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Co-terminosity of health and social care – a pipe dream?

With all the talk about the NHS White Paper and the need for better integrating of health and social care, one of the fundamental geographical barriers to doing this is being misunderstood and forgotten. At the parliamentary level GP consortia are being urged to be co-terminus with local authority boundaries as this will provide “the best opportunity for the design and delivery of integrated, high quality care”. Whilst this is true, it is far from realistic and shows a fundamental misunderstanding of the differences in health and social care provision on this point.

The general principle is that health services are provided by the authority where the person is usually resident, which will be determined by where they have registered with a GP and social services are provided by the authority where the person is ‘ordinarily’ resident. GP practices can and do extend over multiple authority boundaries, and therefore GP consortia, being an amalgam of GP practices, will as well. There is complicated guidance on who pays for what and when, when disputes occur, but the end of the day resolving these disputes over who pays can be costly and can have a very negative effect on a person’s wellbeing. This mismatch means for example that for someone receiving ongoing social care support, a referral into Intermediate Care services may not be timely enough to help prevent them being admitted to hospital, and the person’s situation deteriorates as a result, such that they are admitted into residential care.

Resolving this mismatch between health and social care provision would either require a re-registration of people with different GP practices, or a re-definition of local authority boundaries – neither of which is likely to be achievable in either the short or the medium term. On top of this, allowing people to choose their GP practice, puts paid to any idea of achieving co-terminosity.

Apart from the cost of resolving disputes, why does this matter? To deliver an effective health and social care system truly focused on improving people’s lives requires an understanding and reliance on the different contributions that health and social care play. This is particularly the case in terms of creating a complementary and close partnership between Intermediate Care and Re-ablement, focused collectively on reducing the requirement for ongoing support by improving people’s lives. Achieving this is the key to public services being able to withstand the impact of the ageing population and the growing number of younger adults with very complex needs. With the difference in local models of Intermediate Care and Re-ablement, it is not possible to achieve this close complementary partnership between Intermediate Care and Re-ablement without an assumption on where both services are assessed from and the model of provision.

So in the interest of delivering improved integration of health and social care services, is now not the time to tackle this basic discrepancy? The massive re-organisation of the NHS being brought about through the white paper, provides a perfect opportunity to provide improved integration of health and social care through common geographical criteria for funding, without impacting how front line services are delivered. Either this or we need to go back to some of thinking behind the idea of a National Care Service…

Georgina Owen is an Assistant Director at iMPOWER. To contact her to discuss this blog or any aspect of our work, email gowen@impower.co.uk or call 07515 973751

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