Select Committee on Health First Special Report

The Relationship between Health and Social Services

SESSION 1998-99
Health Committee Recommendations: Progress - Health & Social Services

First Report: The Relationship between Health and Social Services (HC 74) Published: 13/01/99

Government Reply: Cm 4320 Published: 04/99


Government Response and Action

2. We recommend that audits of the provision of information to users and carers on discharge from hospital should be carried out and that clear national guidance on the process for communicating information should be published by the DoH. Authorities should make full use of available technology to ensure effective provision of information (paragraph 17).

We will be reviewing the Hospital Discharge Workbook which will include process guidance on Information for users and carers on discharge.

3. We recommend that the DoH should draw up appropriate 'user pathways' for a comprehensive range of conditions and services, and that it should initiate discussions with a wide range of user groups both on the contents of the 'pathways' and on how the information in them can most effectively be disseminated to users and carers. As part of these discussions, the DoH should specifically invite user groups to draw attention to any information in the official 'pathways' which the user groups regard as incorrect or misleading, with a view to identifying weaknesses in existing service provision (paragraph 18).

LT service agreements are increasingly built around pathways.

4. We believe it is vital that the processes for deciding eligibility criteria and assessing patients' needs are transparent and uniform across the country. Whilst we recognise that local discretion is important in order to 'fine tune' services to meet local circumstances, we repeat our predecessors' call for the introduction of a national framework for eligibility criteria (paragraph 19).

We are developing a framework for Fair Access to Care Services which will help local authorities to review and improve the way in which they define and apply eligibility criteria for adults seeking social care support. The framework will be implemented from April 2002, and will lead to greater consistency in service outcomes across the country.

5. We recommend that information about good practice models emerging from the local reviews in 1998/99 should be disseminated so that it can be taken into account when authorities develop their agreed frameworks for assessment (paragraph 22).

The NHS Plan sets out proposals for introducing a single assessment process across health and social care for older people. This will be introduced in the first instance for the most vulnerable. The Department is now working to implement this proposal.

6. The Audit Commission report, The Coming of Age, called for health and social services staff to "review assessment arrangements and standardise procedures." We strongly support this recommendation. (Paragraph 22).

See no. 5

7. We recommend that the proposed "national beds inquiry", which the SofS announced on 30 September, includes a review of delayed discharges, including an assessment of the costs incurred by the NHS (paragraph 28).

The National Beds Inquiry, published for consultation on 10 February, looked at the effect of, and reasons for, delayed discharges. The Inquiry found evidence of significant inappropriate or avoidable use of acute beds, concluding that, for older people, around 20% of bed days were probably inappropriate if alternative facilities were in place. The consultation period ended on 5 May 2000. Ministers will be making their response in the Autumn.

8. We endorse the recommendation of the Stroke Association that hospitaldischarge plans should include provision for the continuation of rehabilitative work begun in hospital (paragraph 29).

Stroke will be addressed in the National Service Framework for Older People. The advice we have received from the External Reference Group covered stroke prevention, immediate management and rehabilitation. It also looks at long term support for stroke patients and the organisation of stroke services. This advice will play an important role in how we take forward work on stroke.

9. We recommend that the Government give urgent consideration to implementing the changes called for by the Ombudsmen, with a view to ensuring that Ombudsmen services reflect the current process of change in the provision of health and social care (paragraph 31).

A review of the public sector ombudsmen arrangements was commissioned in March 1999 by the Cabinet Office. The report of the review team was published in April 2000, and in June the Cabinet Office issued a consultation paper on the report's recommendations. The consultation period ended on 29 September, and the Cabinet Office is now considering how best to take forward the review's recommendations.

10. In 1995 the DoH issued detailed guidance on the roles and responsibilities of health and local authorities in relation to continuing health care. Our predecessors welcomed the fact that the DoH had recognised the need for such guidance, but commented that further clarification was needed. We recommend that the DoH review the 1995 initiative with a view to extending it into other areas where there may be overlap between the two agencies (paragraph 36).

The continuing care review is currently underway with the view to issuing revised guidance later in the year.

