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Wednesday, January 13, 1999 Published at 10:31 GMT


Carers caught in political crossfire

Carers are let down by professional services

Patients and carers are suffering because of the poor relationship between health and social care services, MPs have warned.

The Health Committee launched an investigation after Health Secretary Frank Dobson said it was his aim to bring down the "Berlin Wall" between health and social services.

Ministers published a consultation document, Partnership in Action, in September 1998 that proposed ways to promote joint working between health and social services.

But the Health Committee has warned that a huge amount of change is required before the two sectors can work together harmoniously.

Currently, the NHS provides health care and local councils are responsible for social services.

The report highlighted cases where people had suffered:

  • One stroke victim received no help at home for six months after leaving hospital because she did not know who to ask
  • Cancer victims who left hospital to die sometimes had to wait 26 days before social services assessed their needs.

The "farcical" nature of the current system was summed up by arguments about who was responsible for helping people who needed care to have a bath, the report says.

If a bath was needed on health grounds it was up to the NHS, but if it was a social bath it was up to social services, and the individual had to be means tested before the assistance was provided.

Very confused system

[ image: David Hinchliffe chaired the committee]
David Hinchliffe chaired the committee
The report says: "We consider the current system for continuing health and social care to be very confused.

"Responsibilities are blurred, professionals face unnecessary problems, and users and carers are suffering because of barriers created by structural division which is based on an ill-defined and arguably non-existent boundary."

The MPs, who took evidence from a wide variety of sources, said they were "disappointed" by the lack of vision demonstrated by professional bodies.

"We were concerned that organisations seemed to consider the issue only form their own, narrow point of view and did not appear to view things from the users and carers perspectives," the MPs wrote.

The Partnership in Action proposals to promote integrated provision were described as a "step in the right direction".

However, the MPs warned that the only effective way forward was fully integrate health and social services.

This could be within the NHS, local government, or a new separate organisation.

The MPs called for a debate on the best way forward, and for pilots to be set up to test different options.

In the meantime, they called on local and central government to work together to establish a framework in which collaboration can flourish, and in which attempts by health authorties to work together can be monitored.

Incentives should be provided to encourage joint working, and perverse incentives eliminated from the system.

The Association of Directors of Social Services published its own survey, in which 60% of local authorities reported improved relationships with health colleagues over the past year.

More than 90% of directors in England and Wales thought relationships good, very good or adequate.

However, 70% of respondents reported difficulties in working with GPs.

Dobson defends record

Health Secretary Frank Dobson claimed barriers were already being broken down.

He said the government had pumped money into integrated health and social services schemes across the country.

The British Medical Association accused the Health Committee of "failing to make coherent proposals for change".

The report identified the problems, but offered only piecemeal, partial solutions, the BMA said.

Dr Clive Bowman, chairman of the BMA's Community Care Committee, said: "Vulnerable people are falling through the net of care.

"It is clear that health and social care need to be integrated but this report fails to offer a vision of how that could be achieved."

Dr Bowman said the NHS needed to improve the way patients were discharged from hospital, and to exercise greater influence on the way social services plan and deliver social care.

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