Commissioning from specialist children's trusts.

Health Secretary, threw the phrase " children's trusts " into the arena of public debate when he addressed a national social services conference in Cardiff on 16 October 2002. He said: " I intend to create specialist children's trusts to jointly plan, commission, finance, and, where it makes sense, deliver children's services. Children's trusts which commission services will be based in local councils with the power for the first time to commission health as well as social care. And for those children's trusts that want to specialise in providing services we will want to explore a range of models in different parts of the country. These could potentially include local not for profit public interest companies that could enlist the involvement of the community, voluntary, and private sectors alongside the public sector. We want to pilot this new approach, so in December this year my department and the education department will ask for expressions of interest from local organisations keen to test how children's trusts could improve local services. " 1 2 WHICH CHILDREN'S SERVICES? Paediatricians reading this will be well aware of the problems in acute services that are being addressed by the National Service Framework and other initiatives. The children's trust proposals are not principally about acute services. Rather they encompass: • Services for disabled children • Children with special educational needs • Child protection • Identification, referral, and tracking of children at risk • Speech and language therapy • Child and adolescent mental health services • Areas where social care, health, and education services need to work together. A recent government spending review looked at the services for children at risk. • It identified a lack of unified local authority vision. • There was no coordination in the way new initiatives were used. • There was insufficient local ownership of services and an imbalance between prevention and crisis intervention. • Parents have to negotiate bureaucratic boundaries between services that are supposed to work together to help their children. • Rigid ways of working by these service providers stifle creativity and innovation. • There are huge problems in recruiting and retaining a skilled and motivated work force. This is now funded from numerous different budgets across health, education , social services, the voluntary sector, and parents themselves. Generally any professional that recommends equipment has access to a budget. Each budget has a life of its own, often being …