Joining health and social services 'not on agenda'

At a meeting of the health select committee last week, chair David Hinchliffe suggested it was 'time to look at models which bring the two together'.

'If I was coming from Mars, or even another European country, I would find it very odd that health and social care are organised separately,' he told Chris Kelly, the new permanent secretary at the DoH.

'I think the man from Mars or Europe would need a history lesson to understand why they are organised as they are,' Mr Kelly acknowledged. 'But the white paper looked at structures and it did not say 'let's have a grand restructuring'.

'I think the reasons were two-fold. One is the cost of disruption, which would be large and which ministers are concerned about.

'The other is the question of boundaries. Wherever you put the boundary it creates different boundary problems from the ones you have got.'

Sir Herbert Laming, chief inspector at the Social Services Inspectorate, also warned against 'the great temptation to go for structural change'.

'What we are doing is trying to get people working together,' he told the committee. 'We have recently issued guidance asking health and local authorities to make some joint investment plans. The white paper makes it clear there should be joint working on the ground.'

Mr Hinchliffe said MPs received many complaints about access to simple services. Constituents were also baffled by the different cultures of health and social services, which meant 'health baths' were free and 'social services baths' were subject to means-tested charges.

Sir Herbert acknowledged the charging issue 'adds bite', but repeated the DoH's view that the key to making sure patients got the services they needed was multidisciplinary working.

Sheila Adam, deputy director of the DoH's health services directorate, said the internal market 'leads some people to think more about their organisations than individuals', but claimed this was changing. She told the committee the introduction of primary care groups should also help to unify health and social services at local level. She said that, where possible, PCG boundaries would be drawn to match local authority boundaries to facilitate this.

But Nick Boyd, head of the general community care and elderly social care branch of the DoH, said financial and legal barriers would have to be overcome by legislation. He told the committee that local authorities were not allowed to spend money on health, which was an impediment to creating joint budgets, but they were legally responsible for social services assessments, which meant health staff could not take charge of them.