Memorandum by Macmillan Cancer Relief
RELATIONSHIP BETWEEN HEALTH & SOCIAL
SERVICES (HSS 68)
4. THE CURRENT
SITUATION
Working to support cancer patients and their
families in a variety of settings, Macmillan has a unique national
perspective on the current debate about the relationship between
health and social services.
Successes in cancer treatments, such as those
which result in extending current remission periods, have contributed
to a significant and projected increase in the numbers of people
living with cancer. These patients receive care in both the hospital
and community settings and will frequently "dip" in
and out of the health and social services systems over a protracted
period of time. A complete package of care is required to meet
patient needs. The speed with which certain types of cancer progress,
such as lung cancer, means that assessments of patient need must
be carried out quickly and bespoke care packages developed and
implemented without delay.
Through its work in the field of cancer care
provision, Macmillan has identified a number of specific problems
arising from the often poor relationship between local authorities
and the health services. By and large, these stem from the fact
that whilst health care provision is free to the patient, social
services are chargeable. This can lead to patient care being determined
by cost factors rather than clinical need, and considerable delays
in the implementation of an effective cancer care package.
For ease of reference, Macmillan has grouped
its comments on problems caused by the current situation under
the terms of reference headings; Macmillan has confined its comments
to those aspect of the system which have an impact on cancer care
provision:
— Agency Responsibilities: respective
responsibilities for health and social service departments are
not clearly defined; misinterpretation and disputes over budgetary
responsibility for service provision are common.
There is general breakdown in communication,
with two different sets of personnel and systems. Incentives for
co-operative working are scarce, and in particular there are no
effective mechanisms for encouraging financial as well as practical
co-operation between health and social services. For example,
the closure of local authority homes for the elderly has led to
many patients occupying hospital beds, resulting in bed blockages
in the acute sector.
— Organisational Systems: standards
and systems for cancer treatment vary throughout the country.
For example, the time allowed from initial assessment to putting
care packages in place ranges from five to 26 days. This is particularly
evident in relation to the social service provision of home support
for cancer patients, which needs to be activated quickly to enable
discharge.
Moreover, the lack of referral guidelines, protocols
and procedures to enable people to be swiftly assessed, reassessed
and referred to the most appropriate setting and the apparent
gap between health and social services referral criteria means
that cancer patients may not be receiving the most appropriate
care for their needs.
Variations in the access to full, multi-disciplinary
assessment have been recognised in the NHS White Paper, published
in December 1997 (see below).
— Staffing issues: there is
a general lack of knowledge of cancer treatment and the needs
of people with cancer amongst health/social care professionals,
including GPs. In particular, social services (and carers) are
not adequately informed about referral criteria or the progress
of the disease. This is a cyclical problem, especially amongst
carers, and one which organisations like Macmillan seek to overcome.
There has been a progressive decline in the numbers
of social workers in the community. This has led to an increased,
and often unmanageable workload for those remaining. This has
adversely impacted on the community care packages available for
cancer patients and continuity of care.
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