Seamless service

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

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:


Scheme: Integrated mental health

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.

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