There was only ever one justification for the creation of 22 Local Health Boards. That was the potential they offered, by virtue of co-terminosity, for genuine integration of health and social care provision. Of course that hasn't happened. The underlying conflict between the business cultures of local authorities, both constrained and legitimised by democratic accountability, and Local Health Boards (and Trusts) accountable to no-one but the Minister, was always too tough a nut to crack merely by creating common boundaries.
It was Peter Walker as Secretary of State (mercifully many years ago) who used the memorable phrase "creating a seamless robe of care" to describe the joint working arrangements between county councils and health authorities required under the Care in the Community legislation. An admirable aspiration which would have meant the experience of the patient would be unaffected by whether their needs for care and support were being met by social services or by health services. But it was an aspiration that could never be met as there's no such thing as a seamless patchwork. The component elements of the partnerships were too far apart structurally, culturally, financially and even ideologically for it to work. Put crudely, no-one ever resolved the issue of how Mrs Jones was to get a bath without bare-faced stand-offs between the two authorities arguing about whether Mrs Jones's ablutions were driven by a medical or a social need (i.e. who would pick up the bill). In the meantime Mrs Jones is probably still part of the great unwashed if, indeed, she hasn't died waiting.
Creating co-terminous health and social service authorities, along with bringing health and social care into the same Ministry at least hinted at a desire to resolve these issues, but it was a half-hearted attempt at best.
Of course 22 Local Health Boards is far too many, and the ditching of this structure is good news. But the ensuing debate should not revolve solely around the health service as if it were a structure in isolation of other services. There must be consideration of the social care dimension in whatever replacement structure is created. Neither should the the issue of democratisation of the new Boards be ducked. Edwina has proven herself as a Minister with the bottle to tackle difficult issues. Are there other ministers with the bottle to tackle the huge, glaring reality that 22 Local Authorities is far too many? Will anyone really open the batting by declaring that the elections on May 1st should be the last throw of the dice for these councils?
It was Peter Walker as Secretary of State (mercifully many years ago) who used the memorable phrase "creating a seamless robe of care" to describe the joint working arrangements between county councils and health authorities required under the Care in the Community legislation. An admirable aspiration which would have meant the experience of the patient would be unaffected by whether their needs for care and support were being met by social services or by health services. But it was an aspiration that could never be met as there's no such thing as a seamless patchwork. The component elements of the partnerships were too far apart structurally, culturally, financially and even ideologically for it to work. Put crudely, no-one ever resolved the issue of how Mrs Jones was to get a bath without bare-faced stand-offs between the two authorities arguing about whether Mrs Jones's ablutions were driven by a medical or a social need (i.e. who would pick up the bill). In the meantime Mrs Jones is probably still part of the great unwashed if, indeed, she hasn't died waiting.
Creating co-terminous health and social service authorities, along with bringing health and social care into the same Ministry at least hinted at a desire to resolve these issues, but it was a half-hearted attempt at best.
Of course 22 Local Health Boards is far too many, and the ditching of this structure is good news. But the ensuing debate should not revolve solely around the health service as if it were a structure in isolation of other services. There must be consideration of the social care dimension in whatever replacement structure is created. Neither should the the issue of democratisation of the new Boards be ducked. Edwina has proven herself as a Minister with the bottle to tackle difficult issues. Are there other ministers with the bottle to tackle the huge, glaring reality that 22 Local Authorities is far too many? Will anyone really open the batting by declaring that the elections on May 1st should be the last throw of the dice for these councils?
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