Plans for progressive merger of NHS and local authority responsibilities for social care were unveiled by Tony Blair last week in the national plan for the health service in England. But the outcome was not the "NHS takeover" that some in local government had feared. Ministers appear to be taking an evolutionary approach to strengthening partnerships between the NHS and social services departments, without downgrading the status of either. Even so, the evolution could be rapid: the first of a new generation of "care trusts" is intended to be in place by next year.
"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 plan says.
The care trusts would be able to "commission and deliver primary and community healthcare, as well as social care for older people and other client groups".
The plan envisages a gradual and voluntary development of the care trusts in most parts of the country. But the small print includes a compulsory element in areas where services are deficient. "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," the document warns.
This looks like a big stick to drive through the first stages of integration in areas not yet making use of partnership arrangements under the 1999 Health Act.
The plan says: "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 would facilitate joint assessment of patients' needs for health and social care and ministers want personal care plans to be provided on this integrated basis for all older people by 2002.
Compared with earlier speculation about social care services being handed wholesale to the NHS, the detail has come as something of a relief to many in local government.
John Ransford, head of social care, health and housing at the Local Government Association, says: "Given some of the doom and gloom that was around over the last few weeks, I think it's a reasonable outcome." Taken together with two aspects of the plan - local government's new scrutiny role in respect of the local NHS and the fresh emphasis on tackling health inequalities - the overall message was "pretty good".
Jo Williams, president of the Association of Directors of Social Services, says the joint working route is "consistent with the policies we have taken over the years" and will mean more effective, efficient services for older people. "It links them with transport, housing, education and wider social provision in ways that will continue to make the local authority contribution to their lives and welfare absolutely vital."
