Letters extra

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Highlights from the Society Guardian postbag
Funding concernsThere were some positive developments in last week's comprehensive spending review (CSR). In particular, the social exclusion taskforce's new emphasis on adults with mental health needs or learning disabilities is overdue and welcome. If the resulting public service agreement provides more support for those adults when they seek settled accommodation, employment, education and training, this will give people a real chance of living a fulfilling life. However, the increase in the budget for adult social care announced in the CSR is still too low to ensure that all vulnerable adults receive decent care services. As the Commission for Social Care Inspection has warned, social care is already being severely rationed in many parts of the country .The level of the increase in the budget falls far below that projected by the Wanless social care review to allow for growing demands for funding, particularly with an ageing population.
A less obvious problem may be the planned cuts to the budget of the Department for Work and Pensions, which could further marginalise employment support services for adults with learning disabilities. Provision is patchy and accorded low priority, despite the huge benefits that employment can provide in terms of tackling social exclusion and reducing people's dependence on welfare benefits. We can only hope the focus on vulnerable adults in the new public service agreement will prove itself by ensuring these valuable services not only survive but grow.Su Sayer, chief executive, United Response
Relationships matterA thinktank talking about "levers" for NHS system reform as Jennifer Dixon of the Kings Fund did! (Nice details, shame about the bigger picture, October 10) Social systems - and anything that involves people is one - are very different from mechanical systems (machines). Levers have no part to play at all. If you are serious about system's transformation, you focus on the relationships between the parts, not on the parts/structures. You organise around the flow of information. Form does not follow function (mechanical), but rather in-formation. Change is always internal. The question is far less about ministers coming up with solutions and far more about uncovering what stops the system using the intelligence it could have access to: ranging from patients own expertise, why operating rooms are often inefficient to the future impact of technology. A shared, grounded theory of system's change would help everyone.