six - Reluctant partners: the experience of health and social care collaboration

Summary

Introduction

The Government has made it one of its top priorities since coming to office to bring down the ‘Berlin Wall’ that can divide health and social services and create a system of integrated care that puts users at the centre of service provision. (DoH, 1998a, p 997)

The ‘Berlin Wall’ seen to divide health and social care services featured strongly in the policy debates of the late 1990s. Particularly in respect of community care services, but also in provision for children and their families, effective service interventions were seen to be frustrated by a lack of coordination between different professionals, agencies and/or departments. In the child protection context, successive official inquiries identified failures in communication or interagency/interprofessional collaboration as a major contributory factor (DHSS, 1974; London Borough of Bexley, 1982; London Borough of Brent, 1985; London Borough of Greenwich, 1987). Earlier chapters have set out some of the potential barriers to interprofessional and multiagency working, in particular the difficulties resulting from different, and possibly conflicting, disciplinary approaches and service paradigms. They have also highlighted problems arising from the diverse systems of regulation and accountability surrounding network participants. This chapter examines the impact of central policy initiatives designed to enhance collaboration between health and social services authorities and identifies further areas of organisational resistance to effective joint working in child protection. After providing a brief history of collaboration between the NHS and social care agencies, the chapter examines the implications for local provider networks of the 1997 Labour government's modernisation agenda.

A brief history of health and social care collaboration

As we have seen, from its inception the NHS was kept administratively separate from the other two pillars of the welfare state – social care and social security. Effective collaboration between health and social care services was hampered by divisions between and within the NHS and the local authorities. Within the NHS, the core medical services – general practice and hospitals – were located outside local government control, effectively splitting them organisationally from the community or public health services – medical officers of health, community nursing and environmental health – which remained under the local authorities (Honigsbaum, 1989; Ottewill and Wall, 1990; see Chapter Five of this book).