Have things only got better?

Hunter: infrastructure boosted

Tony Hunter, president of the Association of Directors
of Social Services:

“The government has undoubtedly improved the professional
infrastructure within which social work is practised, and has
rationalised the management environment in which it is led. In many
respects the building blocks of these changes were laid down during
Labour’s first administration, from 1997 to 2001.

So what have been some of the highlights? The General Social
Care Council – the systematic registration of what eventually
will be the entire social care workforce was a move that ADSS and
other organisations had long called for. Also, the setting up of
the Social Care Institute for Excellence. This, as we have seen
over past weeks, is a tectonic plate which is still settling down.
Eventually it should act as a major catalyst for disseminating good
practice throughout social care. Other achievements are the
creation of the Commission for Social Care Inspection, and then the
declared merger of its functions with those of the Healthcare
Commission and Ofsted, although as yet it is too soon to say
whether this will work for the best. The CSCI had made an excellent
start in developing performance assessment systems based
unambiguously on the experiences and outcomes of service users. The
new arrangements must retain this focus.

We should also welcome the introduction of the three-year social
work degree. This is further evidence of the government’s
determination to bolster social work’s academic and
professional identity.

Nor should we forget the voice the government has helped to
provide for carers and people with learning difficulties: there is
more to be done, but some excellent building blocks have been
laid.

However, the under-funding of social care services compared with
the NHS has not allowed us to keep up with NHS colleagues,
successful though we have been in reducing delayed discharges
across the whole system.

The recent ADSS/local health alliances/Treasurers’ Society
survey of social services budgets has shown there simply
isn’t enough cash in the system to allow us to carry out the
creative, preventive tasks to which we are committed.

We remain seriously concerned, too, over what feels like an
over-punitive approach to people with mental health problems.

On the children’s side, engagement of all local bodies and
agencies is essential to delivering the five outcomes of the
Children Act 2004. As for adults, refocusing our professional and
managerial practice towards the person-centred approaches in the
green paper will be challenging, but it is also an unrivalled
opportunity to deliver in-depth, council-wide community care
services based on people’s choices.

A great deal has been achieved but the next government still has
a lot to do.”

Gunn: More hassle for public sector staff

Sheila Gunn, political commentator and Conservative
councillor in the London Borough of Camden:

“On 2 May 1997, those working in social services must surely
have been among the most excited as the Blairs walked into 10
Downing Street. Less than 24 hours beforehand, I had heard the
cheers against the background of the song “Things can only get
better” as the golden couple arrived at the celebratory party on
London’s South Bank.

I believe that Britain regained her standing and self-confidence
during the Conservative years. But, as a “one-nation Tory”, I hoped
that a change of government would tackle issues we had not
resolved. Nagging worries included the catalogue of tragedies
involving children in care and the less-than-successful care in the
community policy. Maybe New Labour would touch the parts that
Conservatives had not quite reached.

From day one there were surprises. The most obvious was the
adoption of Conservative spending plans for the first two years:
skewing the benefit scheme to “encourage” single mothers to take
paid work; the parsimonious approach to pensioners; and an almost
manic faith in the private sector to deliver public sector
projects.

Perhaps it would be wise to write off New Labour’s first
parliament as a trial run. The second parliament would be
different, we were told. Absolutely right it has been.

The key change, apart from a propensity for committing our
troops to dubious wars, has been chancellor Gordon Brown’s
loosening of the purse strings. There is no doubting New
Labour’s self-belief in distributing public money for the
greater good of our communities. Yet far too little appears to
filter through to those who really matter. These fall into two
categories: firstly, the intended recipients – those who are
not able to care adequately for themselves or their loved ones.

The second is those working on the front line, face-to-face with
the users of social and health services.

At the same time, all those I meet who are working in a public
service seem to be working harder, experiencing more hassle –
and gaining less satisfaction.

And that is without mentioning severe outbreaks of
“crick-in-the-neck syndrome”. You know what causes that? It’s
perpetually glancing over your shoulder to see if you’re
meeting some target, or absorbing the latest badly written,
acronym-strewn directive.

One day – and I hope it is soon – many more people
will connect this with the way we are being governed.”

Adebowale: ‘Intractable
problems’

Victor Adebowale, chief executive of social care
organisation Turning Point:

“The first thing to say in judging the government’s
performance is that there has at least been a performance to judge.
There is a creeping interest in what could be done through social
care, and the impact it could have on a host of society’s
toughest issues. However, we’re at the beginning of that
journey rather than at the end. There are huge challenges for how,
as a society, we perceive social care, measure it and invest in
it.

After two full terms of New Labour government and sizeable
investment, we’re still faced with apparently intractable
problems. What that tells me is that government hasn’t done
enough to understand and overturn the inverse care law. This states
that those who need the most support are the least likely to
receive it. Look at poverty and employment programmes, for example.
The government is to be commended on the effort and investment put
into this area, but so far it has focused on the margins. Some of
the most excluded groups still face little chance of employment and
face severe poverty.

In the green paper on adult social care, the government has at
last started to build on the link between regeneration and social
care. I believe this is an area overlooked to date, and that we
have to focus on investing in individuals as much as we invest in
their physical surroundings.

There has been progress across mental health, substance misuse
and learning disability, but there is still so much more to be
done. In relation to the first two, the focus needs to rest firmly
on building services that people can quickly access at the point of
need rather than following the criminal justice agenda.

Finally, a word on the role of the not-for-profit sector in all
of this. Government isstarting to understand the full role that
voluntary and community services can play. But the big challenge
for the general election winner will be to put a commissioning and
capacity-building framework in place to enable not-for-profit
agencies to play a full role in tackling the challenges discussed
above.”

