Committee: SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE
Date: 6 JUNE 2002
Title: FUTURE
DIRECTION OF SOCIAL CARE SERVICES AND HOUSING, ISLE OF WIGHT
REPORT OF
THE STRATEGIC DIRECTOR OF SOCIAL SERVICES AND HOUSING
1. SUMMARY
This paper sets out the background to changes in the relationship between Health Services, Schools and Social Services. It recommends the setting up of a task group to bring forward proposals.
2. BACKGROUND
2.1 The Health and Social Care Act (2001) and the Health Act (1999) are two important pieces of legislation, which have sought to encourage closer working relationships between health and social care agencies. In addition they have radically altered the shape and structure of NHS services by promoting the development of primary care groups and from 1 April 2002, Primary Care Trusts, across England and Wales. In addition and simultaneously they have seen the changing role and influence of health authorities, which has finally reached its apotheosis in the creation of strategic health authorities from 1 April 2002.
2.2 The Health and Social Care Act also introduced the concept of Care Trusts. This, for the first time, set out the organisational model which had government approval and which would allow health and social care services to come together in one new organisation. There are currently 15 pilot schemes, in the country, which the government hopes will lead to the setting up of Care Trusts. 9 of the schemes are based around work between Social services and the PCT and 6 include Community NHS Trusts. One scheme, Northumbria has secured agreement to establish a Care Trust from 1 April 2003.
2.3 The Government is concerned to encourage closer working relationships between health services and social care agencies. Although the Care Trusts are perhaps the most well known of these arrangements, in recent years the Government has given its blessing to pooling of health and social care budgets for services, joint and integrated planning arrangements and the establishment of lead commissioning and provider arrangements. The Isle of Wight Social Services and Housing Directorate has taken advantage of these new arrangements and has established a lead provider in mental health services in the NHS Trust, a lead commissioner of mental health services in the Primary Care Trust (PCT) and a lead commissioner for services for people with learning disability (Social Services). In addition there are a number of pooled budget arrangements and extensive examples of joint planning. There are also a number of joint appointments principally between PCT and Social Services and Housing Directorate.
2.4
2.5 These changing and emerging opportunities are taking place at a time when other services are re-examining their traditional role. In particular in the field of education, the gradual transfer of budgets and responsibilities to locally managed schools has led to some authorities considering the arrangements for children’s services across the Council. In some of the County Councils in particular this has resulted in the establishments of new departments, which have integrated children’s services for education and social services. Best Value has often been a driver in these developments. On the Isle of Wight, for example, we have just concluded a Best Value review of services for children with disabilities across social services and education with recommendations for closer working between these two agencies.
2.6 In addition the Government has introduced new duties for local authorities to overview and scrutinise the work of health services in their area. From 1 April 2003 all councils will have to have set up overview and scrutiny committees, which will allow for public debate and consideration of health issues as they affect their populations. Many have seen this as a natural development on from the demise of Community Health Councils and the growth and development of local strategic partnerships and production of the community strategy.
2.7 In this evolving and changing environment, it makes sense therefore for the Select Committee to take stock of the changes that are taking place and to consider how it should plan for the future delivery of social care services on the Isle of Wight.
3. OPTIONS
3.1 The possible options and permutations for service delivery and organisation are almost endless. It seems clear that the government is intent on ensuring that local authorities and health services work together more closely to deliver social care services. Much of the recent legislation puts a set of common duties and responsibilities on Primary Care Trusts and social services departments to plan together and implement new policies and strategies. Indeed it would be hard to find someone, in public life these days, who would want to argue against planning together and working in partnership to tackle social problems. In addition many organisations have taken advantage of the new opportunities to pool budgets and to make joint staff and managerial appointments to manage and run services. Again it is hard to find a significant body of mainstream opinion, which would argue against it.
3.2 However when it comes to consider the setting up of new Directorates or organisations outside the traditional bodies, the position is much less clear. Over the past twelve months a number of County Councils, especially in the South East of England, have taken the decision to separate out children’s services from traditional social services departments and place them within what remains of the Local Education Authority. These County Councils include Hertfordshire, Surrey and latterly Suffolk.
3.3 In addition there are a number of local authorities that are working with PCTs to explore the advantages and opportunities for creating care trusts. There is no specific guidance on what can or cannot be included in a care trust. In the New Forest for example, which is one of the pilot schemes, the authorities involved include the district council, county council and the local PCT. The agencies are considering including in a Care Trust not just primary health care, adult social services but also housing functions as well.
3.4 There is therefore no one model to follow, which is being universally adopted by government or authorities. This is a good thing as it allows agencies to work out solutions, which are best suited to their local need and take account of work in developments that have already been happening to date. There are, however, 3 general models, which are being developed which are leading to closer working between health and social care. The first uses lead commissioning and pooled budgets as encouraged in the Health Act. The Council has adopted this for mental health and learning disabilities. The second approach is to set up single service trusts operating across large populations, which can generate economies of scale and create the necessary critical mass to provide a wide range of services. Mental Health trusts are a good example of this (e.g. West Sussex). The third model allows for a more holistic approach and allows for the inclusion of a wider range of client groups including children and possibly some acute services.
3.5 The advantage of joint planning, pooling budgets, joint appointments and potentially new organisations are relatively clear. They can lead to better integration of service delivery leading to a potentially better service for users, carers and patients as well as giving organisations the opportunity to bring together funding and other resources to tackle problems across the health and social care agenda. They also offer opportunities of savings from economies of scale and can reduce overlap and duplication.
3.6 The disadvantages are perhaps harder to see but need certainly to be considered. With the creation of new organisations outside the local authority sphere there is inevitably a loss of direct control by elected members and the local community. Local authorities remain democratically elected and accountable. This loss of democratic accountability is seen by some as a problem. This is, however, to some extent offset by the new powers for local authorities to overview and scrutinise health provision in their area from April 2003. The loss of direct control can sometimes be offset by the growth in influence that comes from partnership working or working through other organisations. The transfer of large areas of function and responsibility out of local authorities can also lead to significant financial problems for central support services within the council as funding, for these services, is derived from the staff employed by the other directorates.
3.7 The Trade Union representatives will need to be briefed on any potential proposals arising from the work of the proposed task group. There views will need to be taken into account by elected members in considering any final proposal.
4. LEGAL IMPLICATIONS
This paper recommends the setting up of a task group to explore options in more detail. The legal implications of any of these options will need to be understood and set out in any reports to elected members.
5. FINANCIAL IMPLICATIONS
Some of the financial implications are set out in paragraphs 3.5 and 3.6. These could and need to be considered in more detail in any subsequent report to the Committee, in conjunction with the Strategic Director for Finance & Information & County Treasurer.
6. RECOMMENDATIONS
The select committee is asked to agree the setting up of a multi-agency officer task group to explore in more detail the options for closer joint working between health care and social services. The task group will include representatives from the PCT, the NHS Healthcare Trust and Social Services and Housing Directorate. It is also proposed to invite the Strategic Health Authority to send a representative. The group will report to the Health and Well Being Partnership Board on progress.
Contact Point: Charles Waddicor, ' 520600 ext 2225
C WADDICOR
Strategic Director of Social Services and Housing