desire to be more relevant to local people. In five
years time we expect councils to be organising their services in
many different ways in partnership to focus of the needs of
individuals living in their local communities.

Mental health

Q: Are you and your department doing anything
to discourage MPs/ ministers/spokespeople from using mental health
related terms as a form of abuse? It is a regular occurrence, most
recently used by Jack Straw (‘psychotic’, ‘psychopathic’, about
Osama bin Laden) and then another political player dismissing the
whole shadow cabinet as ‘known nutters’!

It is a cheap and easy ploy for them but costly in terms of the
negativity perpetuated towards people who use mental health
services or work in them. I train mental health workers and look
forward to a time when students do not first have to unlearn
misinformed beliefs involving a connection between mental distress
and evil. Patricia Walton, Senior lecturer, Liverpool John
Moores University

A: Many people who suffer from mental health
problems emphasise that stigmatisation in its various forms is one
of the most debilitating aspects of their illness. Fear and
misunderstanding about mental health problems prevent people in
need from seeking help, or cause them problems in continuing their
studies and finding employment. Most people are generally caring
and sympathetic, but too often they unwittingly use language which
can cause offence.

We want to create a climate of public disapproval towards
discrimination against those with mental health problems, in a way
similar to the changes in public opinion over such issues as racism
and sexism.

Earlier this year we launched a national campaign, mind out for
mental health, aimed at tackling the stigma and discrimination
faced by people with mental health problems and at supporting their
social inclusion. It is aimed at key groups such as employers, the
media and young people – to help raise awareness of mental health
issues and put an end to the stigma and discrimination experienced
by many people with a mental health problem.

One of its key themes is that labels are for THINGS and not
PEOPLE, and this is a message we are trying to get across to
everyone, regardless of who they are.

Attitudes cannot be changed overnight, but this campaign should
lay the foundation for a fundamental shift in how mental health is
seen in this country.

Disabled people

Q: I am concerned about the lack of attention
given to people with physical and sensory impairments within the
Department of Health’s strategic priorities. Whilst initiatives
such as Welfare to Work, and the joint circulars on dual sensory
Impairment and community equipment services support some piecemeal
progress, these lack the overarching drive and direction afforded
to older people, mental health, learning disability and children
through the NSF’s, white papers and QP.

What plans does the government and the Department of Health have
to address this imbalance, and what assurance can be given to
disabled people and the groups that represent their interests, that
they have not been forgotten? Stuart Rees

A: I certainly want to reassure you that we
have not forgotten about disabled people. We work with the
Department for Work and Pensions on this important area. Since 1997
we have taken a number of important steps such as the establishment
of the Disability Rights Commission and the passing of the Special
Educational Needs Act which I think demonstrate our commitment to
ensuring full inclusion in society for disabled people.

In the Department of Health many of our general initiatives have
considerable relevance for disabled people. For example, our drive
to improve standards and quality in the social care sector through
the National Care Standards Commission and the Social Care
Institute for Excellence.

As you say in your question we have a range of initiatives
specifically for physically disabled and sensory impaired people.
You mention a number of these and I could add others, for example
our ‘Modernising NHS Hearing Aids’ project and work that has
recently begun to review the process of identifying and
registering, with social services, people who are blind or
partially sighted.

But I understand the point you are making when you ask about
some way of giving overarching drive and direction to this
Department’s work for disabled people. You mention National Service
Frameworks, which are one of the Department of Health’s most
important policy development and planning tools. You may like to
know that we have now begun work on the NSF for long term
conditions. This was originally announced by Alan Milburn earlier
in the year. (Our current timescale for this NSF is delivery in
2004 with implementation from 2005.)

We are currently working out the scope of this initiative. It
will, as Alan Milburn said, include a focus on the needs of people
with neurological disease and brain and spinal injury. However,
there are many areas of treatment and care which will be generic to
most, it not all, long term conditions e.g., patient and carer
involvement, information, rehabilitation, pain management, care and
support in the home. By including these generic issues we will be
able to bring about improvements in care for about 90% of all
people suffering long term conditions of any sort.

In addition, the Social Services Inspectorate are currently
developing an inspection of adult disability services. There will
be close links between the development and conduct of this
inspection and the development of the Long Term Conditions NSF. The
pilot inspection will take place in February 2002 with the rest of
the inspection in the second half of that year.

Voluntary sector

Q: Have we not created more pressure for
smaller charities/voluntary organisations who are often the sole
provider of very valuable services e.g. KIDS” playschemes for
children with special needs, with the ever increasing “tender”
culture, to access funding from a wide variety of funds and
initiatives? It’s not particularly the provision and development of
a service, but e.g. time spent submitting bids, which may not be
successful, and finding more office space for extra personnel etc.
which creates the headaches. A local contact says “please don’t
tell me about any more pots of money!” Margaret

A: The Funding Code of Practice, published to
supplement the Compact on Relations between the Government and the
Voluntary Sector, recognised this issue. It states that the
criteria for Government grants programmes should be made clear at
the outset and that the need for extra information in application
forms should be set against the principles of good regulation i.e.
transparency, accountability, targeting, consistency and

Potential applicants should be able to discuss their plans with
officials prior to submitting them. These principles should ensure
that the best schemes get funded and that those with little chance
of success know that at an early stage in the process.

Care leavers

Q: Given that the Children (leaving care) Act
strengthens local authorities’ responsibilities toward young people
as they make the transition from childhood into adulthood. It has
moved leaving care services (and allied local authority services)
away from the old distinction between children (under 18) and
adults (over 18 yrs), preferring a seamless service delivery for
young people 16-21 yrs (or 24 yrs).

Sadly this is not reflected in the health provision to these
young people, particularly in the area of mental health services
and disability.

Are we going to see some joined up thinking being applied to
health services for care leavers who require a distinct approach to
their health needs in terms of engaging with services and in terms
of their transition from 16 to 21 yrs of age? Mike

A: You raise a very important point. The
National Service Framework (NSF) for mental health (published in
1999), while focusing mainly on adult services, included a number
of standards and good practice models relevant across whole
populations, as well as guidance directed specifically to the needs
of young people at the adolescent/adult service interface.

Examples include the need for local inter-service arrangements
to be agreed covering prompt assessment of serious mental illness
in young people; ensuring the safety and dignity of adolescents
where exceptionally care is provided on an adult ward; and
arranging effective handover of care where a young pers

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