Merger’s mixed message

As the first care trusts came into being last
week, the evaluation of the first merger of social care and health
services was timely.

The
appraisal of the de facto care trust running mental health services
in Somerset provides some loud warnings for those leading the way.
It concludes service users benefited but staff, particularly those
who transferred from the social services department, did not.
Increased workloads, more bureaucracy, less therapeutic time with
clients, decreased job satisfaction, and rising pressure on team
managers were all reported.

Evaluators also found that the
cultural differences between social care and health staff remained
entrenched. Social workers’ fears that the social model of care
would lose out to the medical model were vindicated, as were their
fears about the different languages used by each professional
group.

More
worrying was the fact that social workers felt clients no longer
perceived them as “independent enough”. When working with people
with mental health problems it is crucial that service users view
their social workers as their advocates, not as part of the state
mechanism. If social care staff are seen as part of the health
bureaucracy, clients could disengage from services and they and
their families could resort to trying to cope alone, most likely
unsuccessfully.

But as
the evaluation heralds good news in other respects for its care
trust project the government will probably not be losing much sleep
on account of social workers’ feelings. User satisfaction levels in
Somerset rose to very high levels by 2001 despite a fall in the
year after the setting up of the trust. So the project appears to
be working.

But
high quality services cannot be delivered without motivated,
contented staff. Given that social workers are already in short
supply and many agencies are having great difficulties in
recruiting and retaining staff, it is not possible for the
government to miss the message coming out of this study.

Staff
self-esteem, security, and self-respect are crucial not only to the
quality of social care services but also to the government’s plan
to modernise the health service. Social care workers need
assurances that their model of care, their expertise, and their
holistic approach to service users will be protected within the new
structures.

Justice comes at a
price

There is no simple answer to the question
whether some of those residential workers convicted of abusing
children in their care were victims of a miscarriage of justice.
Successive inquiries in areas such as north Wales, Cheshire,
Merseyside and Northumberland have resulted in hundreds of
convictions for crimes mostly committed 20 or more years ago. It is
notoriously difficult to gather evidence in such cases without
calling for corroboration from a great many witnesses whose motives
may occasionally be dubious and, on the law of averages alone,
there must be at least a small chance that, for a few of those
found guilty, justice failed.

But
none of this shows that a single one of the police forces involved
was wrong to carry out an inquiry. The lapse of time does not
lessen guilt, nor do the difficulties in collecting evidence make
establishing the truth any less important. Those who lobby on
behalf of convicted care staff cannot have it both ways. If the
truth of the allegations against them is worth investigating now,
it was worth investigating then. Residential workers, like many
others, hold positions of public trust. When this trust is
seriously called into question, they must be willing to answer for
their actions.