11. We recommend that professional roles be reviewed to consider their continuing appropriateness and whether new professional or occupational roles are needed. We welcome the steps being taken by the Government to regulate social care and we consider there is a strong case for the regulation and registration of all care workers (paragraph 37).We believe that joint training could engender greater mutual trust and respect between different professional groups and would have major benefits for joint working. We recommend that common pre and post-qualifying training modules be established for health and social care workers. In addition secondments between the organisations should be encouraged. (Paragraph 53).

Review of social work training is taking place as part of the consultation on the Quality Strategy for Social Care, which was published on 29 August 2000. Consultants reports on the content and delivery of the Diploma in Social Work are made available on the website, as part of the consultation exercise. The development of a national curriculum for social work training is one of the recommendations. Decisions on the future of social work training will be taken following the ending of the consultation period on 21 Novemb

12. Much of the good collaborative work that we came across was established using funding either from one body alone or as an acceptd joint package. The initial costs occasionally resulted in savings for one side with there being no way for the other investor to take advantage of these savings. We saw an example of this at the Beaufort Road practice in Southborne (see paragraph 57). We consider this to be a serious barrier to effective joint working (paragraph 38).

Health Act Flexibilities now enable a joint management and resource allocation to jointly agreed schemes. Pooled funds, lead commissioning and integrated provision are all already being used throughout the country to facilitate this work of befit to all contributing agencies. Money transfer powers (Section 28A and 28BB) also can be used by one authority to support the work of the other.

13. We recommend that the NHS makes targeted, more long term investments in complementary local authority services, similar to the winter pressures model (paragraph 42).

In April 1999 we introduced the Promoting Independence Partnership Grant, which supports local councils in providing additional services in partnership with NHS bodies, in particular to address winter pressures. Objectives include avoiding unnecessary admission to hospital and inappropriate placement on leaving hospital, introducing or improving joint procedures for the assessment of a person's needs, joint arrangements for discharge, recuperative and rehabilitative services, and joint procedures to reduce the number of emergency admissions to hospital. For the 3 years 1999 - 2002 the Partnership Grant will amount to over £600 million, which is allocated to English Local Authorities in proportions based on PSS SSA.In addition, in August 2000, we announced the allocation of an additional £63 million of non-recurrent funding to support the NHS and social services in jointly expanding capacity for winter 2000-01.

14. We believe the charging regime will always be a barrier to some people accessing services. We recommend that a survey is carried out urgently to establish the impact of domiciliary care charges on the NHS, including the effect of charges on service users take up of health and social care services. We also recommend a review of domiciliary care charges where they are an impediment to collaboration, including an investigation of the implications of abolishing them altogether. (Paragraph 45).

Audit Commission report "Charging with Care" was published on 10 May 2000. We have taken new powers through the Care Standards Act 2000 to issue statutory guidance to councils on home care charges. We plan to issue guidance by April 2001.

15. We are pleased to see that the DoH now intends to address some of the legal barriers by introducing amending legislation and in particular by allowing health and social services to pool budgets. We recommend that action is also taken to deal with the anomalies which arise under Section 113 of the Local Government Act 1972 and Section 47 of the National Health Service Act 1977 (paragraph 46).

Health Act flexibilities are already being used, with over £200 million committed. These enable the delegation of functions from one statutory body to another. Partnership can also be led by LAs as part of their powers as well as powers of well being in the 1999 Local Government Act. Anomalies over the transfer of staff have been resolved (Section 113 of the Local Government Act 1972). In order to ensure that LAs are aware of any disqualifications under Section 47 of the National Health Service Act, information will be more widely disseminated including through a new website.

16. Evidence suggests there has been an increase in recent years in the number of joint planning arrangements which have been locally established; this is a trend which should be encouraged by the DoH with appropriate monitoring and incentives (paragraph 50).
We recommend that DoH includes in its performance management mechanisms a check on the quality and effectiveness of joint planning arrangements, and that it should report back to us in due course on further progress in this area (paragraph 50).

Health Improvement Programmes, Joint Investment Plans (Older People from 1999, Learning Disabilities, Welfare to Work), Plans linked to NSFs - Older People, Mental Health Services as well as Local Implementation Plans for Information management are al required to be produced jointly. They are evaluated, and used as part of the performance management process.

17. We advocate coterminosity of health and social services wherever beneficial and practicable, although clearly a lack of coterminosity should not be used as an excuse for a lack of co-operation. We recommend that social services teams reflect PCG boundaries and that in any future review, PCG boundaries are kept as far as possible consistent with the provision of social care in the area (paragraph 52).

