The boundary between health care and social care

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.6999.208 (Published 22 July 1995) Cite this as: BMJ 1995;311:208
  1. Maggie Pearson,
  2. Gerald Wistow
  1. Professor of health and community care Health and Community Care Research Unit, University of Liverpool and North West Regional Health Authority, Liverpool L3 6AL
  2. Professor of health and social care Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL

    A positive but insufficient step

    The Department of Health's recent guidance NHS Responsibilities for Meeting Continuing Health Care Needs1 merits a cautious welcome. It follows a much criticised draft,2 which originated in the health service commissioner's upholding of a complaint that Leeds Healthcare had failed to provide long term NHS care for a brain damaged patient.3 Even so, it does not resolve all the uncertainties about responsibilities at the boundary between health and social care. Still less does it acknowledge the silent, if not surreptitious, shift in the balance between state and individual responsibilities for funding long term care that has taken place over the past 15 years. The profound implications of that shift for the expectations and finances of the current generation of elderly people and their families justify a long overdue public review of the current arrangements and their consequences.4

    On the more positive side, however, the final guidance can be seen as more substantial, comprehensive, and prescriptive than its draft precursor. In a climate of increasing concern about pressure on resources in the acute sector and emergency medical admissions5 its overt commitment to continuing care as an …

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