Monday, 23 January 2012

Why we should talk about collaboration not integration

Why we should talk about collaboration not integration:

Helping health and care workers understand one another's roles in a positive spirit has inspired more focus on patient outcomes

New governments always believe that integration of health and social care will solve all the problems of underfunding of care for older people, continuing health care and blocked hospital beds.

Earlier this month, David Cameron echoed Frank Dobson's rallying cry in the 1990s to "bring down the Berlin walls" between us.

Do ministers think we want a system which has so many perverse incentives in it, so many changing policies and so many different funding routes?

What really lies behind their real frustration with the system is that social care is not part of the same command and control structure as the NHS, so we cannot be directed in the same way as our health colleagues, although there are many attempts to do so.

The statement by the Association of Directors of Adult Social Services and the NHS Confederation was spot on - it's all about relationships, co-working, shared caseloads, but most importantly it's about individual clinicians and managers understanding the whole system – and not just their bit of it – on both sides of the house.

We have done some work recently in our area which has been very intensive and very illuminating.

At one of our hospitals, we gathered some key people: GPs, consultants, nurses, social workers, community health and mental health colleagues. The task was to "sort out" the elderly frail care pathway, but it was done in such a way that it challenged us all to work differently, using trust exercises, team games and lots of honest discussions.

Some found it hard and felt there was too much navel gazing, but the results speak for themselves. The way we work together has been transformed: the consultant and the social care team leader are now working together closely ("It's not social services' fault," he has been heard to say), daily multi-disciplinary team meetings are held with our social workers via laptops to enable them to be part of the team working 8am to 8pm and every weekend.

From a situation which was in escalation most weeks during the winter last year, we now have a completely different approach, and it is entirely down to taking the time out to understand each other's responsibilities and pressures and be challenged about the way we talk to each other.

It is time we need to build relationships, understand each other's roles and manage the work together, not hand off and blame each other.

The system needs strong, inspirational leadership which is focused on outcomes for patients – not targets and tariffs – to enable different professionals to work together in a complex system, leadership which sees the need for people to have the time to invest in getting this right. It's not done in a day at a "whole system workshop".

We don't need organisational change to achieve this. It saddens me to see social care being transferred into the NHS as part of a care trust. The role of social care is to be the voice of a vulnerable person when they cannot make themselves heard – for example, when they might be medically fit but not fit for discharge as arrangements are not in place. Independence and integrity are key if we are to ensure a social model of disability is maintained in such disabling environments.

So let's have another pause and take the time to think what is it we are trying to achieve between health and social care professionals and whether it will be delivered by "integration" or by simply good, empowered leadership and effective, multi-disciplinary working.

Let's also make sure integration is not a way of making the latest health reforms affordable by giving the NHS responsibility for social care.

This article is published by Guardian Professional. Join the social care network to receive regular emails and exclusive offers.

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