How much support exists for the health select committee's proposal to integrate fully health and social services, wonders Pat Healy; 'Bringing them together would be a disaster. You can't force people to work together'

David Hinchliffe hankers after the 1970s when he was a practising social worker, and community and public health were part of local government.

The Labour chair of the Commons health select committee admits this is partly the reason for his conclusion that 'the problems of collaboration will never be properly resolved until there is a fully integrated health and social services system'.

But it was not simply nostalgia that led the committee to endorse the idea unanimously. Its members looked at the relationship between health and social services from the perspective of users and carers and found, not surprisingly, that there is little understanding of who is responsible for what.

They were particularly struck by the 'farcical question' of whether someone living at home should have a 'health bath' - free because it is provided by the health service - or a 'social bath', which may have to be paid for after a means test by social services.

Total integration might resolve such problems, but it is not something Mr Hinchliffe or his

colleagues expect to happen next week. They see it as a long-term solution and want pilot schemes to be set up to test how it might

be done.

They are not prepared to say who should run such a new service, although Mr Hinchliffe would prefer it to be local government.

The committee is not deterred by the fact that it found no widespread support for yet another structural upheaval, nor are they deterred by research for the Association of Directors of Social Services which suggests collaboration has improved enormously in the past year, largely promoted by government initiatives.

Mr Dobson drove the point home last week by publishing details of nearly 185 partnership schemes between health and social services, funded by£18m of winter pressures money.

The committee found examples of how that money was being used to overcome barriers between the two services. In some places, patients who could not be discharged from hospital because they could not afford to pay for domiciliary care had the charges met by winter pressures money.

Mr Hinchliffe accepts that there are 'excellent examples of collaboration' and was particularly impressed by the experience of Northern Ireland, where health and social services have been integrated for 25 years. He is also optimistic that primary care groups will improve joint working, but concedes that barriers may prevent commonsense solutions. Some of the issues that exercised the committee - such as pooled budgets - will be tackled in the forthcoming bill on joint working.

Making the leap towards total integration is not universally backed, even in areas where it is already being tried. In Somerset, for example, the health authority and social services department are planning a county- wide integrated mental health service from April.

But HA chief executive Jac Kelly would be concerned by the idea of enforced, top-down merger. She says: 'Bringing them together would be a disaster. You can't force people to work together.'

She points out that Somerset has reached this point through a bottom- up approach that has taken three years to develop 'to the point where you can think the unthinkable'.

On the other hand, Yvonne Cox, chief executive of Oxfordshire Learning Disability trust, agrees 'absolutely' with total integration of the two services.

'Both from our perspective as a provider - and we do provide integrated health and social care - and from the point of view of users, it makes no difference who provides the service,' she says.'What is important is that they actually receive the right service at the right time. They are not interested in whether it is health or social services.'

North West London Mental Health trust chief executive Peter Carter says he has always struggled philosophically with trying to understand 'how we ended up in this position'.

He says no one starting from scratch would set up facilities for people with mental health problems to be managed by two

separate organisations with different philosophies, employment contracts and funding regimes.

Neil Campbell, chief executive of Dumfries and Galloway health board, which is praised in the report for its collaborative working, sees the report as 'very positive' but sounds a note of caution.

He points out that it took a year to plan the organisational integration of health and social services staff in the same building and, one year on, they are only just beginning to realise the potential for better communication and other improvements. It has taken two years to achieve this, though both health and social services are committed to it.

City and Hackney Community Services trust has been providing integrated mental health services for the past three years under an arrangement in which social workers are seconded to the trust. Joint teams are managed by the trust and there is a joint management board.

Chief executive Averil Dongworth sympathises with the select committee's view that more needs to be done, but does not think total integration is the answer. 'It is a long-term journey,' she says. 'Old habits die hard.'

A nurse by training, Ms Dongworth believes many of the blocks to joint working are from 'old professional tribes that are reluctant to change'.

She already works with agencies other than social services, including housing, employment, regeneration and the voluntary sector. She thinks those relationships would be hindered if health and social services were integrated.

'An awful lot has happened in the mind set of individuals in this organisation since health secretary Frank Dobson's declaration in 1997 about Berlin walls,' she says. 'It is true that there is a long way to go, but the select committee should not underestimate what is already being done.'