Memorandum by Community and District Nursing
Association
RELATIONSHIP BETWEEN HEALTH AND SOCIAL SERVICES
(HSS78)
CONTENTS
1. Introduction.
2. Issues.
3. Examples of good practice.
4. Recommendations.
1. INTRODUCTION
1.1 The Community and District Nursing Association
is a Professional Body and Trade Union with members working in
primary and community care. The breadth of our membership includes
District Nurses and their teams, Practice Nurses, those working
in Nursing Homes, School Nurses, Health Visitors, indeed, any
nurses who work in the community environment.
1.2 Our members, particularly those in District
Nursing, deal on a daily basis with the subject of this inquiry.
District Nurses are senior clinicians who have completed basic
nurse registration and often have many years experience in hospital
work as ward sisters and managers. Preparation for practice as
a District Nurse entails a BSc degree course in Community Specialist
Nursing taken at a College of Higher Education.
1.3 The implementation of the community
care part of the NHS and Community Care Act in 1993 had a major
impact on District Nurses' daily work and the quality of care
that they are able to give. Although relationships between Health
and Social Services were not always smooth running, on the whole,
prior to this date, District Nurses and Home Care Managers worked
closely together. They co-ordinated packages of care for mutual
clients ensuring that those most vulnerable people requiring joint
care were supported and maintained in their own homes if they
so wished.
1.4 This interface between health and social
services care is of particular concern to District Nurses as,
over the intervening years, the shift of personal care from health
to social has been significant. This shift has not always been
planned adequately, nor has it always been appropriate, and has
resulted in people with complex needs and much frailty being managed
in their entirety by Social Services staff, often with no input
from health.
1.5 The change has happened at different
paces in different parts of the UK; it can vary greatly even between
two neighbouring areas and there are concerns that the changes
have been implemented without proper planning and preparation
of those who take on new tasks.
1.6 The result now is that whilst in some
areas, District Nursing services provide a high level of personal
care to their patients; in others, most personal care is provided
by Social Services even if there are identified health needs.
1.7 Provision of health and social care
is needed throughout the 24 hours. People are not just ill and
needy between 9 am and 5 pm Monday to Friday. When people are
in hospital, they receive health and social care around the clock,
as part of the whole package but when they are at home, their
needs are artificially divided into health and social, (one of
which is provided free at the point of delivery and the other,
means tested) and are often not met outside of normal office hours.
1.8 When the CDNA researched the provision
of 24 hour district nursing services (attached), it was found
that only 28 per cent of Trusts provided a full 24 hour service,
staffed by appropriately skilled and qualified nurses (see CDNA
Position Statement on Commissioning District Nursing Services
for explanation). 36 per cent of Trusts had part provision such
as on call services, sitting services and patient specific services.
The remaining 36 per cent of Trusts did not provide 24 hour services—one
in particular closed up shop at 4.30 in the afternoon.
1.9 Couple this with similar restrictions
on social service provision and it is no wonder that people in
some areas are likely to be admitted to residential home, nursing
home or hospital for something that can be, and is in some parts
of the country, dealt with quite safely and appropriately in their
own home.
| 
