Given the challenges faced by health and social care in dealing with the omicron virus it would seem more important than ever that we continue to move closer towards an integrated service. With this in mind, I read with some interest the article by John Connelly Professor of Public Policy at the University of the West of Scotland (UWS)into the integration of health and social care.
He points out that the idea to integrate public services has been a trend across western Europe relatively long before the pandemic. In Scotland, for example, a flagship social policy centres on the need to integrate social care, historically managed by local government, with healthcare – historically managed by the NHS. The desire to integrate these two key services has been ongoing since 2016, commanding widespread political support.
Europe-wide research, including some from Scotland, has highlighted the leadership and management challenges around the issue. From these studies, seven key lessons have emerged that will help to ensure the successful integration of two of our most important public services.
Seven key points
John Connelly has identified seven key points that will need to be addressed if we are to achieve a joining up of health and social care:
1. Proper political support is required
Without sufficient central government support, innovative and creative attempts to integrate often fail – as happened with the UK’s Sure Start children’s centres. A programme designed to improve the prospects of children in deprived areas, its ring-fenced budget was removed and the initiative suffered from cuts. This led to a sharp fall in the numbers of children attending and benefiting from Sure Start – many of whom lived in the poorest areas of the country.
This is what happens when government – central or local – takes a hands-off approach to the integration of health and social care and bears no responsibility for its progress (or lack of it) at local level. Government must be held to account for the way it rolls out and maintains national public policies.
2. Community involvement is key
Support from local groups and community involvement is a predictor for success in integrating these services. Although health and social care partnership areas can help local groups and organisations work together, concerns have emerged over quality and accountability of services once they are outsourced to other sectors.
3. Professionals must be prepared to integrate
Sometimes of those working in health and social care are reluctant to integrate. Professional boundaries relating to differences in status can create friction. Differing health backgrounds – some based on medical training and some based on social care training – are often barriers to professionals coming together.
A mismatch in cultures, behaviours and understanding of services can create a divide between health and social care. This in turn, makes it harder to establish a clear purpose and agree on longer-term objectives for integration.
4. Shared values and goals are fundamental
For services to work together successfully, there needs to be a common purpose. Strong, effective partnerships depend on the commitment of those taking part. Defining a clear purpose at all levels is key, as well as clarifying roles and responsibilities to engender trust, understanding and respect.
Policymakers must listen to frontline health and care workers and learn from their experiences.
5. Clarity: accountability, communication and data sharing
Strong relationships and effective communication are key to successful integration. In practice this means both at worker-to-worker level and worker-to-client level. Collaborating and sharing relevant information between agencies requires shared management systems with common IT systems and formal agreements on things such as data sharing and constructive performance management systems.
6. Short-term funding doesn’t work
A long-term funding model is crucial for effective inter-agency working. For integration to work, there needs to be sustained funding through budget sharing, realistic staffing and timescales – with time built in for planning, and proper support. Insecure funding is a barrier in the long-term.
7. People need to know if they’re getting it right
Developing the skills of managers in health and social care is important because not everyone possess the tools to evaluate what actually works. Often there is heavy focus on performance monitoring over investigating the actual changes that have emerged from integration initiatives.
Summary
Research across Europe has shown that there is the political will for integrating health and social care services, and in the UK, there is a strong trend in this direction. But if it is to be achieved, policymakers need to listen to those on the frontline and demonstrate that their knowledge and experience are valued and provide ringfenced funding accordingly. The seven points identified by Connelly will need to be addressed if the general public are to receive a joined-up service where it is needed most.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy