Milburn’s local partnership vision lacks detail on joint working

Joined-up working between education, health and social services
can mean different things to different people. As Debbie Jones,
head of children’s services at Durham Council, says: “It has to be
more than just sharing an office, kettle and paperclips.”

Following health secretary Alan Milburn’s address to the national
social services conference last week, the political emphasis on
“joined-up working” is going to increase dramatically.

In Cardiff, Milburn announced that the days of the “old,
monolithic” social services department are numbered. In their
place, he set out a vision of “new local partnerships” where
agencies – statutory, voluntary and private – work together across
traditional boundaries to deliver services.

One of the keys to his vision is the creation of specialist
children’s trusts to plan, commission, finance and – where it makes
sense – deliver children’s services. While not yet compulsory,
Milburn left no doubt that the pace of change will be swift.
Children’s trusts are likely to be piloted early next year, with
the government looking for organisations to express interest in
running them before Christmas.

Many agree with Milburn that change is necessary. “There is too
much duplication at the moment,” says Liz Garrett, head of policy
at Barnardo’s. “It results in service users having to be assessed
again and again by different professionals from different
departments.”

Garrett says that for joint working and partnership to take place
there must be more information sharing and trust between
professionals.

Milburn sees trusts as being one of the vehicles for doing this.
However, Jones says that for them to work they must make a
significant difference and not be a case of “the emperor’s new
clothes”.

While many understand why Milburn is heading this way, they are not
convinced that creating a new model is the right approach.

Camden Council is in the final stages of planning a pilot project,
in which professionals from all agencies working with children will
be involved in developing and planning services at a strategic
level.

“I don’t think there’s any need to call something a trust and
create a new organisation when we already have an integrated and
co-ordinated approach at a local authority level and strong
relationships with other parties,” says Jane Held, director of
social services at Camden.

Held says something radical is needed to obtain better outcomes for
children, and believes Camden can do that without a new governance
model.

But Camden’s approach may not be appropriate for all councils,
particularly where health services are configured differently, she
adds.

Steve Hodges, director of children’s services at charity NCH, says
the organisation is interested in looking at how it could
contribute to children’s trusts, but warns that they will not be a
panacea. “Trusts are very ill-defined at the moment. It would be
dangerous to see trusts as a solution to all the known problems of
children’s services,” he explains.

Hodges says that trusts are likely to be a stepping-stone in a far
more radical process of change for children’s services.

During his Cardiff speech, Milburn made it clear there is no set
model that trusts will have to subscribe to – if it integrates
services and addresses local issues then the government is prepared
to back it. He also said trusts wouldn’t have to be overarching
bodies, but could be tailored to the needs of a specific group of
service users, such as children with mental health
difficulties.

However, all the authorities and voluntary groups Community Care
spoke to saw this as duplicating integrated work already being done
under Health Act flexibilities, Connexions and Quality
Protects.

Chris Pratt, executive director for children and young people’s
services at Trafford Council in Greater Manchester, says he is
concerned about splitting off specific groups from general
children’s services. “If you had a trust for vulnerable children
you would target particular families and could miss some because
you’re not assessing and screening all children,” he says.

Specialist trusts could also create funding issues that wouldn’t
sit well with joined-up working and management, says Garrett. “If
you set up specialist trusts you may need specialist resources and
that would be a shame. It could also mean that groups have to
travel long distances to access services,” she adds.

However, trusts won’t have to deliver services. Milburn outlined
plans for commissioning trusts, which would be based in councils
but have the power to commission services for the voluntary and
private sectors and be entitled to commission health care.

“I like the idea of an overarching commissioning and performance
management body at a strategic level,” says Jones. “I’m open as to
whether you then have separate trusts for the delivery of the
services or as part of the overarching model,” she adds.

Trafford is finalising plans to set up a not-for-profit company
with all agencies represented, which will plan, deliver and manage
children’s services. Professionals will be seconded from council
departments to work in multi-disciplinary teams in four
geographical areas. It is due to start next April.

“We might transfer the assets, resources and contracts to the
company,” says Pratt. “But we want it to focus on delivering
services and not be bogged down by bureaucracy.”

Brighton and Hove, Peterborough and Buckinghamshire Councils see
trusts as an opportunity to improve services. Brighton and
Buckinghamshire have already expressed their interest to the
Department of Health.

Barbara Trevanian, assistant director of children’s partnerships at
Peterborough, says the council has set up a multi-agency joint
development group for disabled children and is working to “pull
together” more mainstream services such as Sure Start, Children’s
Fund and early years services. “Whether it’s through real
multi-disciplinary teams or virtual ones, we aim to get one
assessment of a child and family and draw on the combined resources
of agencies to develop the best possible packages,” Trevanian
adds.

Surrey is another local authority to develop joint working teams on
a project-specific basis, particularly with vulnerable children and
young offenders. While not ruling out the potential of children’s
trusts, Ashley Ayre, the council’s head of children services, says
it will not be bidding in the first wave because of concerns over
the structure of trusts.

How trusts will link with schools and what their legal
responsibilities will have to be addressed. “They could need things
that are already provided by LEAs, social services and the NHS.
These problems are not insurmountable, but they need looking at,”
says Ayre.

Case studies

How councils are developing joined-up children’s services.

Camden

Consists of four elements. To be piloted soon.

• All agencies will be involved with planning and development at
  strategic level.
• Developing multi-agency approach for universal services and
  multi-agency support for vulnerable children.
• Borough-wide early years services are to be based on Sure Start
  model. Also looking at similar models for primary and secondary
  school children.
• Reconfigure specialist services to fit into above.

Trafford

Due to start April 2003. Four multi-disciplinary outreach teams,
seconded from health, social services and education
departments.

• Set up a not-for-profit company that will take charge of
  delivering children’s services.
• Referral and assessment tracking by professionals.
• Outreach teams providing services.
• Service provision in children’s homes, family centres, schools
  and colleges.
• Help to integrate through business financial and management
  support.

Buckinghamshire

County-wide model for integrated services for looked-after
children.

• Multi-agency assessment, plan development and procedures for
  children.
• Panel of core members hold regular meetings to consider cases
  and monitor progress.
• Improved assessment times, educational outcomes for
  looked-after children and joint working procedures.
• Joint training programmes for schools, governors, carers and
  social workers.