Policy Press
Five The shifting boundaries between health and social care
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Abstract
Any study of the development of welfare services for older people in the 1971-93 period must consider the interface between social services and health, a point already made clear in the previous chapter in terms of how health services were often the driving force behind changes in local authority residential care. This period was one of sustained exhortation from central government on the need to work together across the two agencies, but also one of enormous organisational change for health.
This chapter begins by offering a short review of some of these key policy and organisational changes and goes on to explore how health- social services relationships worked themselves out in the four case study authorities. Like other themes in this book, many of the same issues were to be found in all the localities. More specifically, there was constant tension over ‘what is health care?’ and ‘what is social care?’, with the fear on the part of social services that health was pushing more and more responsibilities for older people their way without any significant transfer of resources.
Three years after the creation in 1971 of social services departments in English local authorities, there was a major reorganisation of both the local government system and the NHS. For both services, it was argued that major changes were required to improve efficiency and effectiveness and for the NHS in particular, reorganisation would achieve these objectives through greater integration. Fourteen Regional Health Authorities were established within which there were 90 Area Health Authorities. Under the Area Health Authorities, there were 205 District Management Teams.
Abstract
Any study of the development of welfare services for older people in the 1971-93 period must consider the interface between social services and health, a point already made clear in the previous chapter in terms of how health services were often the driving force behind changes in local authority residential care. This period was one of sustained exhortation from central government on the need to work together across the two agencies, but also one of enormous organisational change for health.
This chapter begins by offering a short review of some of these key policy and organisational changes and goes on to explore how health- social services relationships worked themselves out in the four case study authorities. Like other themes in this book, many of the same issues were to be found in all the localities. More specifically, there was constant tension over ‘what is health care?’ and ‘what is social care?’, with the fear on the part of social services that health was pushing more and more responsibilities for older people their way without any significant transfer of resources.
Three years after the creation in 1971 of social services departments in English local authorities, there was a major reorganisation of both the local government system and the NHS. For both services, it was argued that major changes were required to improve efficiency and effectiveness and for the NHS in particular, reorganisation would achieve these objectives through greater integration. Fourteen Regional Health Authorities were established within which there were 90 Area Health Authorities. Under the Area Health Authorities, there were 205 District Management Teams.
Chapters in this book
- Front Matter i
- Contents v
- List of tables and figures vi
- Advisory Group members viii
- Acknowledgements ix
- Setting the scene 1
- Community care and the modernisation of welfare 13
- Targeting, rationing and charging for home care services 27
- The changing role of local authority residential care 49
- The shifting boundaries between health and social care 73
- Towards a mixed economy of social care for older people? 99
- Towards quasi-markets in community care 129
- Developing community care for the future: lessons and issues from the past 163
- References 179
- Index 193
Chapters in this book
- Front Matter i
- Contents v
- List of tables and figures vi
- Advisory Group members viii
- Acknowledgements ix
- Setting the scene 1
- Community care and the modernisation of welfare 13
- Targeting, rationing and charging for home care services 27
- The changing role of local authority residential care 49
- The shifting boundaries between health and social care 73
- Towards a mixed economy of social care for older people? 99
- Towards quasi-markets in community care 129
- Developing community care for the future: lessons and issues from the past 163
- References 179
- Index 193
