Some of you may know Celtic Knot is hosted in the building of Birmingham Friends of the Earth. The government has plans to radically reform planning laws, dropping many of the rules that could be used to oppose new development. Recently I was quizzed by colleagues at Friends of the Earth about what would happen to the status of all the existing guidance documents, textbooks and caselaw if this happened, so I was exploring what would survive, what would fall, and why.
And it occurs to me the same exercise could be done to Working Together. If it were reduced to 10 pages, as some have suggested, what would fill the vacuum?
To answer this, we first need to understand what its present status is, and how it has any legal authority in the first place. So, first…
A little history
When social services departments were created in 1970, the Act creating them made specific provision for the Secretary of State to issue guidance to social workers. A single court case, R v Islington LBC ex p Rixon  1 CCLR 119 has always contaned the definitive statement about the status of such guidance:
“While guidance and direction are semantically and legally different things and while ‘guidance does not compel any particular decision’ … especially when prefaced by the word ‘general’, in my view Parliament by section 7(1) has required local authorities to follow the path charted by the Secretary of State’s guidance, with liberty to deviate from it where the local authority judges on admissible grounds that there is good reason to do so, but without freedom to take a substantially different course.”
Working Together was first published in 1999. A second edition came in 2006, and split it into two parts, statutory and non-statutory guidance. The same two-part structure is to be found in the current 2010 version.
So, the first half of Working Together has the peculiar status of statutory guidance, and the second does not.
Now, six propositions for what would fill the vacuum
One of the mantras that mental health services are supposed to live by is that there should be joined-up working between the NHS and social services. How’s that working out with children and adolescents?
In adult services, clinicians and social workers both work in Community Mental Health Teams (CMHTs). The CMHT will often have CPNs and social workers sharing offices, so that they can work closely together. In Child and Adolescent Mental Health Services (CAMHS) that’s not a given. Under the pressure of the cuts, quite a few areas have seen a loss of social workers. Social services departments who’ve been told they have to shed posts will often cut the staff over at CAMHS rather than the ones in their own office.
At the same time, both CAMHS and social services are under caseload pressures. Their resources are shrinking, but their caseloads aren’t. The talk in both camps is how to focus on their “core” clients, and who should be seen by other agencies.
Relations between CAMHS and social services have historically been fairly poor. As the gulf widens, this relationship can only get worse. The risk is that it can turn into a game of pass-the-parcel with children. As soon as one service accepts responsibility for a child, the other service steps back.
The Resource Allocation System (RAS) in adult social care in England is the means by which local authorities determine the size of the ‘personal budget’ pot in social care and the money that will be paid (or services in lieu) to the recipient.
The ethos of the personal budget, whether delivered by a direct payment or a ‘managed’ budget or an Individual Service Fund is clarity. The user/recipient of the service knows how much ‘money’ is in the pot to spend – even if they aren’t making those spending choices directly.
So why is there a problem with the RAS? Lucy at The Small Places explains in her excellent and highly recommended post here. She has undertaken a piece of research asking various local authorities for details about their Resource Allocation Systems. What this means in effect is asking how the algorithms are calculated that assigned particular values (money) to ‘needing help with preparing meals’ or ‘having a family member to help’. Lucy explains that two reasons she was given by different local authorities for not disclosing were that revealing the formula might ‘distort’ future requests (i.e. people could fiddle the system if they knew which questions were weighted in particular ways) or that the RAS is a commercially sensitive document.
Quite rightly these arguments are picked apart in the blog post referenced so I won’t go over that again.
I did want to consider a question that was put to me last night (via Twitter) namely ‘What’s the solution?’.
I’m sure I’d be in a position in a very different grade to the one I’m in now if I had a bullet proof solution but it raises some thoughts in me that needed longer than 140 characters.
Here’s a shocker, the new GP commissioning bodies are…wait for it…rehiring the old PCT managers to do the commissioning.
Research by the Health Service Journal reveals that managers from the defunct primary care trusts are being rehired to lead the new clinical commissioning groups made up of GPs. Of 81 CCGs to have made appointments, 50 have chosen a manager.
Andrew Lansley, the Health Secretary, wrote to health workers last week, urging them to use their clinical expertise and their knowledge to ensure NHS services meet the needs of patients. “My ambition is for a clinically-led NHS that delivers the best possible care for patients. Politicians should not be able to tell clinicians how to do their jobs.”
But emerging evidence suggests the reforms, hugely rewritten in the face of opposition from Lib Dem peers and medical bodies, will put in place new complex management structures. Liz Kendall, a Labour Health spokesperson, said the next year will be focused on “creating a huge new bureaucracy”, including 240 CCGs, local education and training boards, a National Commissioning Board, an NHS Trust Development Agency and clinical senates across the country.
Oh well done, Mr Lansley, you have not empowered the GPs to take control of NHS decisions. You have shuffled some chairs around and created another layer of bureaucracy, at a time when the NHS can least afford it.
Who saw that coming, eh? Oh wait, everyone.
What a complete and utter Lansley.
The recent news that the government are going to set a minimum price for each unit of alcohol (40 pence per unit) may appear to be a good idea to curb the increase in alcohol related illness but I fear that it may be too little too late. Sure there is research out there that tells us this might be a good idea and that it may prevent people buying as much alcohol. The producers and bankers will not lose out either as it will see their revenue from sales increase. The government are surely onto a winner then in keeping everyone happy including all those professionals who have to deal with the illness, poverty, homelessness and violence that too much alcohol can cause. So far so good but what if you are obsessed with the stuff, dependent even, on getting your daily dose just to stop the shakes or the anxiety that you know will return if you have to go through the cold turkey of withdrawals?
Many people are drinking far too much and are also very aware of units and recommended daily guidelines but if this does not stop them abusing their bodies will slightly greater prices? I expect that for those who are now so dependant and who no longer find it a pleasure to drink alcohol but a necessity the price hike will not stop them or even slow them down. They will simply go without other necessities convincing themselves that they do not really need them so that they can still afford alcohol. Making alcohol less accessible might have been a better idea as we all know that if we are ever trying to control our intake of anything it is best not to be able to get hold of it in those weaker moments. Would putting up the price of chocolate stop people from buying it? I am guessing not. Removing it from temptation might but then the producers and the taxman would be the ones who lost out.