The White Paper on healthcare outside hospitals outlines a closer working relationship between professionals in health and social care. 'Too much primary care is commissioned without integrating with the social care being commissioned by the local authority. There will be much more joint commissioning between PCTs and local authorities,' it says. 'We will develop a procurement model and best practice guidance to underpin a joint commissioning framework.'
Sound principles. Sick people have a whole array of needs that must be considered. If an elderly patient has a hip problem and mobility issues as a result, that person obviously needs a referral to secondary care probably for a hip replacement. In the interim, he or she probably also needs a home help, and there might be a review of the benefits to which they are entitled to.
Healthcare costs should not be seen in isolation from other costs, because the costs of social care and time off work can actually be greater than the cost of the healthcare required.
To assist joint planning and delivery of health and social care, the DoH will help PCTs and local authorities to move towards joint planning and delivery. Performance assessment, inspection regimes and budgetary will also be aligned. But where is this going?
According to Chris Town, former lead GMS negotiator for the NHS Confederation, the answer is a single health and social care budget, but the DoH 'bottled out' of putting this in the White Paper.
Single budgets are not unreasonable, and the idea fits in with the direction of the White Paper, but the question is who should control and be accountable for social care spending. Mr Town sees practice-based commissioning as the answer.
GPs can give opinions and make requests, but the actual commissioning of social care is something they have neither the time nor experience for. Surely PCT and local authority personnel are those best placed to ensure patients are receiving all the services they need. GPs can then focus their efforts on treating patients, taking on secondary care work and helping to cut waiting lists. The DoH will meet its waiting list targets, and spending on social care for patients on waiting lists will fall as a result, which is the outcome it is after.