What is the NHS plan?
On July 27 2000, the government published The NHS Plan: a Plan for Investment. A Plan for Reform. Billed as the most radical reform ever of the partnership between the health service and social care, it sets out a 10 year programme for change in England (Wales and Northern Ireland are developing their own, probably similar, plans).The programme brings money, staffing and organisational changes to health and social services. A key target is that the two sectors start working together much more closely.
While the NHS gets £19bn over the next five years, social care gets £1.5bn by 2004. Changes will be driven forward by a new modernisation board and assessed through indicators such as the social services performance assessment framework. Judging by 1999/2000 results, things are getting better but need to improve for the plan to meet its targets.
Why and how did it come about?
The plan notes that: "Despite its many achievements, the NHS has failed to keep pace with changes in our society." In March, prime minister Tony Blair set out five challenges to health and social care to be addressed over the next 10 years. Broad areas were patients, performance, prevention, professions and partnerships. The last two highlight the need to break traditional barriers between professions and get local councils and the NHS to collaborate to provide the best care.
Six "modernisation action teams", made up of senior social service professionals, met for the first time in April. Their brief was tough - wide-ranging national consultations leading to recommendations by June, and a plan by July 2000.
What are its implications for social services?
The Health Act 1999 removed barriers to joint local council and NHS working. The plan takes this further by:
• improving the integration of local health and social services in local care networks
• improving services for older people, whose needs often bridge health and social care
• implementing inspections of joint working by the Commission for Health Improvement, Audit Commission and the Social Services Inspectorate
• providing incentives and rewards for joint working
• facilitating integration through primary care trusts and new care trusts.
The reform programme needs to be phased to be realistic. Targets have been set, forming the Department of Health's public service agreement with the Treasury.
There are currently two joint social service and NHS targets. The first is to provide high quality pre-admission and rehabilitation care for the elderly, promote independent living and reduce hospitalisation. The second is to increase the participation of problem drug users in treatment programmes 55% by 2004 and 100% by 2008.
Social services must also improve lives of children in care. Four areas are addressed over four years. Education, training and employment outcomes for care leavers should be at least 75% of those of other children by age 19. The number of children in care achieving 5 A-C GCSE grades should increase to 15%. Guidance should be provided to "narrow the gap" between numbers of those in care and others who are cautioned or convicted, and the contribution of adoption to providing children with permanent families be maximised. This last target will be firmed up in light of the government's adoption services review.
How has it been received?
The plan has had a very mixed reaction, with some fearing that little will change. Others, like Jo Williams, a former president of the Association of Directors of Social Services, are optimistic. "The plan's proposals give us a real chance to make a better, more effective service that really focuses on the people we are trying to help," she says.
The country's first joint care trust, the Somerset partnership NHS and social care trust, has already illustrated what joint working can achieve. Established in April 1999, chief executive Paddy Cooney says: "We use resources in a more co-ordinated way through providing integrated care packages. We are managing and supervising across discipline boundaries and the relationship with primary care groups is more straightforward."
Stuart Etherington, chief executive of the National Council for Voluntary Organisations, is cautious. He agrees with the plan's principles but sees an important role for voluntary organisations. "Government policy places great emphasis on engagement and involvement of communities," he says. "Voluntary organisations can help ensure that involvement actually happens. I strongly believe that if the new trusts don't engage with local communities and are not demonstrably accountable to them for their decisions as well as their actions, health services reform will not meet the needs of the wider community."
He is also unhappy that while, linking social and health care, the plan focuses too much on treating illness rather than its underlying social causes.
