Should providers return ‘in house’?

Up and down the country social services departments are locked in
discussions with their health counterparts on how best to integrate
their adult services. Care trusts represent the latest and most
radical step on the journey to achieving better joint working so
that vulnerable adults no longer fall through the gaps.

The supporters of the integration agenda point to the “Berlin Wall”
effect. They say that cultural differences, professional rivalries,
and different organisational cultures are some of the reasons why
the two sides have not collaborated effectively up to now.

Many people in social care have, with some justification, become
anxious that social care will be flattened by the larger health
juggernaut. This has set a challenge to social care to be clearer
about what it represents and the special skills that it can
contribute. Much has been said about the threat to the social model
of care and it’s up to social services departments to clearly show
how what they do relates to this model.

A major issue that has been absent from discussions on integration
is one that can be traced back to the time when the real Berlin
Wall came tumbling down. This was when the implementation of the
NHS and Community Care Act 1990 resulted in a split between
purchasers and providers. Policy dictated that social care
provision – the domiciliary, day and residential services that
administer the care – was to be chiefly delivered by a fragmented
and privatised independent sector.

The split between purchaser and provider has created a more
cumbersome and bureaucratic system. The time devoted to negotiating
and monitoring contracts, commissioning care, checking and paying
invoices and troubleshooting with providers greatly exceeds that
given to visiting and assessing vulnerable people.

Despite these difficulties it is now taken for granted that social
care provision will remain in the hands of the myriad independent
home care providers – all with their own styles, practices and

The Department of Health’s website claims that: “The introduction
of care trusts is a real opportunity to deliver improved,
integrated health and social care.”1 But care trusts
cannot really be said to be integrated until social care provision
is substantially brought back “in house”, as it always has been in
the case of nursing and other health services.


Peter Scourfield is a senior lecturer in social work at
Anglia Polytechnic University.

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