Recently in Joint working Category

The adult social care sector in England suffered a double blow in yesterday's Queen's Speech: there will be no legislation to reform social care in 2012-13, as had been expected, merely a draft bill; and the Department of Health's notes on the draft bill contained not one mention of to create a sustainable funding system, the sector's highest priority.

A report today sets out a pessimistic prospectus on the future of social care on the part of a group of service users and raises questions about how far users are being listened to as the government prepares its White Paper.
It is published by the Joseph Rowntree Foundation and based on research by user-led network Shaping Our Lives and the Centre for Citizen Participation at Brunel University conducted with a cross-section of 27 users. Crucially, the research, conducted in November, was designed to feed into the government's "engagement exercise" to inform the White Paper, due in June.

Here are some of the key messages:-

• The social care workforce is patchy and unsuited to delivering high-quality support.
• Personalisation is being derailed by cuts and inadequate support for people to manage their own care.
• Preventive services are being cut, leaving people to deteriorate.
• User involvement is being undermined by cuts.
• The welfare reform debate is breeding hostility to disabled people.
• Social care should be free at the point of need and paid for out of general taxation.
• The private sector financial services industry should not have a greater role in providing social care insurance to people funding their own care.

I'm not sure how representative these service users are but these messages are seriously at odds with what is likely to emerge from the White Paper. Most of these issues can only be addressed by substantial extra investment in adult care and the public spending trajectory up to 2017 and beyond is downwards. 

Despite this, the White Paper will very much be couched as a manifesto for service users, designed to create a social care system that responds to them more personally and does more to improve their well-being.

Good Guardian piece this morning about bringing together health and social care from Pollyanna Perkins, aka a "director of adult social care for a large local authority".

Here's the secret of success in her view: "It's all about relationships, co-working, shared caseloads, but most importantly it's about individual clinicians and managers understanding the whole system - and not just their bit of it - on both sides of the house."

She then cites experience of this working in her area and now social workers are having daily virtual meetings with health colleagues to discuss older people on their joint caseloads.

What good joint working isn't about she says is structural change.

This is a particularly good articulation of a longstanding position. However, it often seems to me that for every person who makes the argument that good joint working is all about relationships, you will find another who will say that dependency on relationships is a dangerous thing. That when people move on, good joint working moves on with them.
We linked to a blog articulating this position from consultancy iMPOWER recently, which made the case for some level of structural change to secure joint working against dependency on particular individuals.

I am sure there is something in both these positions.
That you need strong relationships and also some rules in place to ensure security when people move on.

The secret to both appears to be strong leadership - a point made by Pollyanna Perkins - so the question is whether those leaders are working in local government and the NHS today or not. And if they are, what happens when they move on?

Another day, another report on integration for the government, this time from the NHS Future Forum (the advisory body set up to inject common sense into the government's NHS reforms).

The proposals are pretty similar to those put out in last week's report from think-tanks the King's Fund and the Nuffield Trust: strong support for social care and the NHS to be measured against the same performance indicators, for pooling budgets and commissioning and for building services around patients' needs.

Notably, for professionals, there is a call for every person with long-term conditions to have a named care co-ordinator, who could be a social worker.

The government has, largely, accepted the proposals.

However, the question is, will this work where other initiatives to do the same over previous decades have not? 

Social care academic Bob Hudson thinks not, in a powerful piece for The Guardian today, in which he argues that the whole issue is being looked at from an NHS perspective (with adult social care seen as the "handmaiden" to the health service), weakening its potential impact.

More significantly, he says the agenda amounts to yet more exhortation for health and social care organisations to integrate - precisely the approach that has failed for 40 years, he says.

Also, he notes the big tension in the government's NHS reforms between competition for business between providers and integration of care pathways for patients.

Not an easy square to circle, he says.

I fear we may be revisiting this topic with another mountain of reports in years to come.

(Added 13 January: Just spotted this blog post from social worker and psychotherapist Claudia Megele about the government's integration plans, which raises important concerns about the compatibility of these with other government actions, such as the injection of greater competition into healthcare through the Health and Social Care Bill).

I don't know how many times I have heard that integrating health and social care does not require structural change - bringing together the provision or commissioning of both under one organisation - and that it is really about culture, shared outcomes and goals and good leadership.

Well for a different perspective, read this blog from consultancy iMPOWER, which has been working with Herefordshire Council and the local NHS to establish Wye Valley NHS Trust, the country's first integrated provider of acute and community health services and adult social care. As we have reported before, Herefordshire has a long history of organisational integration with a joint management team for the council and the primary care trust.

The iMPOWER blog post argues that partnership arrangements - of which health and well-being boards are the latest example in England - depend on strong personal relationships to succeed. Where these are lacking, they struggle, and financial problems for both councils and the NHS are bringing increasing tensions to these relationships.

Bringing health and social care together more formally to underpin the health and well-being boards can help to overcome this reliance on strong personal relationships," it argues. "In our experience doing so can make those involved think very differently, and better decisions can be made as a result."

iMPOWER says that in Herefordshire, council reablement and NHS intermediate care services have come together - a sensible move given that they perform a pretty similar role and have similar objectives - and social workers and NHS colleagues have gained a better understanding of what they each bring to services.

However, it warns that such integration only happens very rarely and when there is a strong imperative to do so, as there is too much to lose for both sides. That is why it would be a good idea to take a decision to integrate - organisationally - nationally - though leave the detail of implementation up to local areas, as has now happened in Scotland.

It suggests that this move could change the terms of debate in England in the direction of nationally ordained (though not micro-managed) integration.