The NHS has a long history of working closely with social services and the voluntary sector. Indeed, effective care for many cannot be delivered unless services are integrated around their needs. This is particularly true for older people, those with long-term conditions and people with a physical or learning disability.
The NHS is actively involved in a range of partnership arrangements with local government - from children's trusts to budget pooling with social services or full integration of staff in care trusts. Many PCTs work with voluntary organisations, social services and, increasingly the commercial sector, to get people out of hospital quickly by delivering care that spans organisational boundaries.
These sorts of collaborations are set to rise because of the health white paper on care out of hospital. The future is one of joint teams from health, social services and the voluntary sector, working with common systems from the same office. Increasingly, people will see a single service that meets their health and social care needs as a whole, un-fragmented package.
Because of this interconnectivity, it is no wonder that alarm bells started to ring after recent articles claimed that the 'shockwaves' of the current NHS financial situation were being felt in social services departments and amongst the voluntary sector. When the chief executive of Wiltshire took early retirement, he cited NHS financial problems being transferred to social care as his reason. Fortunately his experience does not ring true across the country. As the Association of Directors of Social Services explained, his situation represented an 'extreme' example of the current situation.
It must be remembered that, despite the headlines, 50% of the NHS deficit is found in 7% of NHS organisations. Although all organisations face a challenging climate, delivering new services through a time of organisational change.
The financial climate has led to the NHS, in a minority of areas, withdrawing from some joint projects with their partners in social services and the voluntary sector, as they invest in services that have a higher priority for healthcare. However, the picture is mixed. There are financial difficulties on both sides of the fence. Some social services departments are retrenching from joint projects because of problems with funding. A small number of NHS organisations have told us that social services departments have had to make changes in the eligibility criteria for services like home care and this is having an impact on health services.
The voluntary sector has similar concerns as, whichever statutory organisation has financial difficulties, it is usually the first to suffer because of the short term nature of contracts and because often it is not seen as an equal partner in care.
It is tempting when you have financial problems of your own to blame someone else or another organisation - the 'bunker mentality'. The reality is that when organisations are under financial pressure, this is precisely the time when a collective approach is vital. We must avoid falling back on the assumption that our own services are the most important to citizens. This can be difficult because statutory agencies are managed and regulated in silos which drives concern about your own services rather than the wraparound care which citizens want.
A starting point for improvement must be honest discussion of shared problems, responsibilities and solutions, as well as the alignment of planning cycles. Funding, including the capacity to move money around the health and social care system, is only one element. It also requires a period of stability from re-organisation as delivering imaginative solutions depends on trust and long-term relationships. Sadly, as the new PCT appointments are made, the review of Local Government boundaries is starting and is likely to lead to the turmoil and lack of focus that can accompany even the best managed reorganisation. The voluntary sector watches our antics in bemusement wondering who to talk to as we move the furniture around.
We must also tackle the cultural differences between the sectors. Health, social care and the voluntary sector have much to learn from each other. The voluntary sector must be engaged as effective partners. This means a move away from short-term contracting and the use of fair payment systems which cover the core costs of managing services as well as the actual delivery costs.
In many areas of the country, some of this promise is already reality but local, national and political will are needed to move from patchy implementation to system wide delivery.
The NHS Confederation's annual conference and exhibition, held next week in Birmingham, will bring together NHS managers from across the country as well as partners from social services, the voluntary and commercial sectors. This is an important opportunity for us to cement relationships and plan for the services we would want to use for ourselves and our loved ones.
Dr Gill Morgan DBE
Chief Executive
NHS Confederation
The Guardian - 7th June, 2006
Last reviewed 13 Mar 2007