Social workers ‘must join renewed effort to integrate care’

Social care professionals should be at the heart of multi-disciplinary teams in every area to manage the care of people with long-term conditions and make a reality of integrated care, the government has been told.

This “new capability” should be backed by a transfer of resources from acute hospitals into social and primary care care to provide better community support for adults and children with chronic or multiple needs, with more investment in preventive and reablement services to help people stay independent.

The ideas were put forward in a paper for the Department of Health by influential health think-tanks the King’s Fund and the Nuffield Trust, which called for urgent action to make integrated care “the main business for health and social care”, to improve patients’ experiences and improve efficiency.

Report author Nick Goodwin, senior fellow at the fund, told Community Care the proposals were designed to prevent patients “falling through the gaps” or getting stuck, inappropriately, in hospitals.

He said that he envisaged councils and NHS clinical commissioning groups jointly commissioning community multi-disciplinary teams, including social care and health professionals, based around federations of GP practices, who would co-ordinate the care of people with chronic or multiple needs.

Each service user would have their own case co-ordinator. “You can see this being managed by a range of people,” he said. “If it’s someone with dementia or a mental health problem the care co-ordinator could be a mental health professional; if it’s someone with a physical disability, it could be an OT.

“They need to have two skills: being able to manage the care of the person and being able to co-ordinate the person’s needs across a range of settings.”

GPs would refer patients on to the teams while they would also identify patients in need of support in managing their conditions to avoid hospital admissions, he said.

Goodwin said previous examples of case co-ordination for people with long-term conditions had not worked in many cases because social care had not been involved, health staff had not worked together effectively and there had been problems identifying patients who would benefit.

He said progress in integrating care more generally had been hamstrung by several issues, including a lack of government leadership, and professionals and organisations not being incentivised to work together. “The past is littered with well-meaning schemes to integrate care but they have not had the sustainability because partners are incentivised by different things which take precedence over the more important issue of improving the care experience of the patient.”

“This does not just result in a bad experience for the patient but it is incredibly expensive as you have people using up hospital beds rather than living independently in their own homes.”

However, he stressed that successful integration had taken place in some areas, demonstrating that it was possible.

Today’s report called on the Department of Health to drive forward integration by setting a “clear, ambitious and measurable goal that is linked to patients’, users’ and carers’ experience of integrated care and that must be delivered by a defined date”.

However, the think-tanks said none of this required “structural upheaval” or the organisational merger of councils and NHS bodies, such as the creation of care trusts, and said there should be flexibility to try different approaches to integration in different areas.

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