I’ve been thinking a lot about the linkage between health services and social care services just recently for two reasons; a) Alex and I are writing a presentation on collaboration and leadership that we are going to give at a health service conference later in the year and b) my mother has just been discharged from hospital following a successful hip replacement operation.

At one level there are some big strategic questions that the NHS and Government (both Local and National) need to address about aligning organisational responsibilities and allocating budgets – but at another level you just need to know precisely who is going to turn up when to change a dressing and help wash and shower someone you love.

I have had every confidence in the quality of the individual procedures that various doctors and nurses have performed for my mother over the last few weeks. But I’ve come to realise that the point of vulnerability is always the connection between one action and the next. Looking at the collaboration, the quality of individual transactions has been (mostly) excellent – but who is looking after the relationship between the patient and the totality of the case they need (and receive) and making all the handovers and connections work. Well in my experience that is down to the patient themselves.

Like it or not the UK now operates a fragmented health and social care system with multiple NHS, charitable and private sector suppliers offering valuable individual services – but to join them up in a seamless chain of care for an individual takes a lot of time and effort. And expecting the patient to do that for themselves – especially when they are suffering the after effects of surgery or other treatment just isn’t going to work.

David Archer