Jon Glasby On social care integration

Published: 12/08/2004, Volume II4, No. 5918 Page 17

Children's services are set to have their own director and children's trust, so what should happen to adult health and social services? Health minister Stephen Ladyman has already called for a 'radical rethink', emphasising the need for more personcentred, preventive and seamless services.

At an Association of Directors of Social Services seminar earlier this year he asked a serious of questions centred on what better integration might look like and what the alternatives were.

While the care trust model has pros and cons, one of the main objections from local government is a perceived NHS takeover of social care and the alleged 'democratic deficit' of the NHS.

However, what if health and social care could be brought together in a new model, building on the lessons learned from existing care trusts, but avoiding some of the pitfalls of this approach? There are two models currently being debated by Birmingham University's health services management centre.

Foundation health and social care trusts could be acceptable to local government, with the entire local electorate as members and with elections of the boards and governors at the same time as local government elections.

Some seats could be directly elected from particular localities, while others could be filled by nominations from relevant user and carer groups.

Such a model would combine government policies on foundation and care trusts, producing a way forward acceptable to health and local government, increasing public interest and introducing democratic procedures into the heart of the local NHS.

An alternative approach would be to create a joint health and social care commissioning agency linking health and social care.

With a pooled budget and delegated authority from partners, such an agency could provide a strategic lead and commission health and social care from a range of different providers. To be effective, it would need to be a tangible entity, to provide a degree of permanence amid debates about local government and primary care trust reconfiguration. A strategic body such as this could be supplemented by integrated locality teams or by networks of practitioners working with a particular user group.

Different areas may adopt different approaches. The foundation trust model may work in an area with a co-terminous local authority and PCT, while the commissioning agency approach may be better suited to local authorities where there are multiple PCTs.

Both models have the advantage of creating genuinely shared ways forward - and both would lead to greater local accountability for the NHS. Ultimately, both have the potential to take us further away from separate health and social care services working in isolation from each other, towards the seamless services so central to Mr Ladyman's proposed vision.

Jon Glasby is head of health and social care partnerships at Birmingham University's health services management centre.

See also Speak Out , page 19.