Carrot-and-stick power

It
was a typical example of the health secretary’s favoured carrot-and-stick
approach to dealing with local authorities. The annual 6 per cent rise in
social services funding, announced in the April Budget and fleshed out by Alan
Milburn this week, will be spent predominantly on older people. Other client
groups will have felt left out and, even as he dispensed his £1bn annual
largesse to older people, Milburn gave social services departments several new
hostages to fortune. For once they were not explicitly nannied and hectored in
his speech to the House of Commons, but they could be forgiven for feeling as
though they had been.

In the plus column, there was a focus on the
needs of older people, in contrast to last week’s comprehensive spending review
where most of the attention was paid to children and young people. There was a
move away from the tiresomely narrow emphasis on "fines" to penalise
social services departments deemed to have done too little to alleviate the
bed-blocking crisis. Instead the health secretary has acted imaginatively by
putting power into the hands of older people themselves. There is no escaping
the fact that health and social services too often still find themselves in
stalemate over delayed discharges: in the third quarter of 2001-2 more than
5,000 patients aged over 75 in general hospital beds had their discharge
delayed. Giving older people cash to fund their own care and install equipment
in their own homes will help to break the deadlock.

But at the same time Milburn will make more
inroads into the autonomy of social services departments. Direct payments will
be made mandatory, rather than discretionary as at present, and there will be
stringent new timetables for assessment and provision of services. Furthermore,
the government wants the proportion of older people supported intensively to
live at home to rise to 30 per cent of the total cared for by social services,
either at home or in residential care, by March 2006. It will be considerably
easier to implement these measures in some local authorities than in others,
not because some are inherently better than others but because traditions,
priorities and circumstances vary so enormously.

It is a pity that, just as the local
government white paper talks of restoring some autonomy to councils, the health
secretary has given free rein to his centralising instincts. If ever there was
a time to ring the changes, this was it.

Children are not aliens

Fears
that the government will opt for a radical overhaul of child protection services
in its response to the Laming inquiry into the death of Victoria Climbie
are well founded.

Such
a move would be a disaster. Cutting child protection services off from the rest
of children’s services would create new gaps into which vulnerable children
could fall. It would further stigmatise services, make it more difficult for
social workers to tread the difficult line between supporting families while
protecting children, and bring to an end the current flexible situation where
children can move between being deemed at risk and in need.

To
avoid this scenario, the government is understood to be considering a separate,
all-embracing children’s services agency, which would create even further
confusion, disorganisation and demoralisation of staff. It would change the
shape of local government and ministers would face a fierce battle. Any such
plan should be opposed.

Children
live in communities – they are not an alien species that can be sectioned off.
And it is in communities that children can be protected.