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
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
- 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
- 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
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
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,