Bright future – for some

It was the health secretary’s clearest statement yet on the future
of social services. Alan Milburn, speaking at the National Social
Services Conference in Cardiff last week, set out a vision of
social care repudiating once and for all the generic principles of
the Seebohm report that underpinned social services departments
when they were founded 30 years ago. Milburn signalled the demise
of the old-style, public service monoliths, which should be broken
up and replaced by local partnerships meeting the needs of local
communities. As he put it: “We are moving into a whole new ball
game with brand new rules: where flexibility and freedom come in
return for delivery and reform.”

The health secretary does a nice line in alternately threatening
and cajoling his social care audiences and never more so than at
this annual conference, the fourth he has addressed. He stuck
doggedly to his policy of introducing cross-charging, punishing
local authorities with fines if they fail to cure bed-blocking in
their areas. Just such a policy exists in Sweden and the Department
of Health seems to have persuaded itself that if it works there, it
must work here. Yet the health and social care system in Sweden is
fundamentally different from that in this country and there is
simply no evidence that cross-charging would be anything more than
a blunt instrument with which to bludgeon local authorities.

The star-rating system, another crude tool for measuring
performance, also hangs uncertainly over the future of some social
services departments. They face the prospect of government
intervention, the sense of failure to which this inevitably gives
rise throughout the organisation, and the long haul back to
redemption.

But the prospects are much brighter for those departments which
overcome the unnecessary distraction of cross-charging and have the
luck as well as the judgement to score well in the star ratings,
the next batch of which are due in a few weeks. Some of the ideas
floated by Milburn were similar in spirit to those set out in the
visionary report From Welfare to Wellbeing, launched at
the conference by the Institute for Public Policy Research. The
IPPR report, commissioned by the Association of Directors of Social
Services and Community Care, foresees the creation of new
professions in social care with a more specialised focus on
particular age groups and calls for more community-based preventive
services accountable to those who use them. It is an artist’s
impression of social care in the year 2020, but Milburn is an
impatient man and he wants something very like it moved off the
drawing board into reality a great deal sooner.

Especially encouraging is that the government will pilot children’s
trusts from next year to bring down the barriers between education,
health and social services that tend to fragment children’s
services. That these trusts will be based in councils and have
powers to commission health as well as social care is a welcome
vote of confidence in local government. At the same time, the DoH’s
strategic commissioning group, chaired by health minister Jacqui
Smith, has been tasked to establish how local voluntary and
community organisations can play a bigger role in the delivery of
social services.

If these measures mark a shift from the centralising tendencies of
the past, they also indicate a desire to make services more
accountable to those who use them. “New challenges call for new
skills,” said Milburn, virtually redefining the social care
profession. Professionals combining the skills of therapist,
community nurse and home help to provide rehabilitation for older
people in their own homes – or family care workers combining the
skills of health visitor and social worker – are no longer debating
points. They are the future, one which will be with us sooner
rather than later.