Greater integration of health and social services in Wales
– one of the major policies of devolution – has failed to
deliver better health for the population, a report by Nottingham
University has found, writes Derren
Despite spending more per head on health services in Wales than in
England, researchers reported that waiting lists for outpatient
appointments had risen sharply between 1997-2002, compared to a
general reduction in other parts of the UK.
Part of the blame for this poor performance is put down to the more
difficult than envisaged integration of health and social care, the
research suggests, and particularly the poor performance of social
services departments – all 12 inspected between 2000-2002
were judged to be failing to serve most people well.
“The part of the strategy which relied on better integration
between health and social services may have been somewhat over
optimistic in the situation where Welsh social services were
performing very poorly,” it states.
It also suggests these problems could be caused by giving more
power to decision makers in local authorities and community health
councils with the aim to shape services around a more preventative
agenda, such as creating plans to tackle bed-blocking and
post-hospital social care.
“Attempting to place power in the hands of a fairly disparate
group of stakeholders may have been overly ambitious. The more
traditional power centres favoured by other reforms (managers or
professionals) also have their problems, but at least they are
relatively tried and reasonably well understood,” it
Hugh Gardner, social services director at Swansea, said the results
did not make good reading and that the gap between the performance
of services in England and Wales was getting wider.
“Wales is facing an uphill struggle to achieve comparable
performance and social care is very much part of that,” he
However, Beverlea Frowen, head of health and well being at the
Welsh Local Government Association, still believed close working
between health and social services benefited local services.
“In Wales we are trying to address many years of chronic
under-funding to both health and social care, which cannot be
overcome in one term of devolution. However, the policy approach by
the assembly to develop local strategic partnerships is to be
commended,” she added.