Joint working between social and health services has become important to the delivery of community care but can lead to demarcation disputes, to the detriment of users. Suzy Braye points the way forward.

Many social care practitioners remain sceptical about the possibility of successful collaborations with other agencies and professions. Can progress be made?

These concerns are based on ample evidence. While health and social services aim to work better together in providing community care, and might believe that they do so, service users' perspectives point to damaging demarcation disputes and failures of communication.

Providers of key services figure less prominently than they should in consultation and joint planning arrangements. In child protection, joint working seems better established during investigations than in service provision. Disabled children in particular receive a fragmented response to their needs.

These problems arise in part from fundamental differences of structure and culture between the organisations and professions involved.

• Decision-making processes in the large hierarchical bureaucracies of social services are very different from those in medically-led clinical teams.
• Ways of responding to need can reflect opposing individual and social models of understanding, leading to disagreement about the focus of intervention or the priority for spending.
• Differing emphases in professional codes and values may lead to conflicts of opinion about issues such as risk.
• There are duplications and gaps in the allocation of responsibilities between agencies and professions - some needs might be provided for by two or more agencies, some by none - giving rise to ambiguity and conflict.
• Identification with one's own profession or agency can militate against understanding of others' identities and goals.

Factors such as these cause difficulties in establishing a shared sense of purpose and agreed priorities. Yet there are ways forward, drawing first on established and new legal mandates.

• The notion of a seamless service is central to community care legislation and policy. Local authorities undertaking assessments under the NHS and Community Care Act 1990 must notify health and housing authorities and invite their assistance.
• The Children Act 1989 requires local authorities to facilitate family support provision by other organisations. Social services may request help from other agencies in supporting families, and these other agencies must respond. Also, policy guidance on joint working specifies inter-agency requirements in child protection.
• The Disabled Persons (Services, Consultation and Representation) Act 1986 promotes communication about the transition to adulthood for disabled children.
• In mental health, health and social services hold parallel aftercare duties under the Mental Health Act 1983, and the care programme approach requires collaboration.
• Social services' plans must be produced through consultation with a range of organisations.

The Health Act 1999 strengthens the legal mandate under the NHS Act 1977 for health and local authorities to co-operate with each other and jointly plan for people's health and welfare. Greater flexibility exists for health and local authorities to make payments to each other and create pooled budgets where this will improve services.

Observance of the legal mandates alone, however, will not achieve the objective. What is needed is a vision to see beyond each organisation's contribution and evaluate the effectiveness of the whole system. In addition, a "can do" mentality that asks what can we offer rather than how can we protect our territory needs to be developed.

Differences between professions can be an advantage. This needs to be recognised. Lack of uniformity should not be seen as a threat. Finally, the mechanisms for joint work should be visible throughout the organisation, especially at the frontline where joining up makes most difference to service users.

Suzy Braye is a reader in social work, Institute of Social Work, Staffordshire University