Examination of Witnesses (Questions 160 - 165)
THURSDAY 5 MARCH 1998
MR CHRIS
DAVIES and MR
MICHAEL HAKE
Chairman
160. Do you see these boxes also in health?
(Mr Davies) They are there in that the NHSE has no
responsibility for social care and the split takes place right
at the top of the Department of Health. But considerable efforts
have been made in the Department of Health over the past three
or four years to bridge those gaps. We see far more instances
of the messages between health and social care being consistent
and coherent than would have been the case 10 years ago.
(Mr Hake) Government can help us—we understand
that guidance will be coming forward—by clarifying the relationships
between children's service plans, reviews of day care under the
Children Act, early years plans, education development plans and
the health interface between health improvement programmes, joint
investment plans and community care plans. We have the potential
for some difficulty unless those relationships are clear. We also
have very clear legal frameworks underpinning joint work between
education and social services in the form of the mutuality provisions
for collaboration in education legislation and the Children Act.
Of course, "children in need" is a corporate definition
within which the whole council works towards a solutions, but
the sorts of joint working initiatives that Mr Davies describes
are happening in my authority and elsewhere. There is some recognition
that young people must be viewed in the home, at school and in
the community and occasionally they come into contact with the
police. If the relationship with education is different sometimes
it is because we deal with only a minority of children. Much of
our input tends to arise before children start school and as they
get into difficulty when growing up and for one reason or another
they are troublesome or troubled. That perhaps shapes the nature
of the relationship in a way that is different from health where,
for example, with older people we may be working with a substantial
number of others jointly, although we will not be able to find
out because there are no statistical systems to enable that information
to be generated. If one looks at the health and personal social
services statistics one will not be able to form a view on it
because of the way that the information is presented.
Audrey Wise
161. Do you have any views on how the statistics in this
field should be changed?
(Mr Hake) We need to be a lot clearer about what we
want to know and why we want to know it. We must also have statistics
that enable systems to make outcomes matter, to put it like that.
At the moment, our statistics focus on outputs rather than outcomes.
I have used the health and social services statistics as an example.
You have all the health statistics and our statistics but there
is no easy way of matching them up. If somebody wants to know
how much social care and health care activity or work with troubled
children involving education welfare occurs in my own authority
area it is very difficult to discover the answer. We have a joint
inventory of service for community care. That is maintained by
all the agencies including the independent sector. We have some
information in relation to education. However, to obtain connected
data to inform decisions about these problems is very difficult.
That must be done jointly and nationally.
162. It will not happen by accident. Do you have any working
party or sub-committee which is linked with others to try to get
the statistical side sorted out?
(Mr Davies) A group of our members works constantly
on that kind of performance and service measurement. They link
up with a body called the Technical Working Group within the Department
of Health. They are the departmental statisticians who determine
the configuration of these matters. But at the moment our feeling
is that most of the statistics that are collected are not measuring
the most important things.
Mr Lansley
163. Time may not permit us to deal with three further items.
If you are unable to deal with it now perhaps you can let us have
a note. The first matter is whether co-terminosity can be explored.
You have referred to the importance of it, in the sense that it
is one thing to seek it but another thing to achieve it. What
lines do you think can be pursued in that respect? Secondly, you
have made reference to joint complaint mechanisms. Can you elaborate
on that, looking at the respective ways in which you and health
trusts typically deal with that matter? Thirdly, you have made
reference to performance indicators. Have you talked to health
department officials about the role of protocols and eligibility
criteria and the extent to which it is desirable to promote good
practice by reference to eligibility criteria or protocols or
performance indicators, and how far good practice can be built
into nationally agreed criteria or protocols or performance indicators
and standards? Can you reflect on the extent to which you think
it is desirable to pursue the question of good practice and move
towards nationally agreed standards of those kinds, which would
be designed to ensure that there were no more turf wars because
each would know who was responsible for what judged against the
particular criteria to be used for measurement purposes?
(Mr Davies) To pick up the last point, there must
be room for both approaches, that is, the setting of national
standards and the spreading of good practice. Our wariness of
national standards comes from a number of directions: first, the
issue of local democracy; and, secondly, whether people at a central
government level understand enough to prescribe the detail of
what goes on between people in local areas. There is a question
as to the ability of central government to prescribe at that detailed
level. Thirdly, the more standards you have the harder it is to
have any policing of them. While we are not here to argue for
even more vigorous policing of local authorities, the question
is how far it is worth having standards if there is no way of
checking whether they are observed in practice. Our argument is
that there is a need for a framework of national standards but
it must not try to deal with every possible eventuality; it must
remain at a broader level and provide a fair amount of discretion.
Mr Lansley: It would assist us if you looked at the current
balance and considered how it might be struck differently.
Mr Gunnell
164. I was struck by one of your answers to Julia Drown in
relation to Northern Ireland. One wonders whether one of the problems
in the relationship is the particular difficulty faced by those
in social services, which after all is a joint partner with the
health services in most of these matters, because the public perception
of the status of the services is very different. When people think
of the Department of Health they think primarily of the health
service and much less of social care. That is reflected by Members
of Parliament when they table Parliamentary Questions on health.
One does not see very many Questions on social services issues.
In many ways the status of a GP in the local community is very
much determinative of the status of the social worker. That status
is reflected in salary. There is a difference in perception because
the public perceives a GP in such a way that if he tells people
to do something they will do it. It is not the same if the public
receives advice from social services. The Department of Health
has had great difficulty in establishing general social services
standards and raising the status of that profession. Obviously,
it has not been necessary for the General Medical Council to take
such action. How far do you believe that the general public's
perception of the differences between the services is a handicap
in getting a seamless service?
(Mr Davies) It is a handicap in all sorts of ways.
I do not think that we would be looking for the sort of humble
respect for social services that people show for doctors. We envy
them their salaries but not the humility and respect. We are in
a more robust and servant-like relationship with our populations
than that. The greatest problem we face is that each person expects
to use the health service. By and large, people hope to goodness
that they will never have to use social services. That makes a
big difference to the way they are perceived and valued and the
interest that is shown. It has changed a bit since the new arrangement
of 1993 was introduced. We are now involved in a much broader
range of provision for the elderly population in terms of community
care. That has been a gain for us. We have acquired more community
interest in what we do as a result of those changes. But I do
not see a day when we will ever be held in the sort of love and
esteem that is enjoyed by the health service. I should like to
see more public understanding of what we are trying to do.
Chairman
165. Do the witnesses have anything to add to what has already
been said?
(Mr Davies) Earlier my colleague referred to carers
and said that we dealt with only 15 per cent of the problem. We
have not spent much time on that. We would like to leave you with
the very powerful message that all that the health service and
we do pales into insignificance compared with what family friends
and neighbours do. All our efforts must be directed to backing
them up. Looking at it from the most cynical of perspectives,
if they give up the national exchequer is in trouble. The importance
of bringing our efforts together is not least so that from carers'
point of view they feel that they are getting sensible and consistent
support across the board.
Chairman: On behalf of the Committee, I should like
to express our appreciation for your willingness to give written
evidence and to attend today to provide oral evidence for two
and a half hours.
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