Responsibility for social care needs to be considered

EDITOR,—The article by the Rationing Agenda Group was well thought out and comprehensive.1 I would like to comment on what should be health and what should be “other” forms of care responsibility—that is, social, etc. Although I agree that, ideally, social care should be the responsibility of agencies other than the NHS, in practice this is not the case. Because of funding problems the NHS is often “forced” into paying for social care as a form of insurance against the greater health consequences of not doing so.

I have responsibility for purchasing for mental health, learning disability, and substance misuse locally, and this is a definite and worsening problem. For instance, if we do not spend money on social care in the form of partnership homes or day care or as intensive social support for some ex-users of NHS beds for any of the above three reasons we risk being forced into purchasing far more expensive care—for example, for inpatients, as extracontractual referrals, or privately. We therefore pay for such services knowing that they are predominantly social but being aware that we cannot unilaterally extract the NHS from doing so either on moral or ethical grounds (casting the patients out) or on legal grounds (against government guidance on joint working).

I accept that an ideal position may need to be stated, but to help in reality I think that such practical problems must be faced by any group trying to shed light on the subject. This interface is a huge area of spend (up to 20% of the NHS budget for some of these client groups).