The difference between an NHS manager and a LA/ SSD manager is significant when considering the integration of health and social care and I believe has been under explored when considering the reasons for frustratingly slow progress. So here goes a rather undiplomatic account of over 30 years trying to make it work.
As a new manager in Social Services I was quickly exposed to my colleges in the NHS. You might be surprised to know that all those years ago we regularly met with managers from the NHS to discuss how we cold remove duplication of services, better integrate services and avoid patients/ clients/service users having to repeat the same basic info over and over each time they met a professional from one or other agency.
In those early days I bought the myth peddled by my Health manager colleagues that Heath unencumbered by elected officials/councillors could move faster, and were freer to make management decisions unlike us who were enthusiastic about any and every proposal but always qualified by the need to take a report to committee and get member support and authority.
I was also made aware early on that Health had a different attitude to budgets and budgeting. I remember even as a senior manager being obliged to update Hospital Trusts on our budget problems/ cuts and the implications for our joint work. As such I was subjected on more than one occasion to a senior manager in Health telling me how we should better run our budget. Of course in those days the massive over spends by hospitals often went unreported. You see a LA has to balance its budget every year where as hospitals didn’t/don’t so they overspent and carried forward the overspend as debt! This approach was matched by how the two sets of managers tried to manage their budgets. In the LA /SSD we cut back on services, closed day centres and old people homes and suffered the public out cry as we cut our cloth to match our budget. Health simply extended their waiting lists. Which in part reflected another reality about Hospital which was consultants called the shots not managers.
In fact the medical profession not managers called the shots in primary health as well. The clearest example of this was a Health organisations drugs budget. This was one of Healths biggest areas of spend and it was a run away budget that managers could not control. Managers wanted doctors to prescribe generic version of drugs which could be purchased at a fraction of the cost of branded versions. GP’s refused as a matter of professional principle to be dictated to on their prescribing habits.
Another area of difference in authority of managers was the sharing of information. The medical profession has always taken a very ridged line on sharing patient information siting confidentially as a fundamental principle of the medical profession and unwilling to provide even aggregated patient info to non medical professionals. This despite the fact that social workers subscribe to the same professional principles of confidentially.
Managers were held in different regard in Health as opposed to LA. In Health they were regarded more as administrators (by the consultants).Which may explain their fixation on bed blocking and their persistent claims that delayed hospital discharges were due to poor or inefficient LA social services when in fact the majority of reasons lay within the internal administration of hospitals as the ADASS regularly evidenced to central government.
When an exciting innovative joint initiatives did take root it was nearly always initiated and led on the health side by a consultant.
This is history and as such their is a temptation to dismiss it as irrelevant to the current agenda of making Health and social care work better together. But history is our legacy and explains much of why things are the way they are. Of course much has changed since this those days. But not that much, integration is still more an aspiration than a reality, LA managers are still forced to make cuts to services as NHS waiting lists reach record levels.
Blair Mcpherson former Director of Community Services www.blairmcpherson.co.uk
