Addressing the Association of Directors of Social Services, Mr Malone announced publication of a finalised framework of accountability for fundholders which should strengthen working relationships and cooperation between health authorities and general practitioners and with other agencies both inside and outside the NHS, including social services departments.
'The framework puts emphasis on joint working between agencies and individuals, not the old command and control arrangements of the past. It reinforces the need for partnership, not just between health authorities and GPs, but between health and social services,' Mr Malone said.
The framework deals mainly with GP fundholders' management accountability and their accountability to patients and the public.
'The framework emphasises the principle of GPs using their knowledge and judgement to best meet patient's needs. It provides the basis for the further development of effective partnerships between health authorities and GPs, and provides a strategy for joint working at local level between health authorities, fundholders, primary health care teams and social services departments.'
Mr Malone said that the NHS Executive has been developing with GPs and NHS managers a training package based on a workshop approach and how the framework might apply in different situations in practice. More details would be announced next month.
Turning to the importance of stronger working between social services and the health service, Mr Malone said:
'There is a common agenda between health and social services. Entrenched organisational apartheid is now a thing of the past and I am pleased at the increase in joint working across agencies since the introduction of the NHS and Community Care reforms.
'If developed effectively this can bring substantial benefits most importantly for the people who need health and social care, and the agencies themselves.
'Partnership is crucial. The people served by both health and social services must be able to expect coordination and cooperation in the services they receive.'
Emphasising the need for effective joint working between agencies, Mr Malone rejected major changes to existing structures. Instead what is needed is 'greater value being placed throughout our organisations on a commitment to joint working as a means of achieving common goals.'
Mr Malone said that issues such as continuing care would require health and local authorities and others in the NHS 'to take an increasingly proactive approach to joint commissioning if resources are to be used most effectively across agencies.'
He said that the department of health would issue very shortly comprehensive practical guidance which looks at matters involved in joint commissioning between health, social services and housing agencies and identifies some of the benefits which can be realised.
'An important shared priority for the coming year will be the development of local community care charters,' he said.
'The NHS is expected to play a full part in developing effective local charters using its experience of implementing the Patient's Charter.
'Effective partnerships between fundholding practices and social services are already being developed in some places. For example:
- a fundholding practice in Beckenham, Kent, has just completed a six month pilot with a local social services department involving a social worker attached to the practice to carry out assessments of patients likely to require social care
- in Runcorn, Cheshire, a fundholding practice together with the FHSA and the social services department have jointly appointed a social worker based in the practice to carry out assessments on elderly patients.
'Over the next few months we will aim to work closely with you and other interests in social services, general practice and health authorities in considering more thoroughly the implications of primary care led purchasing for community and social care.'
Mr Malone answered criticisms that the government's recent guidance on continuing care takes away people's entitlements to NHS care.
Mr Malone said: 'This criticism is clearly wrong. There has been a longstanding boundary between health and social care which has existed since the creation of the welfare state.
'The guidance does not change that boundary, rather it reinforces and clarifies the responsibilities of the NHS in this area.'