Debate on whether cultural differences prevent closer integration

We asked for people’s views on whether cultural
differences prevent closer integration between social care and

To read a recent article on the subject

click here

These are the comments we received:

I believe that closer integration between
social services and health can work. But at the same time, we must
expect that change won’t happen overnight. I feel that integration
will allow for a better quality of service to service users as it
will open the lines of communication. For too long we have worked
in isolation that at the very thought of change will cause anxiety
in each service. Yes, we may have different methods in how we work,
but it’s all about knowing each other’s service and how it
functions. The key to this is joint working: I believe this needs
to be encouraged more.


I am sure that better cooperative work between
heath and social services practictioners will benefit clients,
providing that adequate training is provided and comminication
paths are clear. Yet another understaffed and under-funded
initiative is the last thing that workers at the frontline

Mo Roberts representative of family members of ATD
Fourth World

I qualified as a nurse before qualifying as a
social worker, and I can fully appreciated that health and social
services are entirely different organisations culturally. Within
health, there is a far more regimented regime, based around power
and control. This is why I have chosen to remain within social
work. Health is a culture that I have found to be bullying,
oppressive and discriminatory (racism within the NHS for example is
well documented), factors in fact the exact opposite to our core
social work values and principles.

As a social worker, I have sat in on enough ward rounds to hear
clinicians discussing “the stroke in bed 7” or the
“Chronny-Bronny in bed six” (chronic bronchitis).
Within the health culture seeing people as an illness is by far the
norm. Within community nursing I have repeatedly seen these same
views expressed, and again, the hierarchal pecking order seems to
underpin all relationships within health. My experience has shown
me that many nurses cannot wait to obtain progression to management
posts because they are tired of being mentally abused by their
bullying managers and let’s face it, health certainly
can’t stop creating more and more management posts to be

I would dearly love for health and social services to work
closer together, but the approach by government of forcing such
joint working and integration (through guidance, legislation and
financial incentives) is not the way forward. Closer working could
be achieved by staff developing a better understanding of each
other’s roles, but the real challenge is to change the
culture within health. Whilst that might have occurred with health
having more social work managers, the reality is that joint teams
predominantly have health managers.

It is certainly worth considering that forcing staff together
does not necessarily make them work together as a seamless service.
Ask a ward nurse if she can easily borrow a drip stand from the
ward next door? Ask how well one specialist district nursing team
works with another?

Social services and health can form closer working relationships
for the benefits of the people they support, but the staff do not
have to be based in the same office, or be employed by the same
organisation to do so. Very good examples of joint-working exist,
but these have occurred locally over time.

Finally, the issue of managers appointed to jointly manage
health and social service provision: this is fundamentally flawed
due to the need to manage budgets of two organisations, and we see
more and more difficulties arising from this.

Under the NHS, care is provided free whereas local authorities
have always financially assessed for their services. However, we
see more and more care provided (and funded) by social services
that arguably should be provided by the NHS. Many families are
currently seeking compensation for the incorrect placing of
relatives in LA funded residential care, following Ann
Abraham’s (health ombudsman) four test cases in February. We
now know that this is just the tip of the iceberg The final bill
for compensation will top £300 million. We will see similar
situations when community packages of care provided by social
services come under closer inspection, as many LA’s are
providing care that again is a NHS legal responsibility (health
seeing more and more needs as a ‘social need’). It is
difficult for social services to challenge, or seek judicial
reviews of funding when the senior managers of both organisations
are the same person.

To the casual observer, it might make great sense to merge
certain organisations. Perhaps we could amalgamate the police and
the ambulance service, because they both get called out together.
Come to think of it, why are the armed forces divided into army,
navy and air force? Surely they would work better if we made them
into one?
Stewart Ford

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