Memorandum by the Royal College of Nursing
Relationship between Health and Social
Services (HSS61)
SUMMARY
At the heart of the relationship between health
and social services is the artificial divide between health and
social care. Nowhere is the divide more obvious or more troublesome
than in debates over the provision of community care. The Royal
College of Nursing strongly supports the principle that people
should be cared for in their own homes or in a homely, rather
than an institutional, setting. Nevertheless the experience of
community care policy to date has largely been one of failure.
The relationship between health and social services
must be improved if high quality services are to be delivered
to the most vulnerable members of our society. Where there is
effective joint working this exists despite rather than because
of current structures. The experience of the past five years of
community care leads the RCN to conclude that only structural
reform can bring about the necessary changes.
The new structure proposed in the recent White
Paper "The New NHS" may provide a suitable vehicle for
community care. The RCN argues that the remit of the proposed
commissioning bodies, the "Primary Care Groups", should
be enlarged to become "Primary and Community Care Groups".
There should be two separate funding streams
into these Groups: from social services for social care, and from
health services to meet the health components of community care.
The Groups would then devolve budgets to integrated teams of community
health and social services personnel. These integrated community
care teams would have the authority to make joint decisions about
the care needs of their clients, and commission appropriate services
without recourse to the current battles over financial responsibility.
The RCN argues that this proposal recognises
the value of the different cultures and ways of working of health
and social services personnel, while requiring a team approach
to ensure patient-centred care.
Essential to the model that the RCN proposes
are the following key proposals:
— Single registration care homes
— A funding formula to guarantee free
nursing care wherever it is provided
— Joint health and social services
inspection
— National criteria for which services
can be means tested.
Each of these is discussed in more detail in
the evidence attached.
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