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Graham Hopkins reports on how mental health service users in Somerset have their voices heard and receive a better service following the integration of social and health care provision.

Much head-nodding usually accompanies any theoretical policy discussion about the integration of services. The government has come down like a ton of bricks (so to speak) on the “Berlin Wall” between social and health care.

However, while some feel they are banging their heads against this particular metaphorical wall, the Somerset Partnership has advanced once more (than most) into the breach and is now leading the way.

The Somerset Partnership NHS & Social Care Trust, commissioned to provide mental health and learning difficulties services for adults throughout the county, formally came into being in April 1999. Three years on real benefits for service users are shining through, although not all staff appear to be convinced.

One member of staff who needs no convincing of the virtue of joint working is team manager Mark Sloman: “For example, in my team we’ve got eight nurses of varying grades and three social workers. We are one team: we meet as a team, we assess as a team. From a professional’s perspective it’s fantastic because you’re literally sitting next to community practice nurse colleagues and team doctors - so information about health or medication can be easily accessed. The quality of service this now provides for service users is much better.”

The fear of health staff being managed by social care staff and vice-versa is softened through experience and supervision. “There is peer supervision as well,” adds Sloman. “Social workers and nurses also meet separately. Social workers don’t give injections but apart from that there’s little difference between our colleagues.”

A critical and crucial success for the partnership has been the integrated care programme approach  combining the best parts of the social work care planning and traditional health care programme approach. Not only has it resulted in better shared information but it has cut duplication. “Administrative tasks have been cut in half: there were two care plans, two reviews, two assessments, two keyworkers. But it gives the service user greater clarity as well,” says Sloman.

This is no professional boasting either, as service users agree. “In the past you might have been banging your head off a brick wall,” says Robÿn Swiss. But now it’s more like ‘what’s the problem?’”

Swiss has been using mental health services since 1993 and has been a service user representative for two years. “I do a lot of meetings,” he says. “I’m a member of about half a dozen committees - most of them high-powered - and we are listened to. When I walk into a room I am treated as a qualified person by experience. And I like that.”

Swiss also approves of joint working: “It’s more homogenous since the partnership came together. You had social on one side and medical on the other. To be honest they still are in some cases. But it’s a lot better than it was.

“There wasn’t any service-user input when I first came to use services,” Swiss continues. “The professionals knew best. They were qualified and you were the subject. Historically, we’ve always been nutters - and once a nutter always a nutter. But that’s coming round now. It’s not so much what do you think or I think - it’s more what do we all think? We’ve proven that we can be just like them - just as they could be like us.”

Indicative of the centrality of service-user involvement is that Swiss claims to find it easier to get appointments with the locality manager than staff do. Sloman agrees: “This sort of open door policy is really about being accountable for the service we provide.”

Doors once closed are now open. Walls once impregnable are now crumbling. Increasingly for users and staff, the Somerset Partnership is showing that the more you break things down the more joined-up you can become.

- For more information and a pack call Mark Sloman on 01749 683 374 or e-mail: mark.sloman@sompar.nhs.uk

Background

Scheme: Integrated mental health services.

Location: Somerset.

Staffing: About 1,200 employees, including 700 nurses and 80 social workers.

Inspiration: An awareness of confusion for service users over health and social care responsibilities led to the commissioning of a review of mental health services.

Cost: About £30m.