Accepts - will review progress in 2002.

18. We urge the Government to ensure that, under any replacement system, full local accountability arrangements are maintained and that voluntary bodies retain their representation (paragraph 55).

Voluntary bodies will be fully involved.

19. The 1998 Emergency Services Action Team Report provides a useful contribution to the evaluation of how "winter pressures monies" were used and of the success or otherwise of the projects established. We recommend full evaluation of such projects and that examples of good practice be distilled from this analysis and be widely disseminated with supporting DoH guidance notes (paragraph 60).
We acknowledge that co-location may not be suitable for every locality, but we strongly support this type of close collaborative working and the attempt to create a seamless service by developing closer strategic working. We recommend that successful examples of co-location should be documented and widely disseminated in an accessible format (paragraph 61).


20. The DoH's proposals in Partnership in Action to allow a lead commissioner and integrated provision are a step in the right direction. However we consider that the problems of collaboration between health and social services will not be properly resolved until there is an integrated health and social care system, whether this is within the NHS, within local government or within some new, separate organisation. We acknowledge that such an integration would lead to an emphasis of the boundary between the health and social care body and other functions, for instance housing and education, but we believe it is the only sensible long term solution to end the current confusion. Implementation of the White Paper and in particular the involvement of social services and community NHS trusts in PCGs and PCTs, provides an excellent opportunity for improved collaboration between health and social services, but falls well short of unifying the two agencies. We would like to see a full and widespread debate on the case for the integration of health and social care. We recommend that pilots are established to test ways of integrating health and social services based on the lead commissioner model proposed by the DoH. (Paragraph 68).

Local solutions to problems and issues arising are being developed without recourse to massive and distracting organisational and structural upheaval; Health Act Partnership Arrangements are already in place in 24 sites, and are being developed in many more. Care Trusts as described in the Plan will enable the development of integrated provision for health and social care.

22. We recommend that the functions of CHCs are carefully considered in light of the implementation of the White Paper (paragraph 73).

Proposals to dissolve CHCs have been published in the NHS Plan, to be replaced by a patient Advocacy and Liaison service, to be established in every NHS Trust, providing an independent facilitator. Patients' views will be required to be sought by all NHS trusts, primary care groups and primary care trusts, and each NHS organisation will be required to publish in a patient prospectus the views received from patients and action taken as a result. Every NHS trust and primary care trust will have to establish a patients' forum. A scrutiny role will be given to Local Authorities and Chief executives of NHS organisations will be required to attend LA scrutiny committees at least twice annually if requested, major changes in service will be referred to them.

23. It is vital that PCGs are properly accountable to their local community and we recommend that the DoH issue guidance to PCG Boards on the best ways of involving the community and addressing the "local democratic deficit" (paragraph 74).

Accepts - has done so

24. We recommend that performance frameworks should require joint working at both strategic and operational level. We support the LGA's call to re-frame "performance indicators for the NHS and local authorities to numbers of people referred to rehabilitation or other intermediate care facilities by age group or disability, and the long term success of supporting these people in the community." (Paragraph 76).

Published proposals for new performance assessment framework on 23/02/99 - includes rehabilitation and community care.

25. We recommend that DoH's proposals on integrated provision are used to improve the provision of basic preventive health and social care. We also support the LGA's call for "a stronger statutory requirement for health co-operation and investment in early years services [which] would have obvious benefits for respite care, health care of looked after children and child protection." (Paragraph 78).

The Government recognises that health professionals have a vital role to play in ensuring children and families receive the care, services and support they need in order to safeguard the interests of children. Health professionals may often be the first to be aware that families are experiencing difficulties looking after their children. The child protection system as set out in Working Together to Safeguard Children is based on effective co-operation between all agencies with child protection responsibilities. Working Together places strong emphasis on the role of health services in protecting children from abuse and neglect.
The Looking After Children materials produced by the Department of Health and used by most local authorities, are now being integrated with the new Assessment Framework to create an integrated children's system for all work with children and families.Draft guidance on Promoting Health for Looked After Children was issued for consultation in December 1999. Revised guidance is due to be published at the end of 2000. This guidance will stress the importance of partnership work between health and social care for improving health outcomes for looked after children. The guidance will take a holistic health approach to health.

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