This morning I chaired the last of four seminars for peers about the new draft Social Care Bill. They’ve been organised by Baroness Jolly from the Lib Dems. The last seminar this year but not the last of the many more I expect for next year when the bill finally arrives. The topic today was the integration of Health and Social Care. As long as I can remember these divergent services have been cajoled, bullied, encouraged and exhorted to work together. In most places they never have. From the patient’s point of view the lack of coordination between the NHS and those that provide personal and domestic care has been incomprehensible, but as long as the organisations responsible come under different management systems and different funding regimes split by the ideologies of central and local government, nothing much will change. I was hoping personal care budgets held by the individual would help but so far they have hardly taken off. Neither the last Health and Social Care Bill nor the current draft social care bill has any real hard incentives to change the status quo. There are areas where they have managed to bury their differences in the interests of patients and their families and many places pride themselves on a joint planning system. But Dr Clare Gerada from the Royal College of GPs thought the situation was getting worse in some areas. There was some debate about whether GPs were trained to work with other disciplines or not at the moment. Lady Cumberlege’s experience suggested perhaps not. I do not see GPs rushing to become co-ordinators of care and like Lord Laming I am not convinced that it would be the right direction to take. The difficulty is that someone’s got to manage across the system and right now no-one does.
But until staff in both services take to heart the fact that people with long-term conditions usually need more social care than health care and that all people in receipt of social care have an illness or disability, I suspect matters will go on as they are, endlessly wasting resources in the Health Service and starving social care of funds. The Government has a responsibility to provide the right incentives but since 1948 successive administrations have continued to sidestep the issue.