Solutions are out there

The problems of recruitment and retention in
social care are at their most intense in London.

the fact that London is one city should help its 33 boroughs to
work together on strategic solutions, both directly focused on
recruitment and retention of staff, and tackling the problems that
feed the recruitment crisis, such as the poor media image of social
services and the lack of public understanding of their

could and should be a model for the whole country of co-operation
between individual local authorities in the common interest. Yet it
is far from that. In fact, a spirit of competition between
authorities exists that does not merely fail to address the
problems: it exacerbates them by driving up costs until poorer
authorities automatically lose out, and by generating an
unwillingness to share ideas and best practice.

report Is Anybody Out There?, published by Community
to launch our Care in the Capital Week campaign, makes
many recommendations to help London boroughs avoid a worse crisis,
which would inevitably jeopardise the overall improvement in
service standards seen in London over the past year.

elected members must take the lead, and must work across party
boundaries. The contribution to quality made by the location of
social services within local government is by no means so clear
that local politicians can afford to be part of the problem, rather
than part of the solution.

But if
the power of local government were harnessed in the interests of
better social care for everyone in London, it is exciting to
contemplate what could happen. Housing schemes for social care
workers; managed staff development across boroughs, perhaps
including the voluntary sector as well; work with schools to
encourage enthusiasm among young people for a career in social
care; a pan-London consortium to negotiate with recruitment and
locum agencies; a strategic approach to media relations, including
London-wide campaigns.

time for some joined-up thinking.

Fears need to be

Unison’s local government conference has voted
to step up the union’s campaign against care trusts, indicating the
extent to which absorption of social services by the NHS is still
feared at the grass roots. In our view Unison has gone a step too
far. In some localities care trusts may be the best way to deliver
health and social care effectively, although such judgements should
always be made on a case-by-case basis. There will be many other
areas where it is better to use the flexibilities of the Health Act
1999 to promote partnership than to bring health and social care
together in one organisation.

However, the concerns that give
rise to Unison’s campaign cannot be ignored. The argument that the
NHS is undemocratic looks somewhat forlorn in view of the moribund
state of local democracy, although it is undoubtedly true that the
health service has a long way to go to improve its own systems of
accountability. But the union also argues, with greater
justification, that the medical model of care may prevail over the
social model if care trusts become widespread.

Unison vote should be a lesson to the government. Those in
government who advocate care trusts as an important part of the
future of health and social care must do much more to allay the
fears of all those staff whose own futures are tied to


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