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Editorial

Editorial In my last editorial I had hoped, without much optimism, for a boost to community care from what was then being called the ‘national plan’ for health and social care. Writing just a couple of days after ‘The NHS Plan’ was published, I fear that there will be no boost to compare with the impact of Caring for People and the legislation that followed it in 1990. Admittedly, the clear purpose of the Tory changes was to halt the increase in public expenditure on residential and nursing home care through social security payments, but at least it secured a flow of funds to be used at local discretion for a wider range of services. This was backed up with a matching flow of ideas, for example, about care management, user and carer focus, and the development of the independent sector. Things changed. Maybe the disadvantages proved too great in the end, but it was the beginning of a creative period. Recently I heard Will Hutton, formerly of The Guardian and The Observer, say that his greatest fear for Britain was that New Labour would win the next election and then achieve nothing of significance in social policy. That the Government is obsessed with public opinion and fearful of giving a lead on big issues is not a matter of debate now, and the NHS Plan gives ample indication of these sorts of problem. While the Comprehensive Spending Review signals a welcome boost for publicly funded services, the NHS Plan: has crucially failed to deal with the health and social care divide has tried to bury the Government’s loss of nerve/lack of vision over the Royal Commission on Long Term Care has not been honest that much of the extra money available to SSDs will have to be used to offset loss of income, has done nothing specifically for disabled people. What is most perverse is that stronger central control (over policy direction, resource allocation and performance management) is pursued alongside an option which can cause divergence and disarray in local arrangements – a weakly forced marriage of primary health care and social care. No-one in their right mind, of course, would keep SSDs in their current form. With local government effectively being by-passed in all this, and the NHS Plan very appropriately named, why not propose the repeal of the Local Authority Social Services Act, and be damned? The idea of ‘care trusts’ is hardly a Trojan horse when all and sundry can see inside it. Some SSDs will espouse this approach (for the right reasons) allowing the thin end of a wedge to make its initial penetration. It will then be gradually forced in over the years by the Government. As a way of managing much-needed organisational and attitudinal change, this nevertheless has a lot to commend it. However, what are the prospects of really beneficial collaboration, when the definition of what is ‘personal’ or ‘nursing’ care will still have to be fought over, and the public criticism will not be any less when resources will still be tight and when evidence of the practical and cultural obstacles in the way of this marriage continues to emerge? The little matter of capacity to create and sustain real change in front-line (as opposed to management) practice is worthy of a moment’s reflection too. Of course, the ‘early adopters’ will show what can be done and may be rewarded, but for the majority it looks as though it will be more of the same for quite a while to come. Peter Thistlethwaite Editor Managing Community Care Volume 8 • Issue 5 • October 2000 © Pavilion Publishing (Brighton) Ltd http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Integrated Care Pier Professional

Editorial

Thistlethwaite, Peter
Journal of Integrated Care , Volume 8 (5) – Oct 1, 2000
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Publisher
Pier Professional
Copyright
Copyright © 2000 by Pier Professional Limited
ISSN
1476-9018
eISSN
2042-8685
Publisher site
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Abstract

In my last editorial I had hoped, without much optimism, for a boost to community care from what was then being called the ‘national plan’ for health and social care. Writing just a couple of days after ‘The NHS Plan’ was published, I fear that there will be no boost to compare with the impact of Caring for People and the legislation that followed it in 1990. Admittedly, the clear purpose of the Tory changes was to halt the increase in public expenditure on residential and nursing home care through social security payments, but at least it secured a flow of funds to be used at local discretion for a wider range of services. This was backed up with a matching flow of ideas, for example, about care management, user and carer focus, and the development of the independent sector. Things changed. Maybe the disadvantages proved too great in the end, but it was the beginning of a creative period. Recently I heard Will Hutton, formerly of The Guardian and The Observer, say that his greatest fear for Britain was that New Labour would win the next election and then achieve nothing of significance in social policy. That the Government is obsessed with public opinion and fearful of giving a lead on big issues is not a matter of debate now, and the NHS Plan gives ample indication of these sorts of problem. While the Comprehensive Spending Review signals a welcome boost for publicly funded services, the NHS Plan: has crucially failed to deal with the health and social care divide has tried to bury the Government’s loss of nerve/lack of vision over the Royal Commission on Long Term Care has not been honest that much of the extra money available to SSDs will have to be used to offset loss of income, has done nothing specifically for disabled people. What is most perverse is that stronger central control (over policy direction, resource allocation and performance management) is pursued alongside an option which can cause divergence and disarray in local arrangements – a weakly forced marriage of primary health care and social care. No-one in their right mind, of course, would keep SSDs in their current form. With local government effectively being by-passed in all this, and the NHS Plan very appropriately named, why not propose the repeal of the Local Authority Social Services Act, and be damned? The idea of ‘care trusts’ is hardly a Trojan horse when all and sundry can see inside it. Some SSDs will espouse this approach (for the right reasons) allowing the thin end of a wedge to make its initial penetration. It will then be gradually forced in over the years by the Government. As a way of managing much-needed organisational and attitudinal change, this nevertheless has a lot to commend it. However, what are the prospects of really beneficial collaboration, when the definition of what is ‘personal’ or ‘nursing’ care will still have to be fought over, and the public criticism will not be any less when resources will still be tight and when evidence of the practical and cultural obstacles in the way of this marriage continues to emerge? The little matter of capacity to create and sustain real change in front-line (as opposed to management) practice is worthy of a moment’s reflection too. Of course, the ‘early adopters’ will show what can be done and may be rewarded, but for the majority it looks as though it will be more of the same for quite a while to come. Peter Thistlethwaite Editor Managing Community Care Volume 8 • Issue 5 • October 2000 © Pavilion Publishing (Brighton) Ltd

Journal

Journal of Integrated Care – Pier Professional

Published: Oct 1, 2000

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