Trust doubts spread

We have become used to speculation about the
future of social services, whether they will still exist in five
years’ time or whether the spoils will have been divided between
health and education. No harm in speculation, perhaps, as long as
it leads to healthy debate about the best ways to provide services
to clients. But speculation born of confusion is another matter,
and there is considerable confusion surrounding the government’s
stance on care trusts.

Health secretary Alan Milburn has made it
clear that he expects to see care trusts, integrating primary care
trusts with adult social services, put in place all over the
country. Originally trailed by Milburn himself as a last resort
where voluntary partnerships had failed, care trusts are now
presented by him as a miracle cure for the ills of health and
social care. Yet there is ample evidence that this “one size fits
all” approach is doomed to failure.

Wiser voices in the Department of Health
appear to urge moderation, but who can say that the juggernaut has
not already begun to roll? Nobody knows and Milburn – the one
person who could clear up the confusion – keeps us guessing.

The GPs whom the NHS Alliance represents know
that yet more reorganisation would be disastrous. PCTs themselves
are new and “change exhaustion” will be the inevitable result of a
rush into further reform. Professor Gerald Wistow, director of the
Nuffield Institute for Health at the University of Leeds, warns
that PCTs working in deprived areas are already struggling to
provide core services and may be overwhelmed by the additional
burden of forming care trusts. Rob Greig, the government’s own
learning disability director of implementation, fears that care
trusts may be ill-equipped to meet education, housing, employment
and leisure priorities.

Even if the 15 pilot care trusts show that
they can be made to work, we know that other models work too. In
Barking and Dagenham, for example, the social services director is
also the PCT chief executive, although the respective organisations
remain distinct. In other localities the partnership powers
conferred by the Health Act 1999 have been used to good effect.
Everybody says it: local problems require local solutions. But is
Milburn listening?

– See news, pages 8 and 16

Rough figures

The government claims it has almost “cleared
the streets” of rough sleepers. So it has now decided to set up a
new directorate to tackle homelessness as a whole.

But there should have been a comprehensive
approach to homelessness from the time the government came to power
– particularly in view of its other priorities, such as ending
child poverty, and joined-up working. The rough sleepers unit is
vulnerable to accusations that it is aimed at nuisance reduction
rather than tackling the root causes of homelessness, especially
given that rough sleepers are only the visible tip of the
homelessness iceberg.

The charity Crisis claims that 95 per cent of
homeless people are not sleeping on the streets, but are using
friends’ floors or living in hostels. Many policies from government
departments contribute to inappropriate placements in bed and
breakfast hotels, substandard housing for families, and the problem
of rough sleeping.

Homeless people are vulnerable before they
become homeless. They are excluded by society before they exclude
themselves by taking to the streets. Welfare and housing policies –
and, dare we say it, funding – must be targeted at the causes of
homelessness.

– See news, page 13 and 14