Nurses and social workers know it is impossible to tell where social care ends and healthcare begins. Yet they waste time, effort and money trying to prise them apart - because government policy says they must.

Meanwhile, the sick, the old and the slowly dying suffer the consequences. It may be that some lateral thinking about two recent initiatives - the end of life care strategy and the public consultation on funding of social care - could provide the key.

Case study

Joan is a lady of 96 and is dying slowly. She has a delicate heart and a sound mind and has not left her home for years, secure and happy in its familiarity and its memories. She is deaf and underweight and barely mobile. She just about manages with social carers once a day and friends dropping in.

One day, she is hospitalised after a stroke just bad enough to render her bedbound and a bit confused. She stabilises, still bedbound and confused, and wants to go home. But there is not enough care available for her to do that. Agency carers could come in briefly four times a day if she paid for most of the cost. Twenty-four hour home care is actually what she needs, but it is not available from the council (even subsidised) in her area, or from the primary care trust, which could theoretically provide it free if Joan had "health" needs. However, hers are defined as "social care" needs only.

If she were imminently dying and her condition were unstable, she would qualify for "healthcare". Otherwise, care is too expensive for state funding. Joan cannot afford to pay for 24-hour care herself.

So forms are completed to decide whether the care home she must go to is to be residential or nursing. Neither nurses nor social workers can fit her into the nursing home category, where at least some of her care would be free from the NHS.

In the residential care home where Joan pays for most of her care, the carers are kind but untrained and too few in number to spend long with each resident. Joan is turned in bed infrequently and develops severe pressure sores. She is not encouraged to drink and no-one has time to feed her. She develops dehydration, a urinary infection, a chest infection, and her confusion worsens. Now her needs are for healthcare and she goes back to hospital where she dies.

Joan had end of life care but it was not good quality, her choice or - for the most part - free. It was not provided through the end of life care programme, despite the fact that the neglect of her social needs led directly to her need for healthcare and she died quicker than expected, her wishes unfulfilled.

Funding debate

The future financing of long-term social care is out for public consultation and the end of life care strategy has just been published. The two are running on parallel lines but are concerned with the same vulnerable people - the chronically ill and the frail and sick elderly. The reason the lines do not touch is the artificial distinction between health and social care that has been created to save money. Healthcare is free at the point of need. Social care is means-tested, frequently causing much publicised distress as people sell houses and use up savings to pay for often inadequate social care in care homes or their own homes. So the consultation on future funding is timely.

The end of life care strategy, with its promised government resources, its proposals to commission joined-up social and healthcare for those within its remit, and its appropriately vague definition of "end of life", could also embrace all those currently financing their own social care needs.

A radical solution would be to join the dots of health and social care and merge them into one national health and social care service. This would reduce bureaucracy and inequities of care because social as well as health aspects could be funded through taxation. Perhaps taxpayers could be persuaded to accept this, if asked in the right way.