Let’s stay together

Nurses and social care workers have tough messages for government
this week. And with the two professions speaking out, we feel
confident the Department of Health will be listening.

Our survey has some good news for ministers too. Considering the
time required to achieve massive cultural change – and make no
mistake, breaking down divisions between social care and health is
exactly that – joint working is in its infancy. Yet a majority in
both professions is positive about the relationship between them.
Most who expressed an opinion said joint working had improved the
standard of care. And a majority of both nurses and social care
workers feels the other profession shares their values.

In fact, although the main obstacles to joint working are often
seen as being the entrenched attitudes of front-line staff, there
is scant evidence in the survey to support that view. Admittedly,
nurses and social care staff succumb to some stereotyping – the
sooner we vanquish the myths of social workers in thrall to
political correctness and nurses in thrall to doctors, the better –
but the respect between the professions is clear. Professionals
themselves are clear about why joint working sometimes fails. For
if joint working between health and social care is still like a
child struggling to find its way, it is being bombarded by a
bewildering array of instructions, punished for problems that are
not necessarily its fault, and made to run when it has not yet
properly been trained to walk.

The tools developed by the government to manage the joint working
process and improve health and social care come in for some
significant criticism. A large majority in both professions
condemns fines for delayed discharges on local authorities. And
neither nurses nor social care professionals believe performance
indicators and targets in the NHS and social services benefit those
who use services.

This lack of faith in the performance management system should not
surprise ministers, however. Targets are a blunt instrument in a
service where sensitivity is paramount. Their impact is
disproportionate, and on the front line it seems as though the
assessment of individual need and the exercise of professional
judgement too often play second fiddle to a one-size-fits-all
approach. Meanwhile, services that are not measured barely seem to
exist on politicians’ radar, despite being just as desperately
needed as any other.

Professionals know that the priorities cascading down the service
are driven by the government’s need to meet its election pledges
before the voters get their next chance to reach a verdict. Yet
when the targets the government sets itself prove to be
unrealistic, excuses are found, deadlines extended and indicators
modified. Such flexibility is rarely on offer to anyone else.

Advancing joint working is the only way forward for better
services, as our survey makes clear. But the way in which the
government micro-manages health and social care can be more of a
hindrance than a help.

It’s time to stop blaming front-line staff for the inevitable
problems encountered on the road to seamless services. Many of the
reasons for poor relationships between health and social care cited
in our survey are beyond their control: differences in priorities,
and staff shortages, for example.

And the best way to achieve better services? More resources,
minister.