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Land of boundary confusion...
Land of boundary confusion

The misery's over for social care managers. Well, not all of it, obviously, but the misery of waiting for the NHS to make up its mind about primary care trust (PCT) boundaries has finally ended.

Managers are bewildered over how the NHS came to decisions which have huge implications for its joint work with social care.

The director of one unitary council which has lost shared boundaries, known as coterminous, with the local PCT complains: 'If coterminosity was an objective, it should have been for all PCTs, not just 70% of them.

'Having been coterminous, it's really frustrating for us to be going backwards.'

One director in a county blamed politicians for setting back local joint work. 'In our neighbouring area, the Department of Health has caved in to pressure from two MPs and gone for two PCTs, paying no attention to the principle of shared boundaries.

'If they have not got the courage on this issue, what does it bode for the more politically difficult decisions they will have to make about hospital reconfiguration?'

One county director was luckier - but only moderately - despite receiving her wish of a single PCT covering the same area as her council.

'Sharing boundaries across our strategic health authority area has meant the management savings targets have not yet been met. This raises worries about further hits on services as the NHS locally tries to get to financial balance,' she warns.

And a good few social care professionals believe this latest reorganisation will not be the last. One county manager sees no logic in the new arrangement and fears it will have to be rectified, forcing yet another shake-up: 'Looking at the variation in size of the new organisations I'm sure that they will already be working on the next efficiency-driven model.'

Cash crisis needs treatment

Even in areas unaffected by the PCT restructuring, the NHS is still the main worry. In many parts of London, health deficits are leading to huge cuts in mental health services, threatening the financial agreements seen as integral to partnerships.

'The [health] white paper and partnership seem to have been forgotten with financial balance the one imperative. We are in danger of going backwards,' a director bemoans.

And in a county, one director said her local mental health trust was taking a disproportionate hit as the NHS tried to make savings. With the council's budget frozen, day services were likely to suffer.

So the message seems to be, the NHS is bad for your health at least it is if you make your living as a social care manager.

Views published anonymously. To join the social care Insider email:

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