Right chemistry?

Tennis whites and luscious green lawns are hardly symbolic of
social care. Yet this was the sight that greeted the employees of
Hammersmith and Fulham Council who turned up at the world famous
Queen’s Club in west London for a consultation on the development
of the children’s trust.

The spectacular backdrop seemed to instil a feeling of optimism
among more than 50 staff from social services and the primary care
trust who gathered to discuss how the services will evolve.

Hammersmith and Fulham found out in July that its bid to become a
children’s trust had been successful (“Birth of a children’s
trust”, page 32, 26 June). As one of the 35 pathfinder children’s
trusts it has to bring together children’s social services,
education and health services into a single structure. Along with
the other selected authorities, it will receive between
£60,000 and £100,000 from the government.

The event focused on one of the council’s children’s trust
projects, a pilot whereby the children and families teams from
social services will integrate with the primary care trust. By the
end of the year staff from the PCT, including health visitors and
school nurses, will join the social workers in child protection,
and referral and assessment teams who are already based
there.

Improved communication is high on the wish list. At the moment,
most of the contact between social workers and the health team
takes place over the phone, which can be problematic given that
both groups are often out visiting clients. But interaction between
the two teams is crucial. The social workers need to find out about
the health of children as this can provide insight into how the
child is being cared for. And the health team needs to be able to
quickly refer any child they are concerned about to social
services. Face-to-face contact resulting from sitting in the same
office should make this easier, as well as having practical
benefits in terms of arranging joint visits and holding informal
meetings.

The front-line workers involved in the changes hope that
integrating the two teams will improve the service provided to
children and families. They expect it to be more accessible for
families, and end the duplication of numerous assessments. They
also hope that sitting near colleagues from different professional
backgrounds will allow earlier identification of problems and more
targeted preventive work.

Despite an overall mood of positivity, there are concerns. There is
a general worry that, as a result of working in an integrated team,
health visitors risk being viewed in the same negative way as
social workers. This could result in clients holding back
information from their health visitors. But on the flip side some
hope that the image of social workers could be improved by virtue
of their association with health visitors.

There is also concern about the blurring of the professions. Andrew
Christie, assistant director of children’s services, did his best
to quell fears, stating that, although the two organisations were
trying to achieve similar outcomes, “that’s not the same as saying
anybody can do it from either organisation”.

“We need those professions and skills,” he said. “That’s the whole
point of multi-disciplinary working. It’s about maximising and
bringing together what individual disciplines and backgrounds
offer.”

The next step in Hammersmith and Fulham’s progress will be the
creation of a partnership board to govern the children’s trust. It
will be made up of PCT non-executive directors, two councillors,
the PCT chief executive, the directors of primary care, education,
and social services, the managing director of the council and the
children’s trust director, who has yet to be appointed. The first
meeting will be in October.

Those who attended the consultation were clear about their role in
how the process is carried forward. They want to be involved and
consulted along the way. And they were keen to ensure that real
change happens and that integration is “not just moving
offices”.

Pluses and minuses

It will be up to the teams to build on the positives to ensure
they outscore the negatives. 

Positives 

• Face-to-face contact. 
• Arranging joint visits will be easier.  
• Making referrals will be easier. 
• Information sharing. 
• Informal meetings will be possible. 
• Will help with early identification. 
• Should enable joint training. 

Concerns 

• Public perception of health visitors may deteriorate. 
• Professional boundaries may blur.  l Integration means being
  based in the same room. 
• Health visitors offer universal service, unlike social
  workers.  
• Issues over how notes will be accessed. 
• IT system in need of overhaul. 
• Potential human resources issues over differing
  contracts. 
• Better understanding of each other’s roles will be needed.