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Service provision

Never the twain should meet

Combining health and social care services makes sense on the surface, but they have different
objectives and priorities, argues robin Jackson. He suggests that, to avert the looming crisis,
we need to create a model that concentrates on social care rather than rely on merger

ocial care is in crisis and, without need and social care need. recreational activities outside the home;
radical changes in the very near While there is no legal definition of a assistance to use educational facilities;
Sfuture, I believe it will collapse. healthcare need, in general terms, it can and help to find accommodation such as a
Reforms introduced by successive be said that it is related to the treatment, care home.
governments have left it seriously control or prevention of a disease, illness, The essential characteristics of
underfunded and underperforming. It has injury or disability, and the care or social care have been identified
become heavily dependent on the aftercare of a person with these needs, (Williams, 2003).
profit-oriented private sector and regardless of whether the tasks involved First, care of both the self and others
outsourced provision by powerful global are carried out by a health professional. are meaningful activities in their own
companies which have frequently been In general terms – again, there is no right; they involve us all, men and women,
exposed as incompetent and, on legal definition – a social care need is one old and young, able bodied and disabled.
occasions, criminally irresponsible. focused on providing assistance with Therefore, care is an activity that binds all.
many for-profit companies providing activities of daily living, maintaining Second, in receiving and giving care, we
care have shown scant interest in independence, social interaction, enabling can, in the right conditions of mutual
maintaining adequately staffed facilities the individual to play a fuller part in respect and material support, learn the
and an appropriately trained workforce. society, protecting them when their civic virtues of responsibility, trust,
Companies have a strong incentive to circumstances make them vulnerable, tolerance for human limitations and
keep running costs down by employing helping them to manage complex frailties, and acceptance of diversity.
poorly qualified staff and maintaining less relationships and, in some circumstances, Third, an ethic of care demands that
than full staff establishments. accessing a care home or other type of interdependence be seen as the basis of
This crisis will be made worse by supported accommodation. human interaction; in these terms,
merging health and social care. Social care needs are directly related to autonomy and independence are about
The idea of merger appears to have the type of welfare services that local the capacity for self-determination rather
arisen from the belief that the benefits of authorities have a duty or power to than an expectation of individual self-
the two sectors are greater when they are provide. These include but are not limited sufficiency.
combined into one rather than left as to: social work services; advice; support; Fourth, it attributes moral worth to key
separate entities. practical assistance in the home; positive dimensions of caring relationships
However, this is mistakenly built on the assistance with equipment and home such as dignity and the quality of human
assumption that there are strong adaptations; visiting and sitting services; interaction, whether based upon blood,
similarities between health and social care. provision of meals; facilities for kinship, sexual intimacy, friendship,
occupational, social, cultural and collegiality, contract or service; it
why synergy fails
There is a belief that synergy inevitably
confers advantages. However, it
frequently fails because those seeking it
focus too much on the financial and
strategic aspects of merging and
frequently underestimate the cultural
aspects of the organisations being
brought together.
In the one sector that one might
reasonably have expected synergy to have
a successful track record – mergers and
acquisitions in banking – Leon
Cooperman, a former Goldman Sachs
partner, has confessed to being unable to
identify one example where a merger has
succeeded.

Defining the difference
The National Framework for NHS
Continuing Healthcare has attempted to Politicians could create a separate department of social care; this would require dedicated
clarify the difference between healthcare funding

22 Vol 31 No 4 | Summer 2018 community Living www.cl-initiatives.co.uk