We asked for people's views on whether cultural differences prevent closer integration between social care and health.
To read a recent article on the subject click here
These are the comments we received:
"I believe that closer integration between social services and health can work. But at the same time, we must expect that change won't happen overnight. I feel that integration will allow for a better quality of service to service users as it will open the lines of communication. For too long we have worked in isolation that at the very thought of change will cause anxiety in each service. Yes, we may have different methods in how we work, but it's all about knowing each other's service and how it functions. The key to this is joint working: I believe this needs to be encouraged more."
Anonymous
"I am sure that better cooperative work between heath and social services practictioners will benefit clients, providing that adequate training is provided and comminication paths are clear. Yet another understaffed and under-funded initiative is the last thing that workers at the frontline need.
Mo Roberts representative of family members of ATD Fourth World
"I qualified as a nurse before qualifying as a social worker, and I can fully appreciated that health and social services are entirely different organisations culturally. Within health, there is a far more regimented regime, based around power and control. This is why I have chosen to remain within social work. Health is a culture that I have found to be bullying, oppressive and discriminatory (racism within the NHS for example is well documented), factors in fact the exact opposite to our core social work values and principles.
As a social worker, I have sat in on enough ward rounds to hear clinicians discussing “the stroke in bed 7” or the “Chronny-Bronny in bed six” (chronic bronchitis). Within the health culture seeing people as an illness is by far the norm. Within community nursing I have repeatedly seen these same views expressed, and again, the hierarchal pecking order seems to underpin all relationships within health. My experience has shown me that many nurses cannot wait to obtain progression to management posts because they are tired of being mentally abused by their bullying managers and let’s face it, health certainly can’t stop creating more and more management posts to be filled.
I would dearly love for health and social services to work closer together, but the approach by government of forcing such joint working and integration (through guidance, legislation and financial incentives) is not the way forward. Closer working could be achieved by staff developing a better understanding of each other’s roles, but the real challenge is to change the culture within health. Whilst that might have occurred with health having more social work managers, the reality is that joint teams predominantly have health managers.
It is certainly worth considering that forcing staff together does not necessarily make them work together as a seamless service. Ask a ward nurse if she can easily borrow a drip stand from the ward next door? Ask how well one specialist district nursing team works with another?
Social services and health can form closer working relationships for the benefits of the people they support, but the staff do not have to be based in the same office, or be employed by the same organisation to do so. Very good examples of joint-working exist, but these have occurred locally over time.
Finally, the issue of managers appointed to jointly manage health and social service provision: this is fundamentally flawed due to the need to manage budgets of two organisations, and we see more and more difficulties arising from this.
Under the NHS, care is provided free whereas local authorities have always financially assessed for their services. However, we see more and more care provided (and funded) by social services that arguably should be provided by the NHS. Many families are currently seeking compensation for the incorrect placing of relatives in LA funded residential care, following Ann Abraham’s (health ombudsman) four test cases in February. We now know that this is just the tip of the iceberg The final bill for compensation will top £300 million. We will see similar situations when community packages of care provided by social services come under closer inspection, as many LA’s are providing care that again is a NHS legal responsibility (health seeing more and more needs as a ‘social need’). It is difficult for social services to challenge, or seek judicial reviews of funding when the senior managers of both organisations are the same person.
To the casual observer, it might make great sense to merge
certain organisations. Perhaps we could amalgamate the police and
the ambulance service, because they both get called out together.
Come to think of it, why are the armed forces divided into army,
navy and air force? Surely they would work better if we made them
into one?"
Stewart Ford