Harding: ‘Essential care pared to the
bone’

Tessa Harding, senior policy adviser, Help the
Aged:

“Since 1997, this government has promised an elephant on health
and social care for older people, and delivered a moderately sized
mouse.

Early in its life, the government asked Sir Stuart Sutherland to
head a Royal Commission on long-term care – an encouraging
sign. After all, Royal Commissions are not every day events and
long-term care is not a popular subject, and here was a new
government setting out to take the bull by the horns. But it
didn’t. In particular, it failed to address the key issue of
funding for personal and social care.

The national service framework for older people published in
March 2001 was a high point. It brought older people out of the
shadows of the NHS and social care, where they habitually reside,
and into the limelight – wonderful. What is more, it involved
older people directly in developing its recommendations, and that
showed.

Age discrimination was to be rooted out, services were to be
individually tailored and take account of the views of the person
concerned, and attention was to be paid to helping people stay
healthy, as well as treating them when they were ill. But, while
recent extra investment in the NHS has certainly benefited older
people, again social care has been the poor relation and “who pays
for what?” has continued to be the dominant theme.

Now we have the new vision for adult social care to raise our
hopes again. And yes, the principles sound wonderful: helping
people stay healthy, affirming their personal dignity, enabling
them to have a decent quality of life and more control over their
own affairs – all laudable aims. But there is no promise of
new funding.

Eligibility criteria have already been squeezed till their pips
squeak. Essential low-level care has been pared to the bone. Carers
in their eighties are left unsupported to look after spouses who
would otherwise be in care homes. People in their nineties who
urgently need adaptations to their home are told they must wait for
many months. These things are surely shameful.

How can people be assured of dignity in old age when the
services that are supposed to support them are so thinly spread and
so discriminatory? And how do we as a society expect the needs of
the rapidly growing cohort of those in advanced old age to be met
if we are not prepared to spend more?”

McCulloch: ‘They’ve taken on the
doubters’

Andrew McCulloch, chief executive of the Mental Health
Foundation:

“The past eight years have seen major change and achievements in
mental health policy and services. Labour has grasped the nettle of
service change and taken on the doubters in the medical
establishment by radically shifting community care for people with
severe mental health problems. This has been done by massively
accelerating the rate at which intensive community care has
developed. Specifically, NHS Plan targets for assertive outreach
have been achieved. And while progress has been slower on crisis
intervention and early intervention, growth has been significant.
There has also been major investment in secure services.

While this change has been the crowning achievement, there have
been helpful broader policy developments including a fairly
comprehensive national service framework for adult mental health,
and significant investment in children and young people’s
mental health. Suicide rates have declined and there is an
emerging, albeit barely resourced, emphasis on public mental
health. The philosophy of recovery has also helped to drive
attitude and service change. Most recently we have a welcome
emphasis on social exclusion and employment although, as yet, only
limited signs of practical progress.

Despite some of these landmark changes, Labour’s
achievements have been tainted by its abortive and muddled attempts
to reform mental health legislation. This sorry saga has undermined
relationships between the sector and government and has added to
the stigma and fear experienced by service users. In misconceiving
and mishandling its attempts to reform the 1983 Mental Health Act
Labour has worked against the social inclusion agenda it has
advocated elsewhere, and public fears about people with severe
mental health problems have increased rather than declined.

Other areas where Labour has struggled to deliver include older
people’s mental health, the needs of people from black and
ethnic minorities (where the emphasis has been on rhetoric and
fudge), the needs of carers, and improving primary mental health
care. We also need a fundamental rethink of child and adolescent
mental health services – not just more of the same. If
re-elected, Labour’s key challenge will be to put the mental
health legislation debacle behind it and free up the logjam which
now exists in mental health services.

Further progress and further investment in service modernisation
will be impossible without tackling acute inpatient care. Unless we
turn our attention to this key policy issue we will not be able to
complete the modernisation of mental health services.”

Tickell: Joint-working worries

Clare Tickell, chief executive, the children’s
charity NCH:

“It is too early to judge definitively this government’s
impact on social care when it comes to children because Every
Child Matters is a 10-year programme. At NCH we strongly
support the government’s vision of integrated, child-centred
children’s services, with social care having a central role
alongside health, education and the voluntary sector, among others
– as it already does in Sure Start.

Social care’s contribution is crucial if children are to
be effectively safeguarded. Social care’s values of working
alongside children, young people and families must also be given
full expression; otherwise we will not maximise the potential of
the system as a whole.

But questions arise over the extent to which this balanced
integration of children’s services will really happen. This
is particularly important following the decision to integrate
arrangements for children’s inspections.

Every Child Matters spells the end of social services
departments that span children and adults. At NCH we worry that
this may weaken joint working with families in which there are
child welfare concerns, and where the parents have mental health or
substance abuse problems. Similar issues arise over disabled young
people’s transition to adult services. Local protocols are
needed to support effective joint working within the new
structures.

This government accepts that most looked-after children are not
fulfilling their potential. Some of its responses helpfully
recognise that looked-after children are a corporate
responsibility, not just a job for social care – such as the
new duty to promote the education of looked-after children in the
Children Act 2004. However, government targets for the looked-after
system should have been much bolder and resources should have been
allocated to ensure they are achieved.

It is disappointing that there is still no youth green paper, as
this is an important part of the jigsaw.

Since social care is a “people business”, a critical element of
government policy is the workforce. We applaud the government for
recognising the need to praise social workers for the difficult job
they do, rather than just blaming them when things go wrong.
Tackling social care recruitment and retention difficulties,
including those among foster carers, is hugely challenging, and how
the government addresses this may be the most important test of all
of its approach to social care. We await the publication of the
children’s workforce strategy with interest.”