Features: February 10th, 2017

Achieving the vision of health and social care integration calls for a shift in culture and a new way of working, suggests Mark Raeburn, who examines the thoughts of seven directors of adult social services on the topic.

The debate about how best to bring together health and social services has been a feature of local authority agendas for some time. But with demand for both services looking set to increase in the years to come, the question of integration has taken on a new urgency.

As we get nearer to realising the vision of health and social care integration, professionals from both services are looking at how to make a joined-up service offering work successfully.

This was a central topic for discussion at a recent roundtable event hosted by Capita One in partnership with the Association of Directors of Adult Social Services (ADASS). On the day, seven directors of adult social services gathered to share their vision of integrated health and social care and to explore the barriers and opportunities in bringing the services together.

The best of both

A key concern expressed by professionals working at all levels in social care is around how to retain the cultural differences that exist between the two services once they are operating in closer partnership. Having worked for many years in parallel, the health and social care sectors have developed their own particular characteristics and values, so does it make sense to preserve these qualities rather than lose them in an integrated future?

David Pearson, director of adult social services at Nottinghamshire County Council says, “If we think about the NHS over the last 70 years, what it has done incredibly well – alongside changing lifestyles – is keeping us all alive for longer. Health is not set up to look after the wider needs arising from disability. Social care, on the other hand, is set up to do this along with housing and other partners.”

There is also the view that social care needs to ensure its own strengths are recognised and valued, by knowing what its core role is. As Liz Bruce, director of adult social services for the London Tri-borough councils, explains. “It is important that social care’s identity is not lost in the rush to integrate. We should be clear about our ask and our offer in social care. The strengths and skills that you have if you mix up health and social care are tremendous if we get it right.”

While there is agreement that successful integration should bring out the best in both health and social care, senior leaders also highlight the need for services to embrace collaborative working in a way that achieves better communication between teams.

Lines of communication

Fundamental to the success of health and social care integration is relationships that are built, nurtured and sustained by the people in them.

This view was backed up by the results of a recent survey* which examined whether the challenges to health and social care integration were perceived to be cultural or technical. When questioned, nearly twice as many local authority leaders (65%) felt the greatest challenge was the cultural shift for the people involved, than the challenge of bringing systems together (35%).

As John Powell, director of adult social services for the London Borough of Redbridge, explains, “Where integration and joint working is successful, it is because of long-standing arrangements with relationships between people in the various organisations.”

If relationships are not already in place, then they need to be created, and encouraged to flourish. “We’ve intentionally gone into GP practices, starting dialogues in the localities and working together,” explains John Powell. “GPs, district nurses and social workers are all working together, bumping into one another. What we’re now trying to do is build on the existing relationships we have.”

By establishing a strong joint working ethos, both health and social care will be better placed to meet the needs of vulnerable people and provide the right levels of support for them.

Making it happen

But health and social care will only be able to work more closely together if they have the means to share vital information about the people they support, so the challenges around uniting software need to be addressed. Practitioners need to be able to access the relevant data about vulnerable people in their care, and to exchange information with their fellow professionals in different teams simply.

“There’s plenty of unexplored potential in technology, but there are plenty of hurdles to overcome first. Not least getting data sharing right,” Grainne Siggins, director of adult social services at the London Borough of Newham points out.

The advent of software which makes it easy for authorised people to gain access to real-time data from different agencies could be a game-changer in the move towards health and social care integration, but it is critical that these systems are developed with collaborative working in mind. As David Pearson states, “It is important that, for social workers and health professionals, it feels as if it is one integrated system rather than multiple systems.”

With the right tools, health and social care practitioners can access timely information that can help them to address people’s needs more swiftly and effectively. If an elderly person has been in hospital following a fall, they may need medical treatment as well as aftercare provided by a social worker when it is time to return home. Effective data sharing between the two services could make all the difference to the quality of support and help vulnerable people to not only recover more quickly, but also retain their independence for longer.

But information sharing is just one piece of the IT jigsaw. Technology is also playing a key role in helping people to manage their own needs in the community, where this is appropriate. Devices that are capable of remotely monitoring patients’ wellbeing, and enabling them to access immediate contact with services in an emergency are becoming more widespread. This could help ensure people can remain in their own homes and may reduce the need for more costly support in some instances.

Innovations such as these could go a long way towards helping health and social care manage what could be a steeply rising demand for their services in the future and play a role in improving the quality of people’s lives.
While technology is developing at a brisk pace, and exciting innovations make information sharing simpler, the success of health and social care integration rests with the people who work in these services every day. It is therefore vital that the future of these services is shaped to support this.

To read the full local authority interviews, visit www.capita-one.co.uk/PublicNet

Mark Raeburn is managing director of Capita One

The survey was carried out by Capita One