COMMENT: HEALTH AND SOCIAL CARE CO-OPERATION

Published: 18/08/2005, Volume II5, No. 5969 Page 3

In this age of focus group-created policy, it is often surprising how large swathes still sit outside what a reasonable person might expect from their public services.

We report this week (news page 9; news analysis, pages 12-13) that the government is considering imposing a legal duty on primary care trusts and social services departments to work together to improve care for adults.

With many problems for patients and carers arising at the boundaries of health and social care, that co-operation is not a non-negotiable foundation of the service for, say, the frail elderly would surprise and concern many.

Department of Health national director of social care Kathryn Hudson rightly stresses that we are meant to be moving away from the era of central diktat .

However, the introduction of a legal duty may help organisations break through some of the bureaucratic barriers created by structural constraints.

But the next 15 months leading up to the deadline for PCT reconfiguration offer an even bigger opportunity.

There are examples of close cooperation which have provided seamless care, but - in general, at both national and local level - health and social care have circled warily around each other, suspicious of losing control.

Now the direction of government policy is combining with the natural inclinations of the best, user-focused health and social service managers to override this caution.

Choice, payment by results, the emphasis on long-term conditions and public health, the need to reduce expenditure on incapacity benefits, the possible extension of individual budgets to healthcare - even the need to control administration costs - are all combining to drive the need for co-operation.

Of course, integration for integration's sake would be pointless, but as the NHS prepares for PCT reconfiguration it must ensure that appropriate and ambitious integration is a driving force behind the changes and that co-terminosity with social services is not simply a geographical convenience.

Only then would another reorganisation - along the lines and the scale proposed - be really justified.