Introduction

Any study of the development of welfare services for older people in the 1971-93 period must consider the interface between social services and health, a point already made clear in the previous chapter in terms of how health services were often the driving force behind changes in local authority residential care. This period was one of sustained exhortation from central government on the need to work together across the two agencies, but also one of enormous organisational change for health.

This chapter begins by offering a short review of some of these key policy and organisational changes and goes on to explore how health-social services relationships worked themselves out in the four case study authorities. Like other themes in this book, many of the same issues were to be found in all the localities. More specifically, there was constant tension over ‘what is health care?’ and ‘what is social care?’, with the fear on the part of social services that health was pushing more and more responsibilities for older people their way without any significant transfer of resources.

The policy and organisational context

Three years after the creation in 1971 of social services departments in English local authorities, there was a major reorganisation of both the local government system and the NHS. For both services, it was argued that major changes were required to improve efficiency and effectiveness and for the NHS in particular, reorganisation would achieve these objectives through greater integration. Fourteen Regional Health Authorities were established within which there were 90 Area Health Authorities. Under the Area Health Authorities, there were 205 District Management Teams. Domiciliary health care services, such as home nursing and health visiting, previously the responsibility of local authorities, were transferred to the NHS. In mirror image, medical/hospital social work was shifted from the NHS to local authority social services departments. At the same time the Executive Councils, which had administered the services provided by general practitioners, dentists, opticians and pharmacists, were replaced by 90 Family Practitioner Committees. Community Health Councils were created at District Management Team level to represent the views of interest groups and the users of health services (see Brown, 1979).