Special report on the health and social care white paper

By Josephine Hocking

The new health and social care white paper launched this week by health secretary Patricia Hewitt contains policies with which it would be hard to disagree. Patricia Hewitt

Integrated health and social care. A focus on early intervention and prevention. Fitting services around people, not people around services. More power to service users, including an expansion of individual budgets and direct care. More help for people with long-term conditions.

But while the paper scores well on describing what will happen in a perfect world, it is not so clear at explaining specifically how to make dreams and best-case scenarios reality.
Costed promises of extra cash are absent, except modest funds for respite and information services for carers.

The government does say it will “review the financial impact on local authorities after the changes have been implemented, to ensure that the correct level of funding has been provided”.

And care services minister Liam Byrne has promised to lobby for more money for social care to fund the ambitious proposals.

But although money is obviously vital, it’s not the whole story. The worlds of social care and health have talked for many years about becoming more integrated. However culture clashes between partners from other sectors to make this happen often feel intractable to frontline workers. And many social care staff would dearly love to do more preventive work but spend most of the working week firefighting a crisis, covering for staff shortages or doing paperwork.

The main social care aspects of the white paper are outlined below.


• A new information service/helpline for carers, which may be run by a voluntary organisation.
• Respite care for emergencies will be established in each council area for carers.
• An expert carers programme, similar to expert patient schemes, to provide training for carers will be established.

Individual budgets

• The government wants to look at expanding individual budget pilots to children, including disabled children.
• If the current pilots for individual budgets are successful, the scheme will be implemented nationally, as early as 2009.
• Local authorities will be invited to join a support network on implementing individual budgets. The government will explore including transport in individual budget pilots and whether to include a wider range of funders in schemes.

Direct payments

• These will be extended to people currently excluded, including those who do not have the capacity to manage payments themselves.
• A national campaign to increase awareness and improve understanding of the benefits of direct payments will be launched.

More support for people with long-term health and social care needs

• By 2008 local authorities and primary care trusts are expected to have joint health and social care teams to support people with long-term conditions with the most complex needs.
• All people with long-term health and social care needs will have an information prescription, currently being developed. The idea is for professionals to provide information on service users’ conditions.
• Service users will have integrated social care and health plans, as part of an integrated health and social care record. These will initially be for people with complex needs.

Mental health

• Two pilots of talking therapies for people with common mental health problems, focusing on “people of working age with mild to moderate mental health problems, with the aim of helping them to remain in or return to work”.
• The government is to work with professionals on standards for which therapies help with which mental illness; and on regulation and “light-touch” registration of counsellors and therapists.
• More anti-stigma and anti-discrimination work, building on the existing Shift campaign.

People with learning difficulties

• The Valuing People support team will lead further consultation on moving all people with learning difficulties into the community. The government says there is already strong evidence that this should be done. “However, further consultation on the detailed arrangements is needed so that no individual is moved from a campus until suitable alternative arrangements have been put in place,” it says.

Voluntary sector

• The sector will be encouraged to provide more NHS services and barriers to this currently happening will be lowered.
• There will be various initiatives to encourage more involvement by the voluntary sector in social care.

Palliative care

• More social care involvement in palliative care.

Risk assessment

• Standard procedures for identifying risk will be developed so there is a national approach to risk management for health and social care professionals. Currently there are many guidelines available.

Commissioning and procurement of services

• Gershon identified that there should be greater standardisation when local authorities commission services. The government will publish a procurement model and best practice guidance to assist with joint commissioning.

Information for service users

• To be improved and integrated. A pilot involving a local authority and primary care trust will work on this.



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