The health and social care divide in the United Kingdom

Catherine Henderson 1. INTRODUCTION The health and social care ‘divide’ is a difficult issue. The problem has been depicted as a ‘sterile argument about boundaries’ that creates a poor experience of care, a poor quality of care and a poor use of public money, and the cause as a disproportionate focus on the needs of organisations (cf. ‘Partnerships in action’, Department of Health, 1998). Expressions of concern over such barriers and ‘a culture of separatism’ between the health and social care systems continue to pepper more recent ministerial discourse (Burnham, 2010; Hope, 2010). The ‘divide’ is a complex or even ‘wicked’ problem (Rittel and Webber, 1973) that can only be framed in terms of its proposed solutions, making it difficult to define and, therefore, to tackle. Other countries face similar challenges in addressing the question of how to bridge the health/social care boundary, a question that, however vexed, demands public and political attention in the face of growing demographic and budgetary pressures (Bergman et al., 1997; Leutz, 2005; Mur-Veeman et al., 2008). The following section will consider the policy literature on health and social care relationships in the UK for an analysis of the causes of the divide before turning to a discussion of the consequences for the users of health and social care services and for the wider public. The rest of this chapter will consider the remedies proposed to ‘bridge the divide’ at the macro-, meso- and micro-levels, examining the international and UKspecific evidence...