THIS week our columnist Ruth Wishart reacts to an Advertiser letter-writer's view that the integration of health and social care services should be scrapped...

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I’m assuming he’s a medical doctor, rather than the philosophical variety, since his lead letter in last week’s Advertiser went on at some length about what he thought was wrong with health provision and how he thought it should be fixed.

One of his assertions was that the integration of health and social care was a thoroughly bad idea in the interests of neither service.

I quote: “Wads of taxpayer money are being wasted in a vain attempt to integrate health and social care. At one time, both were efficient, effective services. Due to the austerity cuts since the financial crash of 2008, both services have suffered and neither operate in an optimal way. Integrating the two failing systems will save neither.”

READ MORE: Taxpayers' money 'being wasted' on integrating health and social care

I think the technical term for such a blanket dismissal is ‘mince’. The idea that all would be hunky dory but for the cuts is at best simplistic.

The drive towards integrated services is not some sort of ideological fixation, but an acknowledgement that care of the sick, vulnerable, often elderly is a continuum.

Beds get blocked in hospitals because people who are desperate to be home can’t safely be discharged without a care package or home support.

The Audit Commission report on the progress of integration, published just over two months ago, looked both at what was working and what wasn’t.

Amongst the weaknesses they identified were failures of the joint boards to agree on matters like governance, and often a turnover in chief officers which was self evidently bad for continuity.

Unhelpful, too, was the practice of some councils and health boards to jealously guard their own purse strings not allowing for sound financial planning.

As the report puts it: “There is little evidence that councils and NHS boards are treating integrated joint boards’ finances as a shared resource for health and social care despite the requirement to do this in the legislation.”

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It was that silo mentality which the Christie Commission on public services identified when I served on it some years ago.

It took copious evidence from health professionals and other interested parties up and down the land. Yet it seems that some people still can’t get their heads round the obvious benefits of joined up strategic thinking.

But on the credit side, the Audit Commission’s report also came up with examples of good practice all over the country. Places where, instead of clinging to failed models, and fiefdoms, imaginative thought had been put into tackling the root cause of persistent problems.

Some prioritised keeping people out of hospital by beefing up community alternatives, some extended the joint work to housing departments trying to offer elderly patients a range of informed choices.

Some held regular multi agency case conferences pooling knowledge and facilities to look at needs and devise solutions.

All of the successful ones involved collaboration as a keystone, with health and social care professionals often working alongside third sector providers to optimise local resources.

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None of this is to argue that health and social care enjoy either the human or financial resources to function at optimum levels.

Keeping pace with demand and medical advances is a problem common to all developed countries.

And this week’s report on the closure of many care providing services in Scotland proves just how challenging the fiscal arithmetic now is.

There is still a mountain to climb.

But to suggest the answer is to halt the drive to greater joint working, and cross sector collaboration, is to take a Canute-like stance to the tide of progress.