Crossover culture

In 2000, The NHS Plan stated that: “Primary care trusts have the
potential to make real improvements for patients, making the health
and social care system easier to understand, simpler to access and
more convenient to use.”

Three years down the line, that potential is starting to be turned
into reality, with the development of partnership working between
primary health and social care from the very top down.

As most front-line social workers and their managers would testify,
not everything is working perfectly, but there seems a genuine
optimism that obstacles can be overcome.

Opportunities to tackle “traditional” social care problems
differently have arisen, leading to greater innovation in practice.
Most importantly, clients are beginning to see the benefits.

Over the next three pages, health and social care professionals
explain about the primary care-based projects they work in, what
the benefits are for service users and how they have worked
together to achieve this.

At the moment they are trailblazers, but it is likely that over the
coming years their way of working will become the norm.

Taking off from the day centre

A pilot project on continence at a day centre for older people
proved to be so effective that it formed the basis for a
county-wide advice and training service, writes Sue Brown.

Incontinence is distressing and can have a huge impact on any
individual, but for older people, when combined with increased
dependence on care services, it can be devastating and affect their
ability to stay in their own home.

Concerns expressed by a nurse working at a social services day
centre for older people with mental health problems about the
increase in continence problems, and reluctance by the centre to
accept clients with incontinence, were the catalysts for a pilot
project undertaken there in 1998.

The project entailed consulting staff on their skill needs and
implementing training to enable them to change their practice – by
getting advice from infection control and tissue viability nurses,
and reviewing environmental audit and staff action plans.

The results were that staff could deal with incontinence more
effectively, the continence status of many clients was greatly
improved so residential or hospital admission was prevented, no
client was refused attendance at the day centre because of
incontinence, and the physical environment was improved.

The project’s success meant that in January 2000 it attracted
funding, from prevention grant monies, for two continence advisors
to train social workers and occupational therapists at Nottingham
social services in providing services to clients.

The service was devised, and staff and a mandatory training
programme put in place. The training included aspects of physiology
and anatomy, physical symptoms, management of incontinence, and
proper use of equipment.

The service involved setting up and running continence clinics in
day, residential and intermediate care centres and the Indian day
centre; raising continence awareness with clients and carers
through information and support sessions; partnership in assessment
and care planning; close liaison with community nurses; and
developing written guidelines.

So far, 1,635 people have been trained and 247 clinics held.

Clients seen in day centre clinics have key workers to support and
reinforce advice. They get to know the continence advisers and feel
less embarrassed about discussing their problems. An assessment
tool enables staff to gather information regarding clients for
either the continence adviser or the community nurse.

The benefits are manifold. Relationships with care staff and
community nurses have improved, resulting in more appropriate
contacts and earlier referral for tissue damage, continence
problems and urinary tract infections. Problems previously
attributed just to old age are now raised with community nurses for
proactive management.

A continence adviser-led clinic has been run in a learning
disability day centre. There has been a reduction in laundry costs
in local authority residential homes. And discussion is taking
place with independent sector providers about the potential for
training their staff.

The scope for the development of continence services within social
services is immense. The issue also has implications for older
people remaining in hospital who need social services
placement.

Sue Brown is a worker atcontinence support to Nottingham Social
Services

Extra tool to tackle drug misuse

A GP team in a socially deprived area of Leeds was already doing
work with drug and alcohol misusers, but the addition of an
addictions therapist has allowed it to progress further, writes GP
Dr Jez Thompson   

The Chapeltown area of Leeds is vibrant and alive, multicultural
and colourful. But it also has problems. Indices of social
deprivation are high, as is unemployment. There are large
neighbourhoods of poor-quality housing, and the city’s sex industry
is centred here.

Social inequality and deprivation provide fertile conditions for a
drug culture, while others whose lives have been damaged
financially, socially and personally by drugs gravitate to the
area’s cheap housing.

We at the St Martins GP practice in Chapeltown have always
recognised the links between social exclusion and drug misuse, and
a philosophy of providing non-judgemental care predates any of the
current practice team.

