Website of the Department of Health

Introduction

7.1 If patients are to receive the best care, then the old divisions between health and social care need to be overcome. The NHS and social services do not always work effectively together as partners in care, so denying patients access to seamless services that are tailored to their particular needs. The division between health and social services can often be a source of confusion for people. Fundamental reforms are needed to tackle these problems.

Developing partnership working

7.2 The Health Act 1999 enables local councils and the NHS to work more closely together. The Act swept away the legal obstacles to joint working by allowing the use of:

7.3 Already Health Act schemes covering budgets of over £200 million are in operation. But only a small minority of patients are benefiting. In future, therefore, we will make it a requirement for these powers to be used in all parts of the country rather than just some. The result will be a new relationship between health and social care. In turn it will bring about a radical redesign of the whole care system. In future, social services will be delivered in new settings, such as GP surgeries, and social care staff will work alongside GPs and other primary and community health teams as part of a single local care network. This co-location of services will make easier the joint assessment of patients' needs. The assessments will form part of the new personal care plan which older patients and others will now receive (see chapter 15).

Intermediate care

7.4 A key test of these closer working arrangements will be how well they provide older people with improved services. In future older people must not be left to find their own way around the system or left in a hospital bed when rehabilitation or supported care is what they need. They must receive the right care at the right time in the right place. This Plan provides an extra £900 million investment by 2003/04 in the new intermediate care and related services to promote independence and improve quality of care for older peaple. With the extra funding for intermediate care, health authorities, primary care groups, primary care trusts and local authorities will have to demonstrate that they will put in place the following services:

7.5 They will have freedom to decide on the precise organisational arrangements for their area.

Joint inspection

7.6 The Commission for Health Improvement, Audit Commission and the Social Services Inspectorate will use the Best Value system jointly to inspect health and social care organisations to see how well they are implementing these arrangements. They will also check on what difference joint working is making in terms of such measures as:

Incentives for joint working

7.7 Local authorities, health authorities, primary care groups  and primary care trusts will receive incentive payments to encourage and reward joint working. In the case of health organisations it will be through the National Performance Fund (see chapter 6). In social services £50 million a year will be available from April 2002 to reward improved social services joint working arrangements based on measuring performance from 2001. From April 2003 the fund will rise to £100 million. It will operate as a ring fenced grant and will be focused initially on intermediate care performance. There will be common criteria between the funds.

Primary care trusts

7.8 Primary care trusts are providing a unique opportunity to foster closer working between health and social services. They have the potential to make real improvements for patients, making the health and social care system easier to understand, simpler to access and more convenient to use. Primary care trusts are already bringing together primary and community health services within a single organisation. By April 2004 we expect all primary care groups to have become primary care trusts. They also provide a suitable means for the commissioning of social care services, using the Health Act flexibilities, for older people and those with mental health problems.

New Care Trusts

7.9 We now propose to establish a new level of primary care trusts which will provide for even closer integration of health and social services. In some parts of the country, health and social services are already working together extremely closely and wish to establish new single multi-purpose legal bodies to commission and be responsible for all local health and social care. The Government intends to build on the establishment of primary care trusts so that all those localities who want to follow this route can do so. This will require changes to the governance arrangements for primary care trusts to ensure representation of health and social care partners. The new body will be known as a 'Care Trust' to reflect its new broader role.

7.10 Care Trusts will be able to commission and deliver primary and community healthcare as well as social care for older people and other client groups. Social services would be delivered under delegated authority from local councils. Care Trusts will usually be established where there is a joint agreement at local level that this model offers the best way to deliver better care services.

7.11 Where local health and social care organisations have failed to establish effective joint partnerships - or where inspection or joint reviews have shown that services are failing - the Government will take powers to establish integrated arrangements through the new Care Trust.

7.12 The establishment of Care Trusts will obviously have to take account of the roll out and capacity of primary care trusts. The first wave of Care Trusts could be in place next year.

Conclusion

7.13 These changes will remove the outdated institutional barriers between health and social services which have got in the way of people getting the care they need when they need it. The new arrangements will provide better care services, especially for older people. These changes in the way organisations work need to be complemented by changes in the way that individual members of NHS staff work.