Since the election of New Labour in 1997 there has been an
increasing emphasis on delivering “joined-up solutions to joined-up
problems” particularly in health and social care.
Whether they have a mental health problem, learning difficulties
or physical impairment, or are a child in need, people frequently
have complex needs that cut across traditional service boundaries.
Put simply, people do not live their lives according to the
categories in welfare services, and a joined-up response is
essential if needs are to be met in full and a potential future
At a local level, the partnership agenda is leading to a lot of
interagency working and a range of new service models. The Sandwell
Mental Health and Social Care Trust in the Midlands is one of only
eight care trusts in the country that integrate health and social
The Midlands is setting up partnerships to tackle delayed
hospital discharge and to deliver intermediate care services,
integrated mental health and learning difficulty services, and
joined-up services to children and young people through new
The government’s five-year plan for the health service,
the NHS Improvement Plan, has added an extra challenge to already
complex relationships. In future, the NHS in particular is going to
focus on chronic disease management.
Under this agenda, there is increasing recognition that a
relatively small number of people, often older people, with very
complex needs use a large proportion of health care and account for
the bulk of GP consultations, hospital admissions and delayed
As a result, a number of health communities are piloting new
case management systems where a lead professional – often a nurse
or community matron – will work proactively to support people with
the most complex needs in the community. Walsall is piloting the
scheme in the West Midlands.
While the NHS Improvement Plan highlights a key role for social
care in meeting the needs of people with long-term conditions,
there are concerns, regionally as well as nationally, that the NHS
could come to dominate the agenda and that partnerships between
health and social care will exist separately from this crucial
At the same time, many people in social care are starting to
recognise that the most effective way to support people with
long-term conditions might be to draw on wider services – not just
health and social care, but also leisure, housing, transport,
safety and education.
There would also be plenty of scope to learn from social care in
the process. If the NHS wants to have patient choice, expert
patients and case managers, then surely some of the care should be
based on social models such as direct payments and the care
management and co-ordination work undertaken in adult mental health
and learning difficulty services.
One Midlands health and social care community is trying to take
forward the long-term conditions agenda in conjunction with current
health and care partnerships. Here, local services are developing a
new way of working on three levels:
- Promotion of health and well-being.
- Fast response, including admission avoidance and swift
- Ongoing care for long-term conditions; complex, ongoing cases,
and social care reviews.
While the first level would include much stronger links with
wider partners such as regeneration and the voluntary sector, the
second and third levels would involve the full integration of
health and social care teams. Over time, there is a desire to shift
the emphasis towards prevention – working with older people while
they are still healthy and maintaining their independence.
This kind of joined-up action seems a sensible way of balancing
competing policy priorities, and similar approaches will be needed
elsewhere to ensure the long-term conditions agenda does not
develop apart from existing partnerships, further fragmenting the
Jon Glasby is senior lecturer and head of health and
social care partnerships at the Health Services Management Centre,
University of Birmingham