Trust Milburn?

Another
speech, another opportunity for health secretary Alan Milburn to
spur us on to the Holy Grail of integration between health and
social services. He hinted at a Department of Health conference on
health care leadership last week that more incentives would be
found to “get health and social care working as one”, an objective
that he still clearly believes is more honoured in the breach than
the observance. What he chooses with his usual delicacy and aplomb
to call the “decades-old culture of buck-passing and cost-shifting”
is a lingering menace that he rightly believes must be
conquered.

But how?
As with the health service, there has been a welcome, if cautious,
change of attitude towards funding social services. Milburn now
willingly admits that if the care home market is to be stabilised
and new rehabilitation, intermediate care and home care services
developed, more government money will have to be invested. There
are, however, strings attached: more investment, Milburn made
plain, is conditional on more reform.

For
“more reform”, read “more care trusts”. The government’s programme
of creating care trusts with fully integrated health and social
care under one management has got off to a pitifully poor start.
Since care trusts are his brainchild, Milburn has freely aired his
frustration at the lack of progress. But he should blame nobody but
himself. The procedures for establishing care trusts have been a
shambles. Some of the 16 care trust pilots announced by the
government last year hadn’t even realised they were on the
shortlist and others, originally keen, then pulled out because DoH
guidance had left them unclear about the position of care trusts
within the NHS. Consequently, only four of the pilots are ready to
go ahead.

Other
less cataclysmic forms of integration are also ostensibly on
Milburn’s list and he did, for example, mention the Health Act 1999
flexibilities in his speech. But the eagerness of the DoH to put
care trusts to the test and its relative indifference to the fate
of the flexibilities show exactly where Milburn’s heart is. It is
an obsession that, far from strengthening social services, risks
undermining them. They have a strong and urgent case for more money
now, as the responsible way in which they have used resources to
hasten hospital discharges illustrates. The money cannot wait on
the vagaries of someone’s pet project, even that of a minister.

– See
news, page 14

Stalled crusade

It comes
as no surprise that Tony Blair’s personal crusade to increase the
number of adoptions looks sets to fail.

Latest
statistics show the number of adoptions in the first two years
since targets were set has risen by just 7 per cent and the chances
of hitting the target of a 40 per cent increase over five years is
now looking very unlikely. It was an unrealistic target based on
the illusion that hundreds of children are stuck in the care system
desperately waiting for couples to adopt them.

The
importance of this target to the government makes it even more
surprising that it is playing games with an amendment to the
Adoption and Children Bill that would expand the potential pool of
adopters and help local authorities move closer to meeting the
target. Terrified that such a move could be seen as undermining
marriage, ministers have left just one day for MPs to debate it,
giving it little or no chance of being passed.

Yet
without unmarried couples, who make up 15 per cent of households,
Blair’s crusade will be stopped in its tracks.

– See
news, page 8