New teams must share more than offices

So called ‘integrated health and social care teams’ which in
reality simply share the same offices are no more effective than
traditional non-integrated methods of service delivery, according
to new research, writes Lauren
Revans.

A study by Wiltshire council and the University of Bath suggests
that to see benefits to service users, structural change, such as a
move to care trusts, is needed and not just co-location.

The report looked at the impact of ‘integrated’
primary-care based health and social care teams on older people
living in the community

It found that the degree of integration “does not appear to be
sufficiently well developed to have had an impact upon the clinical
outcomes for older people”.

Despite a speedier response from referral to assessment in the
‘integrated’ teams and a higher rate of self-referrals,
a greater proportion of this group went into residential care over
the 18-month period than those being cared for by traditional
teams, and a higher proportion reported being depressed and having
a lower quality of life. The ‘integrated’ approach also
appears less cost effective.

Louise Brown, co-author of the report and a lecturer in social
work at Bath university, said of Wiltshire: “They haven’t
gone far enough. They need to go as far as they can with
integration: structures, management, budgets.”

But Brown also warned of the “unintentional consequences” of
integration: “The potential problem with that is that you move
social care staff into medical health settings. That maybe why we
saw an increase in the number of people in residential care. Is
that the medical model creeping in?”

Ray Jones, chief executive of the Social Care Institute for
Excellence and former director of Wiltshire social services, said
the study showed that: “Until we are actually one organisation, we
still leave real problems for staff who are pulled apart by
separate organisational requirements and arrangements…The
view that we were taking is that we needed to take a further step
by bringing people together in one organisation where there would
be one set of budgets, one set of procedures, one manager, and then
we can have a truly integrated service.”

Wiltshire is currently in the process of developing three care
trust sites, each to cover services for older people, people with
physical disabilities, people with learning difficulties and the
healthcare needs of children. The three are expected to go live in
2003-4.

‘The Impact of Integrated Health and Social Care Teams on Older
People Living in the Community’ from 01225 386949.