Integration of health and social care: A social work perspective

Outline Make my perspective clear Look at the drivers for change Ask questions about professionalism Summarise the research evidence

My perspective Registered social worker Practice and management background, including partnership working “Late onset academic” Part-time secondment to GCU Involved in inter-professional education

Would we have started from here?

Drivers for change Demographics (more over 65’s than under 15’s) Improving outcomes Personalisation Putting leadership at the heart “Perhaps most ambitiously, it is about establishing a public service landscape in which different public bodies are required to work together” (Scottish Government, 2013)

Drivers for change Money £4.5 billion on health and social care for over 65’s Emergency admissions £1.4 billion 7% spent on care at home

Scottish Government position (Feb 2013) Intention to legislate, including for outcomes Political accountability Financial “It is therefore our intention, as respondents have suggested, to legislate for a duty on Health and Social Care Partnerships to ‘engage with and involve’, rather than merely to ‘consult’ local professionals”

Lessons from England Integration needs to start from a focus on those who use services Crucial importance of leadership Policy should be tight on ends and loose on means Integration takes time to achieve Importance of evaluation (Ham and Oldham, 2009)

Professionalism

Petch review Social services for adults have delivered major achievements – de-institutionalisation – greater choice and control by the individual At the same time there has been recognition of key areas such as needs of carers and dementia

Petch review (2) repeat and emergency hospital admissions enduring issues at the boundaries between systems, most notably between hospital and community a strong body of evidence demonstrating that structural integration between health and social care does not deliver.

Different or the same? Pessimistic model distinctiveness of trait distinctiveness of knowledge distinctiveness of status distinctiveness of power distinctiveness of accountability distinctiveness of culture Optimistic model commonality of values commonality of accountability commonality of learning commonality of culture commonality of location commonality of case (Hudson, 2007) 12

Old or new? Old Professionalism Mastery of knowledge Unilateral decision process (Patient as dependent /colleagues as deferential) Autonomy and self- management Individual accountability Detachment Inter-changeability of practitioners New Professionalism Reflective practice Interdependent decision process (Patient as empowered /colleagues involved) Supported practice Collective responsibility Engagement Specificity of practitioner’s strengths (Hudson, 2007) 13

Old or new? Old care model Geared towards acute conditions Hospital centred Episodic care Disjointed care Reactive care Patient as passive recipient Self care infrequent Carers undervalued Low tech New care model Geared towards long-term conditions Embedded in communities Team based Integrated, continuous care Preventative care Patient as partner Self care encouraged and facilitated Carers supported as partners High tech (Petch, 2011) 14

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References Ham, C. and Oldham, J., 2009, “Integrating health and social care in England: Lessons from early adopters and implications for policy, Journal of Integrated Care, vol. 16, no. 6., pp Hudson, B., Pessimism and optimism in inter-professional working: The Sedgefield Integrated Team. Journal of Interprofessional Care, 21, 1, Petch, A., 2011, An evidence base for the delivery of adult services, IRISS, Glasgow. Scottish Government, 2013, Integration of adult health and social care in Scotland consultation: Scottish government response, Edinburgh, Scottish Government.