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Janet Snell considers the implications of a Sainsbury Centre report which calls for better joint work between health authorities and social services departments

The current legal framework for social services and health staff working with mentally ill people is out of step with the new drive towards joint working, according to a new report from the Sainsbury Centre for Mental Health.1

In Pathways to Partnership the centre urges policy-makers to remove the legal blocks to progress in this area. It is understood that the government's forthcoming consultation document on breaking down boundaries between health and social services will take up many of the report's recommendations, as well as providing wider flexibility for joint working with areas such as housing.

But given that legislative change is likely to be some way off, the Sainsbury Centre is calling for better use of existing mechanisms. Director Matt Muijen says that both negative evidence from mental health inquiries and positive evidence from good practice demonstrate that strong joint working is vital to achieve the best outcomes for users.

"Legislation and regulation is running behind what the field is trying to do," he says. "There are many examples where health and social services do work together, sometimes on the edge of what is permissible. Joint commissioning is happening de facto in a lot of places, but in a rather artificial manner."

Andrew McCulloch, the centre's senior policy adviser, adds that the main legal barriers to progress are the inability to merge budgets and the fact that health authorities and local authorities are unable to delegate to one another. "New legislation is needed, but we're not in favour of 'big bang' structural reforms which throw everything up in the air and achieve nothing for service users."

Across the country, some authorities are making the current system work. For example, in Northumberland, the health authority and county council have managed to use existing mechanisms to establish a single budget to purchase care and support services for disabled adults and those with special needs. David Parkin, divisional director of community care, says they have had to be "bold and creative" to get this far.

Somerset Council is a trailblazer for joint working in mental health, but concerns about pooled budgets mean that those operating the new system have to draw up separate accounts for health and social services spending. Other models, such as the one used in Barking & Dagenham and Havering in Essex - where two senior social services managers run all mental health services - have apparently led to less bureaucracy and a breaking down of rivalries.

But elsewhere, such as in nearby Waltham Forest, the mental health joint working initiative nearly came off the rails recently when a row erupted between the local authority and health authority over the latter's attempt to push through large cuts - another example of the barely concealed hostility that exists between health and social services in some areas.

Though legislative changes may be a prerequisite of effective joint working in mental health, addressing the issue of the cultural divide between health and social services looks like being even more important if a "seamless" service is ever to become a reality. And as the Sainsbury Centre points out, other changes, such as joint accountability and delegation mechanisms, will be essential.

"A crucial aspect of joint working is ensuring that individuals can access services appropriate to their needs, whichever agency they contact for help," says the report. "This will involve joint training, common assessment procedures and agreed eligibility criteria, but must also involve NHS and local authority staff being able to commit resources from the pooled budget."

1 Sainsbury Centre for Mental Health, Pathways to Partnership: Legal Aspects of Joint Working in Mental Health, Sainsbury Centre, June 1998