Mr. John Dunne:

That is the only way to do it but I would urge caution for two reasons. First, historically, that has not been enough. Even when there has been an agreed single national service plan, which presumably incorporated what was going to be done everywhere, there were still lots of discrepancies or unevenness at local level. I mentioned CHO 2 earlier. Overall, the expenditure on carer respite is pretty much in line with the model but on the ground it operates differently because of historic anomalies which have not been addressed. CHO 2 is not the worst in the country for that however.

CHO 1 is a bit of a legend in its lifetime to the extent that the new structures will split it but there will still be boundaries based on structures that no longer exist in the health service yet are still, operationally, what determines the day-to-day. I go back to strategy as well as, let us say, a service specification being issued. If that is not done at a high enough level and there is a 1,000-page specification issued to every regional body, it can still do what it likes with that because it is so complicated. It is a question of having a strategy pitched at a level that is coherent and at the same time allows the discretion. When we heard from the Department of Health first that it would rather not develop or refresh the carer strategy and that it would like to do a social care strategy, our initial reaction was horror because we spent a lot of time fighting to get it to look at family carers. When you realise that the same officials juggle eight different strategies, you find yourself asking, hang on a minute, what is the merit in that? I said to the officials at the time that there was a political challenge in this so they should have a single strategy that is coherent and integrated and then have appendices so that each of the existing, let us say, interest groups could see their agenda and how it is addressed in the integrated strategy but they would have one strategy to map onto, not eight.