John Simmons, a director at independent health and social care watchdog Healthwatch Derbyshire, questions whether the political commitment to better integrate health and social services is translating into improving frontline services for people in the county.

Much has been said over the past few years about the need to better integrate health and adult care services.

Senior politicians of all political persuasions declare it as being one of the most pressing issues of our time in light of the ageing population and the increased demand on care services across all sectors.

However, feedback to Healthwatch Derbyshire from patients, service users and carers across the county is that this rhetoric and commitment to change is not getting through to the frontline and arguments about day to day funding are still a massive stumbling block to local people receiving the services they need.

Nationally, the creation of the Better Care Fund initiative was a good start.  This programme has aimed to span both the NHS and local government to join-up health and care services so that people can manage their own health and well-being, and live independently in their communities for as long as possible.

However, there are now signs that this could be brought to an end if targets are not successfully met.

Locally, senior managers of all services are declaring commitments to bring services together and ensure that seamless provision is available.

Although strategic planning is obviously positive – everyday practice, unfortunately, belies such commitment and no real efforts have been made to bring services together.

In reality, health services have their budgets and local authority adult care services have theirs and all of these budgets are under stress.

The strategic thinking and planning therefore becomes lost in day to day practice where individual managers, whilst aware of the strategy, have to make decisions on practice with no authority to over-commit their budget.

Meanwhile, patients and social care service users are caught in the middle.

An example, cited to us here at Healthwatch Derbyshire, is a woman in her late nineties who lives alone in her bungalow and is totally immobile following a hip fracture two years age which has never healed. This means that she cannot move from her bed or chair without assistance involving a hoist.

She was assessed for homecare and a co-funded package put in place – with costs met by the woman herself, her family and the Local Authority. This involved four carer visits a day involving two carers each time.

Quite understandably this situation has to be reviewed periodically to ensure best value from the money provided.

A recent review concluded that two carers would attend in the morning when she is hoisted from bed, toileted, bathed and breakfasted but that the remaining visits would involve just one carer.

On the first evening the carer who visited raised the fact that she couldn’t administer the nightly pain relief because it was a controlled drug and therefore required witnessed administration.

Fortunately this problem that night was overcome but the service had to return to two people being involved at bedtime – prompting a dispute about whether this was a health or a social care need and who should pay.

To the local authority’s credit, the service has continued seamlessly.  However, behind the scenes, discussions are continuing.

This situation is no doubt being replicated across the county with services potentially disrupted whilst the arguments drag on about who will pay.

Until strategy and commitment translates into reality on the frontline of service provision both locally and nationally, there is always the danger that health and social care services for our increasingly elderly population will be disjointed – affecting some of the most vulnerable people in our local communities.

If you want to share your experiences of health and social care provision in the county, you can contact Healthwatch Derbyshire:

By post: Healthwatch Derbyshire, Suite 14, Riverside Business Centre, Foundry Lane, Milford, Belper,

Derbyshire DE56 0RN

To send via freepost please add the code RTEE-RGYU-EUCK to the front of the address

By email:

Telephone: 01773 880786

Text: 07943 505255

Or visit the website;

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