Memorandum by Age Concern England
RELATIONSHIP BETWEEN HEALTH AND SOCIAL SERVICES
(HSS 34)
4. INCENTIVES
FOR JOINT
WORKING
4.1 In 1992, a previous Health Select Committee
Inquiry concluded that there was a need for a Government role
in the explicit, visible, central co-ordination and monitoring
of community care. Age Concern continues to support the recommendation
for an interdepartmental committee to co-ordinate policy across
all relevant Government departments because we believe that the
lack of a central Government example of joint or inter-agency
working gives less incentive for joint working on a local basis.
4.2 Age Concern remains convinced that older
people will be served best by national eligibility criteria and
will, through this measure, obtain the certainties in responsibilities
which are currently lacking. Moreover, the Government in setting
such criteria must address how it proposes to ensure that individuals
are able to access appropriate services in circumstances where
there may be little or no local statutory responsibility. We further
believe that such national criteria will play a vital role in
moving towards a holistic view of caring for older people which
is, in our view, essential for joint working to be most effective.
4.3 In addition, it is crucial to ensure
that the apparent concentration on joint working between health
and social services does not omit vital relationships with services
such as housing, leisure, transport, and crime prevention and
other safety measures, all of which play an important role in
the care of older people. Moreover, where gaps remain or increase,
joint working must necessarily involve voluntary and private sector
providers and unpaid informal carers, as each of these may be
trying to meet the gaps in statutory responsibilities, without
a statutory duty to do so. Such joint working will require a very
different approach from punitive Government measures.
4.4 Further we have concerns that the suggestions
about pooled budgets could have unforeseen consequences. We have
come across a number of difficulties with individuals benefits
when it has not been clear to the Benefits Agency which authority
has been funding in a particular situation or indeed when both
the health authority and social services department have been
putting in some funding. We also consider that pooled budgets
could make it more difficult to be sure when a service is provided
indirectly by the health authority and so should be free of charge.
Our fear is that pooled budgets could lead to a further withdrawal
of free health care. What may be seen as an administrative simplification
as an incentive for joint working could have other effects which
would need proper debate.
4.5 Recent guidance from the Government
to local authorities regarding settlement of monies for community
care services in 1998-99 states that failure to comply with certain
requirements for joint working with health bodies may lead to
the demand, by the Secretary of State for Health, of repayment
of all or part of the grant monies paid.
4.6 However, similar requirements have not
been made by Government on funding allocated to health or housing
authorities. Moreover, this approach may not be consistent with
other requirements on social services departments. For example,
it has been confirmed in legal judgement that a local authority
may take its level of resources into account when setting its
criteria for services (R v Gloucestershire County Council ex
parte Barry 1997). This does not, however, require the local
authority to take into account the impact of any changes to its
criteria on other agencies. In respect of meeting interpretations
in law, local authorities may necessarily need to concentrate
only on its own actions and resources.
4.7 It is crucial to examine what such selective
castigation (and other Government expectations) is meant to achieve
for older people. It remains unclear whether the primary purpose
is to ensure that agency working is improved for agencies, or
whether it is intended to benefit older people. We are interested
to see whether Health Action Zones will be able to achieve joint
working across such boundaries but suspect that primary legislation
will be required before this is a reality.
4.8 Effective joint working must demonstrably
benefit older people and in this respect suggestions that health
and social services resources should be pooled or otherwise joint,
may not sufficiently address the problems of service deficit.
Analysis of joint commissioning schemes for health and local authorities
have tended to stress their benefit where an individual has needed
a highly complicated package of care, but there appear to be far
fewer indications, in general, that joint commissioning has improved
services for older people more than any other model. We remain
deeply concerned that the emerging identifiable gaps in agency
responsibilities, referred to in paragraphs 2.7-2.10 will not
be filled through pooled resources.
4.9 Age Concern believes that:
— the Government must set the example
of inter-agency working for local agencies to follow;
— joint working and pooled budgets
are not the complete solution to inadequate resources, may ignore
other requirements on statutory authorities and cause older people
to lose free services.
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