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
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 exciting an 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