Open Forum

There is a tendency to view the collapse of partnership working between health and social care in Wiltshire as a little local difficulty.

In fact, the real lesson of how partnerships between councils and health trusts have turned sour can be seen in the history of NHS and council relationships. Superficially, the “problem” can be seen as previously poorly performing primary care trusts now achieving financial balance with the objective of providing a modern NHS. But, in the process, hospitals shut and there are few community services to replace them.

The local authority is left with either picking up the tab for previously jointly funded infrastructure or seeing it collapse: a stark choice which patients cannot match up with the rhetoric of service improvement.

But we have been here before. Following the establishment of social services departments and district health authorities in the 1970s, under-resourcing of community health provision and over-emphasis on resourcing hospitals was a frequent concern. Shifting boundaries between health and social care often benefit older people who should have had the opportunity to be in their own homes. But reductions in beds were not matched by investment in community health. What happened was that social services picked up responsibility for health care needs not recognised by government in funding allocations.

The government should accept that the artificially generated tensions between what is health care and what is social care will not simply go away. It needs to understand that the boundaries between health and social care have been redrawn close to the point where councils are providing many of the health services they were funded for prior to the NHS taking them over in 1974.

Let’s see funding to help meet these responsibilities and an understanding that economic policy will drive long-term health care towards a fully means-tested service.

Christopher Chorley is assistant director, Wiltshire Council adult and community services.

The views expressed by author don’t reflect the policy of the council.

See Health Special, Taking the accent off the acute

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