Newly integrated health and social care
organisations can expect to see a deterioration in staff morale and
a rise in anxiety and stress among the workforce, researchers for
the Institute for Applied Health and Social Policy at King’s
College London warned this week.
findings of an independent evaluation of mental health services in
Somerset following the creation of the Somerset Partnership NHS and
Social Care Trust in April 1999 can be seen as a sign of what might
lie ahead for the government’s new care trusts, the first four of
which came into being last week.
Although findings from the UK’s
first combined mental health and social care provider reveal
benefits of integration for service users, any such benefits for
the workforce are far less obvious.
Questions also remain as to
whether the benefits to service users could have been delivered
without the transfer of social care staff to NHS
According to the findings, in the
first two years staff complained of increased workloads, an
“increased level of emotional exhaustion”, more bureaucracy, a
reduction in therapeutic contact time, decreased job satisfaction
and rising pressure on team managers.
workers, who were transferred from Somerset Council, reported that
they did not have the same levels of contact with colleagues in the
social services department as they previously had, and that they
felt service users no longer saw them as “independent enough”
because of their relationship with their health
were also concerns about working in a team where they were a
minority discipline, and about the loss of informal peer
supervision and its implications for newly qualified social workers
“who had never had the formative experiences of working in a social
However, the report acknowledged
that the trust had, nonetheless, come through the transfer of
employment of most social care staff “without any major personnel
problems or service scandals”.
Although staff reported
improvements in relationships between social care staff and health
colleagues on both a formal and informal basis, the report found
that “cultural differences” persisted.
was evidence in some areas that although relationships were
developing, the underlying affiliation to a health or social care
background continued to exist,” it said.
Locality managers said the
conflicting cultural expectations – which were not always viewed as
negative – continued to exist for three reasons: “Firstly, the
differences in the languages used by different professional groups;
secondly, the perceived threat of ‘managed service’; and thirdly,
another perceived threat, the diminution of the social care model
report suggested that, in Somerset, inadequate funding was provided
to prepare staff members for integrated service provision, and that
“generating positive attitudes towards joint working” was the
responsibility of training organisations as well as