When health secretary Andy Burnham announced his new policy last week, HSJ suggested he was interested in a “marriage” between social care and health commissioning. In Parliament, Mr Burnham added: “We should also be less precious about spending health resources on equipment and telecare to help people live in their own homes.

Uniting health and social care budgets would give commissioners unparalleled new powers to construct single pathways for health and social care.

However, other parts of the document look like an attempt to undermine joint commissioning. It appears that “joint commissioning” will be carried under two very different rules.

When the joint commissioners are buying social care, they will be able to gauge the quality of providers and make the best decisions. So, in the example above for a home telecare system, they will be able to commission the best service.

However, when the same commissioners turn to healthcare, they will not be able to follow the same rules. They won’t be able to make the decision based upon what is best for patients because they will have to commission the “NHS first”. If it is providing poor outcomes, the commissioners will be expected to wait for a couple of years before buying better services from elsewhere.

If, in the case above, the NHS is supplying the telecare service for healthcare, the joint commissioners will not be able to jointly commission a new service. The social care part will be able to go to the best service that the commissioners can buy and the health part will have to stay with the health secretary’s personal preferred provider - the NHS.

This is the problem when a secretary of state attempts an ideological intervention. He has no preference concerning from whom commissioners should buy social care; his attempted intervention in healthcare will stop joint commissioning, not encourage it.

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