Published: 06/02/2003, Volume II3, No. 5841 Page 13 14
Proposals for children's trusts were initially met with hostility by social services, but recent amendments and the Laming report on the Victoria Climbié case have had a warmer reception.Tash Shifrin reports
Eight-year-old Victoria Climbié died alone after horrific torture. She was known to two NHS hospitals, four social services departments, three housing authorities, two police child protection teams and an NSPCC centre. But none protected her.
Now the harsh spotlight of Lord Laming's inquiry into Victoria's death has fallen on joint-working between the agencies running children's services and child protection.
Health secretary Alan Milburn lost no time in writing to every strategic health authority, trust, primary care trust and local authority chief executive last week, reminding them of their responsibilities to children. A full government response to the 108 recommendations in Lord Laming's report is set to appear in a green paper in the spring.
But in a statement to Parliament, Mr Milburn focused on an initiative launched at last October's social services conference - children's trusts.They were intended to encourage shared information, ensure that children did not receive duplicate assessments, harness the resources of the voluntary sector, develop a strategic analysis of children's needs across a particular area and identify a single person in charge of improving children's services in one locality.
A press release issued in October described a future in which 'children's services will come together in children's trusts, while NHS and social services for older people will be brought together in care trusts'.
'These are set to dramatically reshape how social services are organised and delivered.'
This may have seemed somewhat scary to the social services delegates: their departments would be cleaved in two. And - worse - at least one half would be subsumed into care trusts, a controversial model in local government, not least because care trusts are NHS bodies. The takeup of care trusts has not been impressive, with just four operational now. But the guide to piloting children's trusts published last week looks a lot more amenable to health and social care professionals. And although Mr Milburn told MPs that the trusts 'could be public interest companies' - the status also touted for foundation trusts - the guide is refreshingly nonprescriptive.
Even more welcome may be the fact that it is not urging organisational upheaval. Instead, the new bodies will be built around the familiar 'flexibilities' of the 1999 Health Act - pooled budgets, lead commissioning and integrated arrangements.
And health and social care managers really are interested. Chief social services inspector Denise Platt says a seminar on children's trusts was run for the voluntary sector. 'We were going to run one for the statutory sector. But we had to run three because we were oversubscribed and even then we had to turn people away.'
She adds: 'We are encouraging people to come forward with a proposal that makes sense for them locally. We are not saying You have got to look like this; You have got to have this particular model of a children's trust.
'We are saying these are the aims, to bring together services into one organisational arrangement, with a single person in charge, pooling budgets where It is possible to do that and operating in a more integrated way. But the scope of what a trust looks like, We are leaving to local partners to determine. That is one of the things we want to pilot - how models can work.'
And she says: 'There are quite a lot of PCTs that have made joint appointments with social services for children's services or mental health, so in many places There is already a single manager for some of these services. There will not be legislative change to support the pilots because we want applications by the end of March.
And with the best will in the world, I do not think we can get a different sort of governance legislation in place by then.'
But if children's trusts are to be based on Health Act flexibilities, is not the name a bit misleading, suggesting a separately established, discreet body? Ms Platt says: 'It is not a discreet body at the moment, but if it looks as if we need to change governance structures, then we can think about how they might be made discreet bodies.
'People have said they do not like the term 'children's trust', but noone's come forward with an alternative that hasn't got a lot of words in it that would confuse the public no end, ' she says.
The children's trusts - or whatever they are called - could range in size from 'all services for 0-19s' to smaller schemes based on services for disabled children and those with special educational needs, for example.
Association of Directors of Social Services children and families spokeswoman Jane Held says children's trusts are one option for delivering services in a more co-ordinated way - but not the only one: 'Co-ordination, colocation of services, working together and local delivery... are the important things that children's trusts will allow us to do.'
And the fact that they will be local government-led rather than NHS bodies is welcome. But Ms Held points out that 'one of the shortfalls in the children's trust model is the exclusion of youth justice-type services', although some local areas already work with the police and justice agencies in their partnerships.
NHS Confederation policy manager Janice Miles says: 'The thing We are pleased about is, this is going to be piloting on the basis of what localities think is right for them. It is not prescriptive.'
She adds: 'If people want organisational changes as part of their development, That is all well and good. But it shouldn't be forced on them. The Victoria Climbié report is very strong on the need to improve co-ordination. It has recognised the problems. But what it hasn't been suggesting is wholesale organisational change. It is saying there is some good practice in some areas, so let's get on with that.'
She also welcomes Lord Laming's emphasis on child protection not being separated from children's welfare in general.
NHS children's czar Professor Al Aynsley-Green also stresses some positives. 'Despite the gloom and despondency and disasters - though we shouldn't diminish the importance of the disasters - There is a huge amount of very, very good work going on.'
But there are challenges, not least the level of understanding of children - and children's services. He cites a trust non-executive director who thanked him for pointing out that 'children are not small adults'.
Professor Aynsley-Green believes that children's trusts are an 'extraordinarily important opportunity as one part of the agenda emerging for children. There is a huge need for better integrated and co-ordinated delivery of services.'
Ms Platt puts it this way: 'Children's services may feel themselves the Cinderella in the NHS, but this puts them in the mainstream development. It gives them much more status and focus than they might have thought they had in the past.' l Joint taken: Plymouth's group services In Plymouth, a joint group involving the NHS, social services, the voluntary sector and other agencies has been overseeing children's services for three years.The group, which developed out of the city's health action zone, is chaired by Plymouth Hospitals trust chief executive Paul Roberts.
'We have expressed an interest in children's trusts with the city council, 'he says, 'so we can find out more about it.'But the first focus must be 'putting in place basic administrative and professional practice changes that will make children safer'.
The Plymouth group is already changing the shape of children's services.'What we have proposed as our action plan this year is to set up a formal joint children's and young people's commissioning board for the city, which will go down the route of joint budgets and planning.He adds: 'Plymouth Hospitals trust and the primary care trust are consulting on a proposal for a joint children's health board, bringing together all children's services.We are very excited about it.'