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Published: 24/10/2002, Volume II2, No. 5828 Page 12

Anger over charges for delayed discharges overshadowed radical steps to split care in two announced at the Association of Directors of Social Services conference in Cardiff.Carol Harris reports It is all about values not means.

So said health secretary Alan Milburn at the Association of Directors of Social Services' annual conference in Cardiff as he outlined changes that will see social care split in two.

'The values that underpin our social services are more relevant today than they have ever been... It is the means of delivery - not the values of social services - that need to change.'

What social services needed was an end, he said, to 'the old style public service monoliths [which] cannot meet modern challenges'.

His message was echoed by ADSS president David Behan on the closing day of the conference.

'Structural change is a means to an end, ' he said, urging delegates to focus their thoughts on delivering improved outcomes for those in their care, and improving the quality of the services offered.

So is that it? Social care to be split in two and not even a grumble of complaint? Well not quite - but conference delegates were choosing their battles carefully.

And debate over children's trusts and care trusts was overshadowed by a controversy raging far more loudly: cross-charging, or the 'reimbursement' policy as it is officially - and perhaps more tactfully - known.

But first, children's trusts.

The concept will be piloted, and in December the Department of Health will be looking for expressions of interest. And care trusts, which began with more of a whimper than a bang, are to be pushed, with details of a new integrated care network to be announced next month.

'In the next two years, I expect to see health and social services in every part of the country pooling resources and skills to deliver a seamless service for older people, either through a care trust or through these or the existing health act flexibilities. In time, this should become the norm for how elderly care services are provided and commissioned, 'Mr Milburn said.

He also promised new types of social care professionals.

'People who can work in the community, combining the skills of the therapist, community nurse and home-help to provide rehabilitation alongside home care;

family care workers combining the skills of the health visitor and the social worker to provide family support in times of trouble.'

And then the tricky bit: Mr Milburn confirmed that current arrangements for ending delayed discharge from hospitals, with ring-fenced money and intensive monitoring, would also be replaced by legislation which forced councils to reimburse hospitals for the cost of delayed discharges.

He offered some reassurance:

councils that enjoy positive partnerships with the NHS - and those prepared to invest extra resources to build capacity - have nothing to fear from this policy.

He told delegates the policy should help social services get the money spent on social services.

'It is all about putting users centre stage.You can already teach the health service a thing or two about that.'

Kind words. But cross-charging is still making people cross. Mr Behan promised that ADSS would continue to use its powers of persuasion. Referring back to Mr Milburn's speech, he said: 'The secretary of state may have been in 'warm and cuddly mode', as he described himself, but the message was clear. We are going to introduce cross-charging.

'At our meeting yesterday, the membership felt we should continue to influence the development of policy through active discussion and participation.

'As Mr Milburn said, 'partnerships are not always easy or comfortable', but to mix my metaphors, we need to be 'in the tent prepared to use our elbows!'' Earlier Alison King, spokeswoman for the Local Government Association, had condemned the plans, describing them as 'a spectacular own goal' and urged the government to own up to a 'whopping mistake'.

And cross-charging was also a point of discussion among delegates. Roger Miller, cabinet lead member at Leicestershire county council, warned against them.He told HSJ: 'The fines on local authorities for delayed discharge would be a good idea if the money went into primary care, but it will not. It will go into acute services, which will only perpetuate the current system. It will disrupt good working relationships between organisations.'