What do you get if you cross health and social services? A 'care trust', apparently, and they look set to be the Next Big Thing. Tash Shifrin reports

There are good days, there are bad days. And, sometimes, there are 'early days' - when no-one can quite tell if it's going to be a good or a bad day.

Although there was something of a furore in local government circles over a rumoured NHS 'takeover' of social services, the NHS plan has not gone that far.

The establishment of 'a new level of primary care trusts' - confusingly dubbed 'care trusts' - will mean that 'all those localities who want to follow this route can do so' to deliver social care for elderly people and 'other client groups'.

But, while the plan describes five elements of intermediate care for elderly people which health authorities, primary care groups, PCTs and local authorities will 'have to demonstrate that they will put in place', it adds reassuringly: 'They will have the freedom to decide on the precise organisational arrangements for their area.'

Nevertheless, care trusts are the Next Big Thing. The first wave 'could be in place next year', the plan says.

Dudley social services director Chris Williams is keeping an open mind. 'I think it's an opportunity worth giving serious consideration to - where relations between health and social services are working well - if it might result in better services for local people.'

But he adds: 'There needs to be an understanding that health won't dominate in its narrow sense. And it depends on the governance arrangements.'

Yet ask what a care trust will look like, or what the governance arrangements might be, what levels of representation it will give health and local government, what it will really mean in practice, and the Department of Health says: 'It's early days.'

A spokesperson explains that 'work has started' on sorting out the detail of the new measures. 'Officials are starting to go through it and see what needs to be done.'

This means that health and local government may have to wait a little longer to find out whether their hopes and fears will be realised.

Lawyers will be picking through the care trust proposals, too, to determine which elements - if any - will require new legislation, and which can be knocked into action with a stiff bit of guidance.

How long will all this take, eager PCTs might wonder. 'It's early days to give a clear indication of the timescale, ' says the DoH. Surprise, surprise.

But the mad dash to get the plan in place and the hurried pace of consultation may have been what ruffled feathers.

The NHS Confederation's proposals, for a level-5 PCT commissioning social care and a level-6 providing it, appeared to be endorsed by health secretary Alan Milburn at a New Health Network conference in June - the day before a meeting of the partnership modernisation action team.

This provoked anger from the Local Government Association and the Association of Directors of Social Services.

Mr Milburn's talk of 'an integrated health and social care organisation' raised the spectre of organisational change - not a popular move with local government. His timing raised questions about how genuinely the government was consulting.

But now that the dust has settled, confederation policy manager Janice Miles is keen to emphasise that its proposals were something 'we'd never seen as a takeover'.

She says: 'What's come out in the plan is eminently sensible, ' although the possible models for care trusts 'need to be thought through'.

'The governance arrangements of PCTs would need to be changed if they take on the social care role, ' she says.

Despite the government's suggestion that care trusts could be in place next year, the confederation is in no rush.

'When we first started looking at this, we were talking about three years ahead, ' says Ms Miles.

LGA head of social affairs John Ransford says discussing governance arrangements for care trusts is 'a bit premature at the moment'.

The LGA is building up a database to 'gather as much information as we can about how practice is changing in the light of the Health Act flexibilities'.

Mr Ransford does not want to get 'sucked into the bureaucracy' of concentrating on structure. Instead the LGA wants to 'start with service improvements and then find the structure to do it'.

One possible model, he suggests, is a 'virtual' care trust. 'It doesn't have to be an institution in the way an NHS trust or PCT is.'

He adds that 'the bodies providing the wherewithal' behind that - the staff, resources, expertise - would 'retain their organisation'.

He is upbeat about the 'exciting opportunities' in the plan, and wants to 'let a thousand flowers bloom'.

ADSS senior vice-president Moira Gibb is relieved that the plan was 'not more prescriptive' and is 'optimistic' that its focus will 'drive up the quality of care'.

But she is also concerned that 'it is unclear what it will actually mean'.

There's more to seamless services than structures, she feels. 'Any new organisation or set of arrangements would have to pass the test of making it easier for service users to get services easily.'

But another social services director is taking a pragmatic view: 'I think other directors' response hasn't been as positive as my response. They're going to do this anyway in 2004 - it's clear PCTs will be expected to reach level-4 status. I'd rather go in while we can negotiate the rules on an equal footing.'

On the ground, health and social services managers are also getting to grips with the possibilities. Adrian Mercer, chief executive of South Manchester PCT is 'looking forward to seeing more guidance', but says care trusts are 'a very exciting possibility and we're looking forward to having positive discussions with social services'.

Tendring PCT chief executive Paul Unsworth says: 'At the moment we have a full agenda working with social services to devolve services to match the PCT boundary, and to pool budgets to overcome obstacles to a seamless service. 'He believes that 'diverting energy' to push on to care trust status at this stage 'would be premature' .

One social services director has a harsher view. 'The idea that PCTs are ready to take on all this stuff is fantasy really, ' she says.

Ah, well. It's still early days.

Forced marriages One of the most controversial aspects of the plan is the government's power to impose a care trust 'where local health and social care organisations have failed to establish effective joint partnerships - or where inspection or joint reviews have shown that services are failing'.

NHS Confederation policy manager Janice Miles says: 'This needs some thinking about. It's difficult to work in partnership if you don't want to work in partnership.'

A social services director offers a sceptical view. 'Banging heads together doesn't always work. You might get solutions - or you might just get two sore heads.'