“Professional boundaries might be important to you, but they are
not to service users,” health minister Stephen Ladyman told
Community Care Live last month.
Well, yes, but a constant moan of disabled people has been that,
when one’s needs are complex and responsibility for meeting those
needs crosses the boundaries of health, social services and
housing, communication between the organisations has often been
creaky and time-consuming. Which has meant that we have had to wait
for decisions about urgently needed services and equipment.
This has led to protracted discussions about which organisation is
responsible for provision. The standing joke (well out of date by
now, I hope) is whether somebody needed a “medical bath” (for
health reasons) or a “social bath” (to feel “normal”). And the
arguments seemed to be even fiercer over the provision of
equipment. Recently in my area, equipment has been provided by a
jointly managed service.
When the minister calls for new thinking about adult services,
amalgamating adult care into community health services is one
option. Who could argue with a seamless service with fewer,
time-consuming decision-making points?
Well, me, for one. It takes all of these organisations to enable me
to survive independently. It also took several professional
viewpoints to help me construct my life completely. I have needed
the medical perspective to ensure I stay physically healthy, but I
have also needed the social work perspective, in particular the
social model of disability, to help me think about how I structure
There are many honourable exceptions among the community health
professionals, but it seems that the pressure within the health
services to provide scarce, expensive resources, such as
physiotherapy or medication, makes provision resource-led rather
I would like assurance that the social work perspective will not be
lost. For me it can make the difference between living and merely
Simon Heng is a service user