A CULTURE clash could erupt between health boards and council social work departments as the Scottish Government tries to merge the two, a leading expert in elderly care has warned.
Professor Paul Knight, president of the British Geriatrics Society and a consultant in elderly medicine at Glasgow Royal Infirmary, said there were tensions between the two sides - particularly over money.
Noting NHS budgets had been protected from cuts, but not council funding, he said: "Although I think the Scottish Government has an aspiration to link up health and social care a lot more closely, I am not sure any of us know the exact detail of how that will operate. There is a suspicion in health that social care will dump all their large budget deficits on to health and I am sure the reverse will be true (for them.)"
The growing number of elderly people in Scotland has serious implications for the NHS and some measures - such as waiting times in A&E departments - suggest hospitals are already struggling to cope with demand.
The Herald has highlighted the issue under its NHS Time For Action series and is calling for a review of hospital and community care capacity. There is widespread agreement that more should be done to look after frail pensioners in the community, to prevent hospital admissions and ensure efficient discharge arrangements from wards.
Integrating the NHS and social work departments is the major step the Scottish Government is taking in an attempt to progress the situation.
However, Professor Knight said at the moment "it is very much silos thinking," later adding: "It is going to be a bit of a culture clash."
While noting the relationship between individual hospitals and councils varied around the country, with some working well, he painted a picture of distrust in some places between the two organisations.
Talking about parts of England where patients were discharged earlier to be assessed in the community, he added: "You can only really do that if you have very good tie-up with social services.
"At the moment, there is a problem in many parts of Scotland, where we would be reluctant to discharge (earlier) into the community. One, relatives may be sceptical that it will happen and, two, the clinician may be sceptical that it will happen in time. When you do that and you lose control of the situation and the patient bounces back to hospital, it is that clinician who gets it in the neck for that failed discharge."
He said this scenario was ultimately down to resource issues.
"When the Government gets into deciding how integration is going to go ahead, it needs to be very specific about how the money is going to be managed and who is going to manage it," he said.
Professor Knight pointed at previous attempts to merge health and social care that ran into difficulties. One example is Glasgow's Community Health Care Partnerships, which collapsed when the city council voted against committing £400m to the scheme upfront, despite having previously agreed to devolve its entire budget.
Sandy Riddell, president of the Association Of Directors Of Social Work (ADSW) in Scotland, said people were asking questions about parts of the system that were under huge pressure from increasing demand, adding: "There is an issue of whether there is sufficient resources all round."
However, he spoke of both social work and the NHS having shared values and shared concerns.
How much of the NHS budget will become part of the integrated care system is one area which ADSW says still needs to be addressed. Mr Riddell said: "Unless there is some sort of shift of resources from the acute end to the early intervention stage in supporting people, then there is going to be a constant churn of people who are going to go into unnecessary unscheduled admissions."
A Scottish Government spokeswoman said: "We are working with our partners in the NHS and local government to set out the details of this new legislation, including how integrated budgets for health and social care will work.
"A key part of this work is to ensure that where money comes from - health or social care - will no longer impact on the patient or service user. What will matter instead is the extent to which the new integrated partnerships achieve the best possible benefit for service users and patients."
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