Managers should beware as Milburn passes on the pressure to deliver

Health secretary Alan Milburn has lost little time picking up the pace of reform. In his first set-piece conference speech since his return from the Treasury to the Department of Health, he told social services leaders last week that they would no longer be the poor relations of the NHS - a sugar-coating form of words which appears to have sweetened the bitter pill of central regulation sufficiently for delegates to swallow it whole (see news focus, pages 1113).

Ministers are understandably anxious to raise standards of social care. If three out of four hospitals were found not to be 'serving people well', there would be uproar. Only the fact that few journalists can imagine relying on the services of their friendly local social worker keeps such scandals off the front pages. But if quality assurance is a slippery issue in healthcare - witness the difficulty NHS managers had explaining the concept of clinical governance to their French counterparts last week (see news focus, page 17) - imagine what it will be like in social care.

Nor will it be an easy task imposing national service guidelines and care protocols on elected social services authorities - councillors will prove as doughty in defence of their democratic right to run things badly on behalf of local people as some doctors have been in defence of their professional right to make the wrong clinical choice for their patients.

In the meantime, both health and social services have been warned that there can be 'no excuses this winter'. Mr Milburn will not take kindly to bad news if things go wrong. But managers in both organisations should be on their guard. Some newspapers have already decided that there is going to be a winter crisis this year - if not as a result of the millennium shutdown then from some other cause yet to be decided - and it will be difficult to convince them otherwise as the pressures begin to build.

For those managing health and social care this winter, there is a real risk that Mr Milburn's need to deliver on the promises of his earlier incarnation at the DoH will crash headlong into the media's new-found scepticism about the government in general and those associated with prime minister Tony Blair in particular.

As the next general election appears on the horizon - perhaps destined for spring 2001 - so the stakes grow higher.