Behind the headlines

The only way to achieve truly integrated health and social care
is to introduce health care practitioners who cross the divide,
says a report from Labour think-tank the Institute for Public
Policy Research (IPPR). The practitioners, combining nursing,
occupational therapy, social work and home support, would focus on
providing intermediate care services for older people who do not
need to be in hospital. The report, The Future Health
Worker, says health care practitioners would be expected to
take a comprehensive health and social care history for each
patient, develop and implement care plans, carry out physical
examinations and diagnoses and co-ordinate services in health and
social care settings. A support role of health practitioner
assistant would also be created. The report recommends that the
roles be accompanied by major changes in training arrangements for
the health and social care workforce as well as measures to tackle
the two sectors’ pay differentials. Poor co-ordination between the
sectors has affected older people’s services, the report says, and
there have been persistent prejudices and stereotyping between the
respective professional cultures.   

Felicity Collier, chief executive, Baaf Adoption and
Fostering
“This proposal seems to assume that the assessment of an older
person’s needs for physical and emotional support requires the same
generic skills base as work which may then be required to implement
a care plan based on managing and delivering a package of services
– and that social work training is not required for either. Being
creative is one thing: using this to water down the skills base and
value of the social work profession is quite another.”

Karen Squillino, primary prevention co-ordinator,
Barnardo’s
“The report sounds to me as if the practitioners are going to have
to be all-singing and all-dancing. In theory, the idea is
justifiable as having a professional to work across the disciplines
of health and social care would ensure joined-up working. The
reality, though, needs to be considered. Is this just the IPPR
looking for a way to sort out the difficulties that have been
created by the disjointed multi-disciplinary working that has
failed people or could it be the way forward? I still believe
further efforts should be made to work towards a culture of health
and social care working independently yet collaboratively.”

Julia Ross, executive director for health and social care,
London Borough of Barking and Dagenham
“We keep hearing the buzzwords ‘whole systems approach’ which
broadly translates into seamless care and reduced boundary problems
between health and social care. In my locality, Cathy Mitchell is
using this as a driver to redesign the workforce, by creating new
teams with cross-cutting health and social care activities. New
roles and training will need to follow rapidly.”

Bob Holman, community worker at a project in Easterhouse,
Glasgow
“I’m opposed to the integration of health and social care roles in
this way. There would be an inevitable decrease in particular
specialist skills, and social work would lose out. I’ve just taken
my 97-year-old mother out of hospital because, although the
occupational therapy and nursing were good, the social work skills
of talking and counselling were missing. She needed more than
medicine, she needed care. I think things would get worse if we had
integrated posts.”

Bill Badham, development officer, National Youth
Agency
“It seems to me that there is a big difference between
joined-up strategic thinking across professional disciplines, which
is a good thing, and the blurring of specialist skills and
knowledge, which can water down the quality of service to older
people. The sub-plot of the report speaks of slow integration
between health and social care because of poor co-ordination, rigid
boundaries, separate budgets and discrepancies in pay. Those are
urgent managerial and leadership issues that need resolving – but
not by scapegoating front-line workers.”