comment: Growing body of evidence shows folly of cross-charging - but to no avail

Published: 30/01/2003, Volume II3, No. 5840 Page 17

Last year, an alliance of mental health groups, which by their own admission fall out more often than the Gallagher brothers, joined forces to derail the government's draft Mental Health Bill. The strength of opposition to cross-charging social services departments for delayed discharges is equally widespread - unfortunately it seems to be having very little effect. This is despite the fact that evidence that crosscharging is the wrong idea, implemented in the wrong way at the wrong time seems to be arriving weekly. Bob Hudson and Gill Herbert's research (feature, pages 24-25) is among the latest and the most persuasive.

Privately, social services directors say they are determined that their departments will not be fined. 'Success', shout those promoting the policy. But press the directors further and they will admit that avoiding fines will mean redirecting resources. In a week that saw the publication of the Climbié inquiry report, the dangers of reducing resources in any part of the system are only too painfully obvious. There is also significant anecdotal evidence that the inappropriate discharges that the fining system will encourage could have significant counter-productive implications for both health and social services.

What is perhaps surprising about the proposals is that the government's previous track record in this area has been good. The winter pressure funding, Health Act flexibilities and initiatives on intermediate care have shown that the issues raised by the interface between health and social care can be tackled in a much more positive way.

Next month sees the publication of a book on hospital discharges by Dr Jon Glasby of Birmingham University's health services management centre. His research shows that delayed discharge has always been a problem for the NHS - and indeed existed even before the service was founded. This kind of deeply ingrained problem calls for a more sophisticated response than simply blaming one of the agencies involved.

Dr Glasby argues that while health and social care remain divided and driven by conflicting imperatives, the problem of delayed discharges will never be dealt with in an equitable, sustainable way. This, of course, is a tall order, but the progress being made in places like Barking and Dagenham suggests it is not a pipe dream. In the meantime, it must be hoped that the cross-charging bill, currently suffering a rocky passage through the Lords, is amended in a way that reduces its impact and allows other policies and initiatives - the great majority backed by the government - to create real momentum for change.