Memorandum by the Association of Directors
of Social Services (WP 86)
The Association of Directors of Social Services
(ADSS) has pleasure in submitting comments on the White Paper
as requested. In this submission we address the Paper according
to the requested Terms of Reference but looking at each chapter
in turn.
CHAPTER 1—THE
TIME FOR
ACTION ON
HEALTH AND
HEALTH INEQUALITIES
Do the proposals enable the Government to achieve
its public health goals?
The concept of choice should not rely on a consumerist
model where it is assumed that rational processes take place.
Damaged and disadvantaged individuals need more support to enable
them to make healthier choices.
Are the proposals appropriate, effective and value
for money?
Strengthening local and sub-regional partnerships
may require access to financial incentives from central and regional
government.
Are the right public health mechanisms and infrastructure
in place?
Very little attention is paid to the potential
of social care specialists in delivering the public health agenda.
Public health trained monitors may be needed
to ensure compliance with voluntary agreements; the role of national
voluntary organisations, professional bodies (eg ADSS), consumer
associations, and trade unions might help here.
CHAPTER 2—HEALTH
IN THE
CONSUMER SOCIETY
Do the proposals enable the Government to achieve
its public health goals?
There is some evidence of the effectiveness
of nationally run public health campaigns, especially where they
are linked to local action (eg the AIDS campaign in 1980s linked
to specific grants for NHS and social services).
Are the proposals, appropriate, effective and
value for money?
Surveys may be needed to collect reliable health
information at a small area level or for specific population sub
set. Better value for money might be achieved if this work was
undertaken regionally or by groups of local authorities with similar
characteristics.
CHAPTER 3—CHILDREN
AND YOUNG
PEOPLE—STARTING
ON THE
RIGHT PATH
Do the proposals enable the Government to achieve
its public health goals?
For Councils to be effective in tackling underage
tobacco sales they may require additional resources for environmental
health, trading standards, licensing and youth services.
Healthy schools initiative should be linked
to similar initiatives targeting looked after children.
The emphasis on the role of school nurses is
not balanced by consideration of the potential of social care
specialists working with disadvantaged children and families to
better promote health.
Are the proposals appropriate, effective and value
for money?
More radical approaches to universal healthy
approaches to universal healthy school meals provision may achieve
better results than investment at the margins; breakfast clubs
should be available in all primary schools and early years centres
in the 10% most deprived neighbourhoods.
Are the right public health mechanisms and infrastructure
in place?
There is a need to develop public health skills
and understanding of key social care staff, not excluding social
work professionals and students.
CHAPTER 4—LOCAL
COMMUNITIES LEADING
FOR HEALTH
Do the proposals enable the Government to achieve
its public health goals?
Should there be an explicit requirement to include
local PCT targets in Council's annual performance plans following
consultation with local health OSCs?
Are the proposals appropriate, effective and value
for money?
More emphasis should be placed by LEAP initiatives
in addressing the potential for preventing falls amongst older
persons.
More financial incentives are needed to encourage
healthy neighbourhood renewals especially in those areas not eligible
for NRF funding.
Should there be a requirement for NHS local accessibility
plans to be consulted on with LSPs and Health OSCs?
How can the significant levels of investment in
NHS patient transport services and community transport schemes
operated by local authorities be better harnessed to (a) offer
better value for money and (b) encourage healthier alternatives?
Are the right public health mechanisms and infrastructure
in place?
Guidance is needed on the role of local government
and voluntary sector health "champions" (and how they
will be supported locally, regionally and nationally). For example
should this role be aligned with the role of the elected executive
or non executive?
Should the role of public health observatories
integrate more with regional social care information networks?
Local authorities need to be properly resourced
to implement legislation on smoking through additional investment
in licensing, enforcement and monitoring systems.
CHAPTER 5—HEALTH
AS A
WAY OF
LIFE
Do the proposals enable the Government to achieve
its public health goals?
Insufficient attention is paid to the role of
social care staff and other local government personnel in delivering
health training and developing personal health guides—especially
for vulnerable people.
There is little mention here about the capacity
of elected members of health OSC Committees or members of the
public on Patient Forums, Expert Patients Programme, and Social
Services User and Carer Groups.
Are the proposals appropriate, effective and value
for money?
It may be most cost effective for the NHS to
develop the skills and capacity of community and voluntary sector
organisation to deliver personal health advice.
Are the right public health mechanisms and infrastructure
in place?
A public health contribution to promoting health
as a way of life needs to adopt more of a community development
focus rather than rely on a bio-medical model of health education.
CHAPTER 6—HEALTH
PROMOTING NHS
Do the proposals enable the Government to achieve
its public health goals?
In some areas local NSFs (and similar initiatives)
are being co-ordinated by social care services managers (eg in
respect of older persons, mental health, learning disabilities,
children and young people) but little consideration has been given
to how they can contribute to better delivery of the prevention
standards without dedicated resources.
The welcome focus on mental health might be
better achieved by engaging local authority staff and the voluntary
sector seeking to overcome barriers to employment and strengthen
individuals and communities.
Is there a role for health OSCs in assessing local
health and wellbeing?
Are the proposals appropriate, effective and value
for money?
Is there scope to develop the role of the social
care practitioner to enable them to acquire the necessary top
up skills and training to achieve community matron status or equivalent?
Resources will also be needed to develop alcohol
harm reduction initiatives at local level.
Are the right public health mechanisms and infrastructure
in place?
How can social care practitioners and specialist
be encouraged to develop the public health skills and expertise?
CHAPTER 7—WORK
AND HEALTH
Do the proposals enable the Government to achieve
its public health goals?
Do local government employees fit the definition
of Government Department staff for the purposes of this section?
Are the proposals appropriate, effective and value
for money?
Should social care staff employed by local government
expect similar levels of support to that proposed for NHS staff?
Are the right public health mechanisms and infrastructure
in place?
More encouragement is needed for local government
to focus on new settings for promoting health improvement: including
social care settings, young people's services outside of school
and leisure.
CHAPTER 8—MAKING
IT HAPPEN:
NATIONAL AND
LOCAL DELIVERY
Do the proposals enable the Government to achieve
its public health goals?
Health Impact Assessment tools need to be developed
at regional and local level and ensure appropriate input from
appropriate local government leads (including social care staff).
Are the proposals appropriate, effective and value
for money?
Best value for money might be achieved by linking
new investment to other funding programmes at regional and local
level (eg NRF, Lottery bids, LPSA, LAA, specific grants for social
care, education standards funds).
Consideration should be given to the role of
voluntary/community organisations (including social enterprises
and self help groups) in delivering objectives attracting new
investment.
Are the right public health mechanisms and infrastructure
in place?
Health Impact Assessment training is needed
for local government Members and staff involved in decision making
and scrutiny processes impacting on health and well-being.
February 2005
| 
