The Association of Directors of Social Services and the LGA have joined forces with Help the Aged, Age Concern, Unison, Democratic Health Network and the Anchor Trust to write to health minister Lord Hunt, questioning the accountability and funding arrangements for the new bodies.
A copy of the letter follows:
Lord Hunt of Kings Heath
Parliamentary Under-Secretary of State
Department of Health
London, SW1A 2NS
26 February 2001
Dear Lord Hunt
Health and Social Care Bill
We are writing as a group of organisations that meet regularly to discuss our common interest in health and social care issues. More recently our attention has obviously focused on the Health and Social Care bill, where our discussions have been marked by an increasing anxiety about the bill's proposals for Care Trusts, and their
implications for service users.
We remain entirely committed to the need for more closely integrated services between local government and the NHS. However, we believe that the decision to make Care Trusts health bodies poses fundamental issues which did not receive the attention they deserved during the Commons stages of the bill. At our meeting this week we therefore agreed that we should write to you - as the Minister responsible for the bill's passage through the Lords - to record the outstanding areas of common concern which we believe must be addressed during the bill's remaining stages.
Foremost amongst these concerns is the belief that, unless more is done to distinguish these new arrangements from existing health bodies, there is a significant risk that the broadly based community and social care model will lose out to a medical/clinical approach. Users' organisations believe that this may jeopardise the principles of social inclusion and enhanced independence which lie behind social care, and undermine the invaluable contribution of services which do not equate disability and old age with ill-health.
We believe that these hard-won principles will not survive unless any new bodies are truly joint - equally valuing the experience and contributions of both partners. Given the framework for Care Trusts set out in the bill, this will clearly require a real commitment from Government to revise existing regulations for the establishment of PCTs and NHS Trusts, to ensure that Care Trusts can genuinely reflect an
equal partnership between local government and the NHS.
Our recent meeting also served to underline our continuing concern about the lack of information about how Care Trusts will work in practice. As a result, we remain unclear about a number of critical issues of real importance to service users.
Foremost amongst these are questions about the accountability arrangements for Care Trusts. Service users must be clear about who is responsible for their care. This will not only require transparent complaints procedures, but governance and management arrangements that enable local councils to maintain proper democratic accountability to local people for the services they delegate into the Care Trust.
The funding arrangements for these new bodies also deserve much more detailed consideration. We believe that safeguards must be in place to ensure that resources for social care and community based services are protected from the wider clinical priorities of the NHS. Equally importantly, the implications of Care Trusts for the current charging regime must be subject to much closer scrutiny, particularly as the
proposals for free nursing care are taken forward.
Whilst we recognise that many of these issues cannot be addressed on the face of the bill, we believe they must now be the subject of real debate and discussion if we are to ensure that Care Trusts represent a genuine step forward in the standards of care provided to service users. Indeed, without answers to these crucial questions it is hard to see what added value Care Trusts provide to the partnership arrangements which are now being established under the existing Health Act flexibilities.
We hope that the Lords stages of the bill will provide an opportunity to address the concerns set out in this letter. In particular, we urge you to consider how the bill itself can be amended to ensure that Care Trusts will be truly joint bodies, and how Ministers might give more concrete assurances about their governance and management arrangements. We then hope we will be in a position to work closely and constructively with the Department of Health to devise and pilot models for the
operation of Care Trusts which can effectively meet the health and social care needs of local communities.
We have copied this letter to the Secretary of State for Health, the Ministers of State for Health, and Peers with an interest in the bill.
Cllr Rita Stringfellow Moira Gibb
Chair, LGA Social Affairs & Health Executive President, ADSS
Director General, Age Concern
Mervyn Kohler John Knight Malcolm
Head of Public Affairs Head of External Policy
Help the Aged Leonard Cheshire
Local Government Service Group
John Belcher Dr Fiona Campbell, Co-ordinator
Chief Executive, Anchor Trust Democratic Health Network