A service that would seamlessly merge the delivery of health and social care, particularly for elderly people, has been the vision of forward thinkers in both central and local government for decades.
It has much to recommend it, most obviously an end to the frustrating delays and administrative duplication that too often leave elderly people and their families shuttling between the local council and the NHS before a suitable care package can be implemented.
The SNP Government at Holyrood is the latest to attempt an integration of health care and social work services for adults. Proposals, currently out to consultation, would create 32 new Health and Social Care Partnerships which would draw staff from both the NHS and council social work departments. These will be fiercely opposed by leaders of Labour-controlled councils at today's meeting of the Convention of Scottish Local Authorities (Cosla). Yet before the 2011 Holyrood election, both Labour and the SNP proposed merging some areas of social work with some parts of primary health care. This was because, in addition to the benefits for service users of a one-door approach, it could be expected to make annual savings running into hundreds of millions of pounds by, for example, reducing the "blocking" of hospital beds.
Two reports this week suggest that both social services and the NHS will be extremely loath to take on additional responsibilities. With the costs of free personal care for the elderly rising far faster than anticipated and now projected to reach £1 billion within a generation, social work will not be receptive to caring for more elderly people. Health boards, already shedding almost 1000 jobs this year will be similarly unhappy at providing additional services in the community.
Cost alone should not be the driver of change to the care of sick or vulnerable people but it cannot be ignored if we are to provide a decent service to those who need it most.
Jim McCabe, leader of both North Lanarkshire Council and the majority Labour group on Cosla, is preparing to block the SNP's plans partly because, following the mergers of the police forces and fire services, he believes they will lead to further centralisation of services and erode local government. These are important considerations but if progress is to be made on the important area of health and social care, it is essential that criticism of the practical and professional difficulties is distinguished from political opportunism.
Since there is agreement that improvements could and should be made, the focus must be on how to overcome the genuine problems inherent in merged working. These include the professional responsibility and accountability of staff which cannot be handed over to someone trained in a different discipline. Mr McCabe is correct to point out the difficulty for the new partnerships in being accountable to ministers, leaders of local authorities and health board chairs.
A pilot scheme underway in the Highlands was recently blamed for poor standards of basic care and hygiene at an Inverness hospital because there had been blurring of professional boundaries. That should act as a warning.
The Scottish Government hopes to introduce the new arrangement without legislation. It should think again. This scheme clearly needs to be examined in detail and in public.
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