Published: 10/02/2005, Volume II5, No. 5942 Page 17
Here's a quiz. Which service should a 70-year-old approach to get grabbars for their bath at home?
If a secondary-school pupil needs an electric wheelchair in order to access the national curriculum, is that the responsibility of education or health?
And if a five-year-old requires speech therapy in school, who will provide it?
The answer may be clear to those who work in the services (and I suspect that answer is usually, 'Not us!'). But to the user, it is not clear at all.
These are real cases, and the answers in each are: the elderly person was told they must go to social services; the secondary school pupil was told by education it was a health matter, but health refused to provide an electric wheelchair so they had to go cap in hand to a local charity; the parent was told that they would be lucky to get anyone to provide therapy in school, and their child goes without.
Despite years of talk from the top about 'integrated services', 'multiagency working' and 'joined-up thinking', from my perspective very little has changed. The person in need still has to mediate the battle between health, education and social services to provide the simplest piece of equipment.
It is with great hope, therefore, that I find my local services are at last taking integration seriously, employing all sorts of new managers on various integration projects.
Among these is a joint equipment store, due to open in April.
Currently, equipment is provided either through health, education or social services. Which service provides which piece of equipment, and why is usually a mystery to those who need it. Now, all equipment will be housed in one store, under one single budget, managed by a private supplier.
All three services will be able to access this one store, and return equipment there when no longer needed. This way, a proper joint inventory can be kept and used equipment effectively re-prescribed rather than just being left to rust and rot. That must save money.
The importance of a joint equipment store cannot be underestimated as it is a concrete sign of services working together - the joined-up thinking we have all been promised. And there is also the promise that not only will the hard kit be joined up, but the professionals providing it.
At present, if a young person wants to access an adapted toilet seat their community occupational therapist cannot provide it. It counts as a 'fixed' piece of equipment, even though it is completely removable.
('Fixed', I have discovered, has a whole new meaning when it comes to health service provision. ) Now we are told that the community health therapists will, when the new integrated equipment store is up and running, be able to provide things they have not been able to in the past such as toilet seats.
Only problem is, I have asked the community occupational therapists, and they have no idea they will able to do this. They have not been told that they will not have to continue to pass us on to social services or education. As far as they are concerned, it is only the equipment that has been integrated, not them.
This gets to the nub of the problem. It is fine, and relatively easy, integrating walkers and grabbars, but people are proving the real challenge. But from the patient's perspective, it is people who are the most important element to join up.
Being needlessly assessed by several different professionals is currently every regular health service user's experience.
There is no point having a joint equipment store if to access it you still have to go to an OT in social services, who may never have met you and knows nothing about your long-term needs, just because it is a 'fixed' shower seat you want. Your community health OT, who knows you well, should be able to make that assessment.
It is not only better inter-agency working that patients want, but intra-agency working, too. Multiassessments happen within the health service all the time, as different departments haggle over their own budgets and expertise.
This is even more of a mystery to the innocent user, who simply cannot understand why one single OT can't be responsible for ordering all their equipment for them.
Examples of this include the provision of a magnifying glass to enable a child to read. This is recommended by the local visual impairment service, which must then refer the child on to the lowvision clinic at the local hospital rather than ordering the piece of simple and relatively cheap equipment themselves.
Similarly, the community OT may recommend a pressure-reducing cushion, but the user will then be referred on to the wheelchair service for another assessment. There is no sign, even with the integrated equipment store, that there will be any improvement in this ridiculous over-assessing.
Inter-agency working is coming slowly, long overdue and much welcomed. But when is intra-agency working within the health service going to begin?
. Dea Birkett is a writer on health and social issues and is a regular columnist for HSJ. Her next column will be published on 17 March. She can be contacted via www. deakbirkett. com Or if you have a view for publication, e-mail hsjfeedback@emap. com Next week: former adviser on health to the prime minister and new regular columnist Simon Stevens.
Find out more HSJ is organising a conference on managing long-term conditions in London on 12 April, including sessions on better integration of community services. To register, phone 020 -7505 6044 or e-mail hsjconferences@emap. com.
Integrated care network
integratedcarenetwork. gov. uk/ Inegrating community equipment services team, set up by the Department of Health
www. icesdoh. org/contact. asp National Association of Primary Care
www. primarycare. co. uk