Why is joint working important?
Successful joint working between health and social care staff is a vital component of improving the lives of vulnerable adults and children. Objectives of joint working include:
• Streamlining assessments and preventing families from having to give the same information to multiple professionals.
• Improving information sharing between professionals.
• Improving the efficiency of the care system as a whole.
• Co-ordinating the provision of care.
• Improving the planning and commissioning of care so that health and social care services complement rather than disrupt each other.
Types of joint working
There are a number of ways in which health and social care services work together:
• Multi-disciplinary services or teams including health and social care professionals, such as community mental health teams or child and adolescent mental health services. See our expert guide to multi-disciplinary teams.
• Joint commissioning of services by local authorities and primary care trusts or NHS boards.
• Pooled budgets across councils and NHS organisations.
• Structural integration of organisations, such as the creation of care trusts to provide or commission health and social care services or the establishment of joint management teams to run councils and NHS bodies.
• Strategic partnerships such as local safeguarding children boards.
Problems with joint working
Despite longstanding support for joint working, it has been beset by problems across all client groups. Examples include:
• Delayed discharges from hospital, mainly of older people. These involve cases when a patient cannot leave hospital because of the unavailability of health or social care services in the community or because of administrative issues within hospitals.
• NHS cuts to continuing healthcare. This has led to disputes between NHS and social care professionals and shunted costs on to councils, who often have to fund care packages for people no longer fully funded by the NHS.
• The break-up of community mental health teams. In some areas of England councils have withdrawn social care staff from mental health teams, run by mental health trusts, because of cost pressures or concerns over trusts’ approach to issues including adult safeguarding and the personalisation of care.
More generally, barriers to good partnership working include:
• Health and social care agencies facing different government performance regimes.
• Health and social care agencies using different IT systems.
• Cuts in one budget creating demand pressures in the other.
• Health and social care staff being on different terms and conditions in integrated teams.
Policy and legislation on joint working
Under section 75 of the NHS Act 2006, NHS bodies and local authorities in England can pool budgets, join together their staff and management structures or delegate commissioning responsibilities to each other.
The Local Government and Public Involvement in Health Act 2007 requires primary care trusts and local authorities to produce joint strategic needs assessments of the health and well-being of their populations. This should shape joint planning of services.
The Health and Social Care Bill would establish health and well-being boards in every local authority area to co-ordinate the commissioning of health and social care.
Under the NHS Reform (Scotland) Act 2004, NHS Boards were required to set up community health partnerships to co-ordinate the planning and provision of local health services, including mental health. In some areas, community health and care partnerships were set up, integrating the commissioning and provision of health and social care services.
The Scottish National Party government plans to integrate health and adult social care further through the establishment of lead commissioning arrangements, under which either councils or NHS boards will take responsibility for commissioning integrated care in each area.
Section 33 of the National Health Services (Wales) Act 2006 provides for health boards and local authorities to pool budgets, integrate teams and commissioning.
The Children and Families (Wales) Measure 2010 provided for councils and health boards to jointly establish integrated family support teams to support families where children are at risk because of parental problems, including substance misuse. These are now being rolled out across Wales.
The 10-year plan for social services, published in 2011, also includes plans to drive integration, for instance by requiring councils and health boards to jointly commission and arrange reablement services, to support people to regain independence.
In Northern Ireland, health and social care services are structurally integrated. All health and social care is commissioned by the Northern Ireland Health and Social Care Board, and most services are delivered by five integrated health and social care trusts.
Good practice in joint working
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