Select Committee on Health Minutes of Evidence


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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