Treatment of heroin addiction with the prescribed substitute
methadone began in the practice around 20 years ago, but at that
time the service was isolated and unresourced, relying essentially
on the goodwill of the practice team.

A milestone was the granting of funding as a secondary care service
five years ago, with the subsequent appointment of a full-time
addictions therapist to work alongside other members of the
practice team.

This step allowed us to broaden and deepen the scope of the work we
do with clients. A beacon award in 2000 gave us an important role
in sharing our good practice with others, and in recent years
doctors at the practice have helped train other care
professionals.

Our drug service is completely integrated with our general practice
work. Clients are offered full assessment and involvement in their
own care planning and are offered supportive help and other
“talking” therapeutic options.

Major focuses are reducing drug-related harm and promoting general
health. We provide maintenance prescribing for drug problems and
detoxification, and relapse prevention for both drug and alcohol
problems. We liaise with, and refer clients to, other organisations
for help with social, financial, educational and employment issues,
and aspire to planning holistic care packages for our
clients.

Problem drug use exists in the context of social, emotional and
other health issues. Providing both the GP and addiction service
for a client enables us to tackle problems that are directly or
indirectly drug-related.

We frequently provide care for families and significant friends,
and offer them support. We also support clients who are parents,
and address child protection issues. The service is community-based
and accessible.

Data relating to our service show low drop-out rates from
treatment. We are particularly effective in engaging with women
service users, who are significantly underrepresented in many other
services, and maintain excellent relationships with local black and
minority ethnic communities.

Our personal observations of dramatic changes in many clients’
lives as they enter treatment are backed up by outcome figures,
which confirm that most service users achieve the targets they have
set themselves.

We continue to improve our service, and are developing close
working relationships with Touchstone, a Leeds-based voluntary
sector mental health organisation. We aim through this to
facilitate access to treatment for those with mental health
problems, and those from black and minority ethnic
communities.

Dr Jez Thompson is a GP at the St Martins Practice in
Chapeltown, Leeds.

An ear to the ground 

Listening to and using the expertise of volunteers from ethnic
minority communities have helped to tackle mental health problems
that often remain hidden, writes Pat Bracken.

There is a growing acceptance that traditional ways of thinking
about mental illness and the development of services have not
always served ethnic minority communities very well.  

In an effort to tackle this issue, Bradford City Primary Care
Trust agreed funding last year, in conjunction with the Centre for
Citizenship and Community Mental Health at the University of
Bradford, for a community development project targeted at new ways
of engaging ethnic minority  communities. Bradford District Care
Trust, the main provider of mental health services in the city,
also supports the project. 

This issue is particularly important to the PCT because it
serves an inner city where more than 55 per cent of the population
are from ethnic minority communities, predominantly of South Asian
backgrounds.  

The project is located within a local voluntary sector
organisation, the Asian Disability Network. Called the Sharing
Voices initiative, it began operating last August.  

Experience so far confirms the original proposal that, when it
comes to mental health, individuals, families and communities have
untapped expertise and know many of the solutions.  

Two workers are already in place and a third is being recruited.
They have found that successful engagement, particularly with
hard-to-reach people, has been possible through an open and honest
approach and one that recognises the limitations of traditional
psychiatry.  

The workers have been supporting “safe spaces” where people can
develop strategies for coping. Other measures involve supporting
partnerships between community groups and services already doing
mental health work outside traditionally defined parameters, such
as supporting staff at a local place of worship to develop their
capacity to deal with the social, political, religious and
spiritual issues they and the regular attendants face.  

Sharing Voices has recruited volunteers from different
communities. These are involved in setting up self-help initiatives
and befriending others, while offering practical support in
applying for jobs, completing application forms and developing
interview skills. 

The team members are also building partnerships with existing
statutory/voluntary organisations and commercial businesses to
support people to re -engage in meaningful work.  

A community development approach to mental health is premised on
the belief that poverty, racism, unemployment, loneliness, family
conflict, sexual abuse and spiritual conflicts significantly affect
the development and outcome of mental illness.  

Pat Bracken is a senior research fellow at the Centre
for Citizenship and Community Mental Health, University of
Bradford.