MEETING PERSONAL HYGIENE NEEDS IN THE COMMUNITY - A DISTRICT NURSING PERSPECTIVE ON THE HEALTH AND SOCIAL CARE DIVIDE

The difference between health and social care is almost impossible to define, not least because 'health' is socially defined; and people wit h 'social' needs inevitably have some medical or health related proble m. The two are intricately, perhaps irretrievably, intertwined. In spi te of this, there has been a requirement to arrive at definitions of h ealth and social care, which has been driven by NHS reforms embodied i n the NHS and Community Care Act (Department of Health 1990). The nati onal picture for the provision of health and social care is an inconsi stent one, with some authorities jointly commissioning services, other s jointly assessing clients for services, and the remainder where coll aboration between the two services is either embryonic, or simply not happening. The health and social services have experienced immense uph eaval in recent years, which is Likely to continue for the foreseeable future. Against this backdrop, the following paper presents an import ant consequence of the community care reforms, which is the re-definit ion of certain aspects of district nursing work as 'social care', focu sing particularly on the elusive 'social bath'. The data presented in this paper comprise part of a larger, ethnographic study of district n ursing work in which 37 district nursing sisters were interviewed in d epth, following 13 days of participant observation of 130 home visits. Illustrative extracts from the data are presented and interpreted, an d the likely professional implications of the findings are discussed.