Forthcoming government proposals must put NHS joint working with social care back on track, writes Chris Chorley.
As we await the white paper on health and social care, NHS modernisation continues apace.
Patients are starting to expect a choice of high-performing hospitals and for community health services to look after the needs of patients with long-term conditions.
Delivery of NHS modernisation in acute care is partly based on increased efficiency in the use of hospital beds. Since 1998 there has been a reduction in bed numbers but an increase in occupancy levels of 5 per cent.
There are benefits in this, but there are also dangers of increased infection (MRSA) rates, higher re-admission numbers and patients left at risk in the community.
But where is social care within this script? The promising heady days of spring last year and the green paper on adult social care gave ground to the destabilisation of many partnership arrangements, driven especially by the NHS’s need to make quick savings.
While managed destabilisation of the NHS is the government’s preferred option for step change, insufficient thought has been given to the impact on whole systems working and on social care costs in particular.
For example, there is increasing NHS withdrawal from agreements to joint fund services. The immediate consequence is that councils are driven to introduce more restrictive service eligibility criteria as costs are shunted across organisational boundaries, and the preventive agenda heralded in the adult social care green paper and widely welcomed, is difficult to line up with what is happening now.
More social care investment is urgently needed because of a redefinition of the boundaries of health care, and because we are all living longer and likely at some stage to need assistance in daily living.
Of course this also provides the motivation to organise and re-balance health and social care more effectively. This means the role of social care has to be centre stage, rather than an adjunct to ticking the box of NHS modernisation by 2008.
Chris Chorley is assistant director of operations at Wiltshire Council