comment: New trusts are timely development of joint-working with social services

Published: 06/02/2003, Volume II3, No. 5841 Page 19

If the failures identified by the Laming inquiry into the murder of Victoria Climbié are horribly familiar, part of the solution may be more novel. The concept of children's trusts originally announced in the autumn now has an even greater impetus.

Health and social care managers will have to wait until spring's green paper for the detail, but the guidance on children's trust pilots published last week is encouraging (news focus, pages 13-15). Decisions about organisational detail seem largely to be left at a local level - flexibility will be vital if applications are to be made before the end of March.

Primary care trusts and social services departments are already working well together in many places. If the goal is to put the patient user front and centre and develop a package of co-ordinated services around them, is there a more suitable or pressing application than child protection?

There are many who feel that the logic of closer integration of health and community services is unstoppable. The costs of mainstreaming schemes such as Surestart or Neighbourhood Renewal will become a problem because, although integrated in themselves, the system in which they sit is not. So when the initial funding tapers off, the bill will simply be too great for one organisation working in isolation to bear.

Importantly, the guidance - and the Laming report - emphasise co-ordination rather than large-scale restructuring. As the National Patient Safety Agency's Sue Williams reminds us (news, page 10) change can affect service quality - and cost lives. The challenge will be to adopt the recommendations of the inquiry with the urgency Lord Laming prescribes while juggling other priorities and resisting the temptation to tinker unnecessarily with organisational structure.