Some may still feel uneasy about it, but it's now so fashionable no-one can ignore it. Tash Shifrin explores the under-reported world of joint working

Joint: what does that word conjure out of the haze? Is it Ann Widdecombe descending upon you with a£100 on-the-spot fine? Or is it work done collaboratively between health and social services?

Health and social care managers will obviously have jumped to the second conclusion. After all, joint working is the solution of the moment, so fashionable that it is now compulsory under the NHS plan.

But many people are still worried that too much joint working could lead to more difficult concepts - such as care trusts - in the search for the ultimate high-quality service.

Perhaps some of the unease is rooted in the long history of separation between health and social services.

We have tried joint working before but, like the politicians' youthful experiments with illegal substances, it was a long time ago.

Hospital services and welfare both fell within the remit of local government until 1948. But when the NHS was born, hospital and health services gained their own organisation and the long separation began.

The Seebohm report of 1968 led to the unification of personal social services - in dedicated local authority directorates, well away from health.

In 1974, a reorganisation of the NHS finally whipped away ambulances and public health services from local authorities, which also lost the key post of medical officer for health.

Overcoming half a century of division is a comparatively recent project. But productive debate about the way forward has been hampered - not just by fears of the NHS 'taking over' social care, but by a lack of data about what is really happening on the ground.

It is this gap that a survey by the Local Government Association is hoping to fill. The LGA has written to chief executives in every local authority to find out the extent to which joint working is already in place, and replies are still coming in.

'We're getting an idea of the range of partnership working that's under way - not necessarily under the Health Act. It's happening already, 'says LGA research officer Juliet Whitworth.

'Emerging findings show most local authorities rate their partnership with the health sector in their area as 'good' Moreover, the majority says the relationship has improved over the past three years.'

They also show that 'more than half ' of the local authorities already 'have existing joint arrangements with health for the provision and commissioning of services.'

This sounds like good news, but it also suggests that a fair chunk of councils and their local NHS bodies have no such arrangements in place.

LGA head of social affairs and health John Ransford says much joint working goes unreported.

He says: 'My concern is we're understating a lot of things. An awful lot is going on that isn't being counted formally.

'These are initiatives that have become part of everyday practice.

'We must get people into the discipline - which the health service is better at because of the way it's organised - of making sure they report what's going on.'

Jo Williams, Association of Directors of Social Services president, agrees. 'I'd be amazed if every local authority didn't have something joint.'

She says things such as joint mental health teams 'are just taken for granted'.

'This kind of joint working has been going on behind the scenes for more than three decades, ' she adds.

She points out that as a social worker, she was based in a GP practice - that of Dr David Colin Thome, now London region's co-director of primary care - in 1973.

'We thought of it first, before Mr Milburn, ' she says.

Just 26 schemes using Health Act flexibilities - for pooled budgets, lead commissioning and integrated services - have been approved by the Department of Health so far. Yet the NHS plan appears to make it compulsory.

It will be 'a requirement for these powers to be used in all areas of the country rather than just some.'

For the present, it seems that there's plenty of joint work going on the quiet. Rumour has it that some people actually enjoy it.

What local authorities say about working with health What helps. . .

Shared boundaries between NHS organisations and local councils.

Health improvement programme and the community strategy bringing agencies together, and national service frameworks which help clarify roles, responsibilities and areas for joint action.

A history of working together at both managerial and fieldwork levels.

. . . and what makes it more difficult The HA investing a disproportionate amount in the acute sector at the expense of community services.

A lack of understanding of each another's areas of operation and planning cycles.

Tension between nationally determined priorities and local priorities.

A lack of democracy in the governance of the NHS.