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When labour triumphantly swept into power in 1997 the then health secretary, Frank Dobson, declared he wanted to br...
When labour triumphantly swept into power in 1997 the then health secretary, Frank Dobson, declared he wanted to break down the 'Berlin wall' between health and social services.
While a few souvenir-hunters may have managed to seize a few paint-daubed bricks, the wall has stayed pretty much in tact over the intervening four years.
The establishment of care trusts, a single body to plan and deliver health and social services as proposed in the Health and Social Care Bill being rushed through Parliament, is likely to see local government peeking enviously over the wall as the NHS flaunts its freedom.
The idea of health and social care working together is of course a laudable one - until you read the small print. Care trusts will be health bodies - based on NHS and primary care trusts - with local government as the junior partner.
If the health secretary is unhappy with joint working arrangements, he or she will have the power to impose a trust - despite the fact the Bill has been trumpeted as a means of devolving power from the centre. Forcing two groups together with one being subservient to the other is unlikely to lead to a happy partnership.
If the government really wants these trusts to work surely they need the wholehearted backing of all parties involved rather than coercion and compulsion at the hands of health secretary Alan Milburn?
But this is not about councils clinging to a function they see as theirs by right. Both social services staff and service users are concerned that the less glamorous priorities, such as services to the disabled and the elderly, will lose out every time a national newspaper prints a story about winter crises and trolley waits.
In Northern Ireland, where health and social services have already merged, there is evidence that social care has been marginalised and resources diverted to the acute sector.
Will care trusts simply be 'ill health' services with social services as an afterthought?
The government has made overtures to councils, and health minister Lord Hunt told peers this week that care trusts should 'include a minimum number of local authority members [to] reflect the wishes of local partners within a flexible national framework'.
But the time has come to see something concrete. There is precious little detail about care trusts on the face of the Health and Social Care Bill and, as the Local Government Association and the Association of Directors of Social Services have made clear in a letter to Lord Hunt, there are question marks over the accountability arrangements of care trusts and, more fundamentally, how they will work in practice.
The Bill is a government priority and is to be pushed through before a general election which could be just two months away.
If we are going to raze that wall to the ground once and for all local government needs some answers soon.
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