The DFEE's connected to the Home Office...

11th September 1998 at 01:00
Here it is time to pick up the left-over threads from July and pull them together into a coherent September story, and I have more joining up to do than I bargained for. I have always spoken up for cross-departmental thinking, but now it has been forced upon me. I re-enter the autumn term by way of the National Health Service.

Gloucester Royal hospital has an excellent reputation for its orthopaedic department, which may be because people round here are always falling off their horses. The women's wards entertain a surreal mix of the usual game old grannies with hip replacements, and Jilly Cooper gals pining for the ponies that kicked them onto crutches. I was the only one there who had been stretchered off the football field.

No, I hadn't just failed the laddish initiation test for the Downing Street policy unit. Unlike Demos co-founder Helen Wilkinson, my motivation had been personal rather than political; I was just kicking along with the son and grandson, as they played out their World Cup fantasies at the local leisure centre.

And I admit my hip might not have hit the ground with such spectacular force if I hadn't still been swinging my handbag and camera as I went for goal, something only David Beckham might have carried off successfully. So to bed, a dynamic hip screw (DHS in the NHS jargon) and a long week on the ward to recover mobility, observe the clash of different lifestyles, and learn how one community service meets so many disparate needs and tastes without serious compromise.

It was one day when the bedside chatter was a particularly incongruous blend of polo pony and housing estate gossip that I laid aside my Booker paperback and Radio 4 and sat back to listen, learn and compare. I wouldn't want to push it too far, but is there anything that a comprehensive school might learn from the even-handed treatment that good nursing staff offer their mixed-ability, mixed-age, socially divided clientele?

Central to my observations is the implacable framework of rules which governs every ritual from drug-dispensing to the number of nurses per bedpan, coupled with targets on the road to recovery to be met and monitored for each patient, each day. Yet inside this rule-bound progression, what shines out is warmth and concern for the individual patient, which may call for ribald humour or tender loving care, according to demand.

I am conscious that my experience was better than many, and I know that staff and money shortages nibble away at standards and compassion. All the same, there may be some transferable good practice in there somewhere.

Meanwhile, from joined-up bones to joined-up thinking. Back to where the Government left us in July with the Treasury's comprehensive spending review and a related Cabinet reshuffle, neither of them properly picked over before the summer shut-down.

I have in mind the need to monitor the ways in which the Prime Minister is pushing forward his joined-up social policies, with social exclusion, action zones and the Sure Start programme. Is Tony Blair clear how he will get the Department for Education and Employment working effectively with health, Home Office and the social services right down the line? Will funding go with the grain of policy, or against it? Who decides which department takes a lead on which programmes? Who will drive seamless policies through from the centre?

Sure Start is a good example. The Treasury decision to spend Pounds 540 million over three years supporting disadvantaged pre-school children and their parents, was a key outcome of its spending review. Health minister Tessa Jowell takes the lead in this initiative to produce children "ready for school", but social services seem to be excluded and, although David Blunkett was visibly involved at the launch, there are still few public clues as to how essential links with early years education will be made.

We know now that joined-up policies need to be knitted together from top to bottom if the seams are to hold, so I am intrigued to know which of the enforcers appointed in the Cabinet reshuffle will count. Will Jack Cunningham, the new minister for coordination at the Cabinet Office, be sufficiently engaged by children's issues to knock heads together on Sure Start, or will it be the new Chief Secretary, Steve Byers, who looks out for the Treasury's new baby?

And finally it would be good to know who is in charge of joining up at Sanctuary Buildings.

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