Working with local authorities

The rationale for joint working between health authorities, providing ‘health care’, and local authorities providing ‘social services’ and ‘housing’, is increasingly consumerist. Health and health-related needs do not respect organizationally defined boundaries. Service ‘clients’, ‘patients’ or, the more neutral term, ‘users’, face confusion in confronting inter-organizational boundaries, and, when (rarely) asked, overwhelmingly opt for the identification of ‘key workers’ to guide them through the responsibility maze, if not to ensure improved service quality (Ferlie, Pahl and Quine, 1987) ‘Overlap’ is a familiar occurrence; for example, much of the community support provided by health authority auxiliary nursing staff may also be provided by social services departments’ domiciliary care staff, such as bathing and night sitting services. ‘Who does what’ often depends upon with which agency the individual’s contact, or referral, was first made, a situation providing for duplication in some circumstances, patchy or non-existent services in others, and one in which users are ill-served, until co-ordination takes some hold.