Looking Back to the Future: Integrating Health and Social Care In Troubled Times Tom Forbes & Robin Fincham, Stirling Management School Paul Williams, Cardiff Metropolitan University

The context There is a long and chequered history of efforts to integrate health and social care in the UK A number of apparent benefits of integration have been suggested However, a combination of professional, organisational, financial, statutory and other factors have conspired against integration There is now a wide literature base offering theoretical insights and practical guides to assist policy makers, managers and practitioners on various aspects of integration 2

Health and social care integration One problem that has bedeviled the policy community is the rate and pace of repeated change and lack of stability Another problem facing people working with integration is that the notion itself lacks any universally understood meaning The frustration with getting integration to work in practice has attracted the attention of researchers and policy makers One reflection of this work is that it often favours a structural and institutional focus and arguably underplays the role of agency This resonates with the type of policy interventions that predominate in this policy field which assume falsely that structural changes will induce changes in behaviour in key actors The institutional environment is complex. Stated policy direction often underplays/states or deliberately glosses over the institutional role division among groups of providers and recipients

Integration is……. Micro – a diverse range of approaches to deliver care to individuals and their carers Meso – focusses on the needs of particular groups of individuals Macro – focusses on delivering care to specific populations 4 “Integration is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors. The goal of these methods and models is to enhance quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex, long term problems cutting across multiple services, providers and settings. The result of such multipronged efforts to promote integration for the benefit of these special patient groups is called ‘integrated care”. (Kodner and Spreeuwenberg, 2002: 3)

Scotland Partnership working and integration has a had a key role in health and social care policy since 1997 However, Joint Future in 2000 the key driver for the integration of health and social care services Community Health Partnerships continued on this theme and absorbed most of the JF initiatives on health and social care CHPs mainly a health driven agenda but some NHS Boards/Councils saw a greater opportunity for integration and several integrated CHP models emerged Community Health Partnerships now to be replaced by Health & Social Care Partnerships 5

Wales Health and social care agenda continues to be the subject of a range of legislative, organisational and policy drivers Welsh Assembly Government has chosen a distinctive approach to public services based on the need to be citizen-centered and client focussed Partnership the key delivery mechanism The aim is to enhance cross boundary working between organisations and sectors, integrate services and respond to citizen’s needs and views A number of health and social care partnerships established 6

7 Northern Ireland Experience of Integration Enhanced professional cooperation Efficient system for discharge from hospital Improved delivery of community care to vulnerable groups More efficient use of resources Improved focus on client need  ‘Junior’ Partner issues  Funding ‘locked’ in acute services  Engagement of Independent contractors ‘The need to continue to develop a ‘culture of integration ’. a ‘culture of integration ’.

Some common integration issues Acknowledgment of the need for partnership working Skepticism about the reality of partnership working Limited sense of interdependence between Health & Social Care staff Poor reward structures Trust important Confusion over role of committees Integration outcomes unclear Co-location has mixed benefits Partnership capacity Terms & conditions and professional and Line management Evidence needed of the benefits on partnership working 8

A process towards integration?? Identify appropriate relationships Understand the context Obstacles? Pull factors? Push factors?

Conclusions Managing in a partnership environments is materially different from other forms of organising Policy makers need to acknowledge there real differences between the health and social care sectors when it comes to partnership working Managers and practitioners must learn and practice leadership skills 10