What makes good joint working? Anabel Unity Sale talks to three pairs of practitioners from health and social care who have forged successful partnerships
Making any relationship work requires good communication and commitment. The government’s health and social care white paper, published last year, pledges to draw together the professions to meet the needs of clients more seamlessly. The interaction between the professional groups has sometimes been at odds, as they approach clients from their different perspectives. We speak to three sets of practitioners who have overcome these difficulties to achieve successful team work.
Suzanne Watts, a social worker in the integrated transfer of care team, Greater Peterborough Primary Care Partnership, and Pauline Thompson, a registered nurse and the team’s co-ordinator.
In post since 2004, Watts is responsible for assessing clients’ future social care needs while in hospital. Before this job she had never worked with health but now works alongside many health staff, including nurses and physiotherapists.
One health colleague Watts works closely with is Pauline Thompson. Together they discuss cases and decide who does what for the client: “We are both working to the same end, to a safe and timely discharge to the client’s home or where they want to go.”
Watts is positive about what working with Thompson has done for her practice. “I’ve found it useful because it’s been a new learning curve. Sometimes you look at a case from your own perspective but when you’ve got a health colleague chirping in about health it makes you consider the broader picture of the client’s needs.”
One problem she faced was the use of medical terms and abbreviations. Now all practitioners in the team spell out exactly what they mean during their assessments to avoid confusion.
The buck stops with Thompson when it comes to clients’ care packages and she works with Watts to identify them. Although she has a good working relationship with her social work colleagues now, when she started her post in 2005 there were obstacles to effective joint working. “As a nurse I felt there were barriers between health and social care because they’d never had the closeness of working together before.”
She says nurses are used to working with a variety of professionals, although nurses’ passion for their patients is often mistaken for bossiness by social workers. “We promote advocacy with patients and I felt social workers thought we were being a bit forceful. Sometimes social workers weren’t receptive to what I was saying, as if they were questioning what I would know about social issues.”
But both sides overcame these problems by learning to understand and respect each other’s profession. Thompson feels strongly about the benefits of team working across professional boundaries: “It is a joint and combined effort to do the best for the client.”
Nicola Read, senior practitioner and mental health officer, and Carol MacBeth, community psychiatric nurse (CPN), for Edinburgh Council’s south west community mental health team.
Read has a caseload of 25 clients. She assesses their mental health needs and works with Carol MacBeth on specific cases requiring the input of both practitioners.
Read and MacBeth are based in the same office, which makes communication easier. Before working jointly with health, Read says sharing information was much harder but the development of shared records has enhanced the process.
At first she was concerned that the philosophical divide between health and social care would be more obvious and dictate how they practised. “I thought there’d be bigger challenges with health than there have been in their approach to clients – that it would be more of a medical approach. But that has been a lot less of an issue.”
She has noted health and social care workers often have many shared values and she and her social work colleagues have identified these through spending time finding out what their health counterparts actually do. “We all face the same sort of problems in different professional settings: access to support and layers or bureaucracy. If we are working together it’s easier to improve the quality of life for our clients.”
MacBeth has a caseload of 21 patients, some jointly with Read. She acts as a key worker for some patients and is responsible for their medication. She and Read see each other daily when they have handover meetings in the morning and in the afternoon if case issues arise. Together, they attend clinical meetings once a week to discuss certain patients and meet formally every three months with the other practitioners involved in a case to review it.
Such constant interaction with her social work colleague makes her job easier, as MacBeth says any problems are highlighted quickly. “I’ve never had any difficulties because we always sort who does what with a case. We’ve had to be collaborative and share out the workload and not try and do everything ourselves.”
This approach to working has taught MacBeth about how social workers function, something she was not completely aware of as she comes from a registered mental nurse background. “Working with a social worker helps you be more open-minded about what you might do with a patient. Social workers’ training is different to ours and it’s really helpful to see this.”
Deni Balban senior practitioner Camden Council social services department’s community rehabilitation team, and Charlotte Elworthy, a head occupational therapist for Camden Primary Care Trust.
When Balban joined Camden in 2003 she did so because it was a multi-disciplinary team. Having graduated with a BA in community care studies and a Diploma in Social Work in 1996 she knew she wanted to work closely with other practitioners. Balban has a caseload of eight older people and works on some of the cases with team member Charlotte Elworthy.
Balban has been involved in creating a development group to steer the community rehabilitation team. The team has also had to find a common language and make sure they are aware of the work their colleagues are doing, much more so than in a uni-disciplinary team.
The problems she has encountered have not been down to health practitioners but because of the confines of the system in which they work. “Individuals aren’t a problem because we talk things through, it is the pressure on hospitals to discharge people into the community before they are ready. We tend to pick up people who shouldn’t have been discharged.”
Camden’s community rehabilitation team comprises 40 inter-professional staff and operates four projects. As well as being part of the team and liaising with Balban about particular clients, Elworthy is also responsible for co-ordinating the eight residential rehabilitation beds at one of the projects.
Having qualified as an occupational therapist in 1971, Elworthy has worked in social services departments before and has experience of the medical and social model. The main skill working alongside social workers has taught her is to find out as much as possible about the client “before you go charging in to meet them”. She says: “Time spent in reconnaissance is worth it, as my grandfather used to say.” She has also discovered that her preconceived idea of what social workers do from nine to five was wrong, as they provide specific help in the community and are not “all singing and all dancing”.
The difficulty Elworthy has discovered while working alongside social workers is that their practice is dictated so much by available resources.
“I find it quite hard that social workers are driven by their financial restrictions. They have to work within fair access to care and sometimes these can’t be met financially despite the work they put into an assessment.”