A busy doctor's surgery in Bristol in 2002. The GP has just minutes in which to refer an elderly man suffering from a chest infection. The 85-year-old lives alone, but his condition does not warrant hospital admission. The doctor rings two residential care homes and a home care service. One puts him on hold, the second promises to call him back and the third line is engaged. He gives up and rings the hospital. The man does not need to be admitted, but the intermediate care system is so difficult to navigate that it is the easiest solution. In 2002, Bristol was experiencing on average 120 incidents of bed blocking a week. 

The same surgery today. The GP makes one telephone call to the South Bristol intermediate care service, a one-stop shop staffed by 30 health and social services staff. He is told instantly where there is intermediate care availability or whether a team can treat the patient at home. This year, Bristol has had an average 17 bed-blocking incidents a week, thanks largely to the new joined-up system. 

The improvement is the fruit of two years' hard effort by Bristol city council and Bristol South and West primary care trust (PCT) to integrate elderly care. The result has been an overhaul of intermediate care services for those who need high-level care without requiring hospital admission. The new centre opened this March in Knowle, south Bristol. This month a similar centre will open in the north of the city. 

"People didn't know who to phone - there was a scatter-gun approach to referrals," recalls Maya Bimson, intermediate care coordinator for Bristol South and West primary care trust. "A GP would call the different agencies for a space, so the simplest thing would be to send the patient to hospital. Now it's easier for practitioners, and patients get a better service." 

The integration championed in Bristol is at the heart of the government's reform of public services, exemplified by the Children's bill, which plans to bring together education and children's social services. Yet joined-up service delivery is at its most advanced in health and social services, thanks to the common aims of community care, according to Nigel Druce, strategic adviser for social care at the Improvement and Development Agency (IDeA). "In many ways health and social services are closer in philosophy than, say, social services and education." 

There has been a raft of government measures to bridge the divide between health and social services. The commitment to joint working was formalised in 1998 in the policy document Partnership in Action, later incorporated into the NHS Plan in 2000. The latter also granted £900m to boost intermediate care by 2003-04. 

The National Service Framework (NSF) for older people is the only framework to apply to social care as well as the NHS. Published in 2001, it introduced the single assessment process and encouraged intermediate care. 

The Community Care (Delayed Discharge) Act 2003 meant social services no longer charged for community equipment and intermediate care services, making it easier for councils to provide services jointly with the NHS. 

As of last month, integrated social care has its own tsar. Kathryn Hudson, director of social services in the London borough of Newham, was recently announced as the new champion in charge of developing a joint vision for the two sectors. 

For Bristol, the impetus for integration was to prevent readmissions, to reduce bed blocking and to boost community-based services. Bereft of a template on which to build the model, Bristol followed both the NSF and the recommendations on delayed hospital discharges from the NHS change agent team. Bimson says the service was shaped mainly using feedback from practitioners and patients. 

With an annual budget of £3m from Bristol North PCT, Bristol South and West PCT, social services and Avon and Wiltshire Mental Health NHS Trust, the service supports 4,000 people and 200 staff. These include psychiatric nurses, social workers, physiotherapists and occupational therapists. 

Representatives from each specialty meet every morning to review referrals and coordinate services. Provision includes an acute rapid response service for intensive, short-term home care, community rehabilitation teams for settling people back into their own homes and a resettlement team that offers up to two weeks of support for patients after they leave hospital. "The beauty of the service is that we can mix and match care to suit the patient," says Nikki Cole, intermediate care manager for Bristol north social services. 

Typical cases include a recently discharged elderly person whose leg is in plaster and who needs resettlement visits alongside physiotherapy sessions. 

Staff carry out joint assessments and a copy of the file is kept at home for easy access. Previously, patients might have been visited by four different practitioners, with four different files, at four different times. 

Bristol is proud that the service has become so streamlined in such a short space of time. A full evaluation has yet to be carried out, but in the future other agencies may feed into the sys tem. Bimson is especially keen on getting the ambulance service on board. 

As for the national agenda on social care, the minister for community care, Stephen Ladyman, is expected to reveal plans to integrate adult services this summer. It is anticipated to be on a par with the government vision for integrated children's services. 

It remains to be seen whether this will lead to the full integration of adult and elderly social services. But is the integration of elderly services really necessary? 

The IDeA's Druce thinks not. "The government's been more successful than it realises," he says of the integration agenda. "I don't feel there's a need to formally integrate elderly services". 

Cole in Bristol agrees that the NSF is sufficient. "We've had a lot of pushing towards integration. It would be nice to be able to allow the efforts to bed in before making more changes." 

For the moment Bristol is happy to reap the rewards of its joined-up scheme. "It's made my job much easier," says Cole of working alongside her health counterparts. "We can communicate with each other and share resources and skills." 

Job satisfaction might also boost recruitment and retention: "There's an excitement about integrated care that means more people are keen to work within it," says Bimson. "We all feel it's a buzzy place to be."