‘There are insurmountable barriers’: readers on linking up the NHS and social care

https://www.theguardian.com/social-care-network/2017/jun/05/integration-barriers-nhs-social-care

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Better integration between health and social care has long been touted as the answer to many of the problems faced by both sectors.

While health and social care leaders regularly debate how integration could – and should – work, we asked what those working on the ground think about the obstacles to closer working with the NHS and how they can be overcome. Here is a selection of your responses.

‘Social care is the poor relative – it’s like an add-on to the NHS’

I have no problem working alongside NHS colleagues but forcing people to sit together does not automatically foster good working practice. The nature of the work is too different. The main problem is that NHS staff have no idea about the work of a social worker, or the values, ethics and code of practice that we work to. Having health managers does not work because they have absolutely no idea about the nature of the work we carry out. Training within the organisation is all geared towards health workers, not social work staff. It is as if social care is the poor relative and an add-on rather than an integral part of the service.

Anonymous, 57, social worker

‘Working together professionally does not mean we need to be integrated’

Putting services in the same building works well but it must be with their own management structure, rather than being integrated. The management styles are just too different: where health professionals are more autonomous, social care requires clear processes that need to be followed. We were told that we needed to mix with health colleagues by having one health person sitting next to a social care worker. This did not work. Working together professionally does not mean we need to be integrated.

Anonymous, 49, social care coordinator

‘I love being a social worker in a health environment’

I believe that the key to success is to share office space and a kitchen! When you work alongside people you feel like part of the same team. We also share training and development opportunities, and that provides a perfect forum to gain insight into each others’ roles. We share so many common skills it’s a wonder there is such a gulf between health and social care. I love being a social worker in a health environment, it’s a real pleasure both personally and professionally. I feel extremely valued – by consultants, junior doctors, therapists and nurses. Health and social care can work together successfully.

Anonymous, 50s, Macmillan specialist social worker

‘NHS leaders must agree what they need from social care’

It’s a mixed picture. Most of our contacts in primary care are willing to work closely, but layers of NHS bureaucracy stifle integration. A while ago we were told we could not contact community nurses directly, we had to use the same call management systems that patients do. Leaders in the NHS must agree and communicate what they need from social care. We want to help but the picture is confused.

Anonymous, 44, social care director and registered nurse

‘Social workers and healthcare need to work together in a much smarter way’

Social workers in hospitals should be much more involved with patients when they are first admitted, rather than wait for a referral from the ward – which often arrives when the patient is ready for discharge, hence the long delays in transfers of care. The discharge process starts the day a patient is first admitted. Social workers, occupational therapists, physios and social services need to work together in a much smarter way.

Bronwyn Kelly, 66, retired social worker and residential care manager

‘It would be beneficial for nursing staff and social care staff to have joint training’

Nursing staff need to understand the essence of a safe discharge and work with social care in a timely fashion to ensure that is what happens. I think it would be beneficial for nursing staff and social care staff to have joint training around discharges, care providers, and processes and policies to follow to get to the end result safely.

Eleanor Skidmore, 53, adult social worker

‘Cooperation is a slow process’

Some GPs, community matrons and district nurses are really open to working with us; others are not. Cooperation is a slow process. We hold monthly meetings between social care, health and housing, which helps all parties ensure that clients get the support they need. Everyone who attends these meetings says it really works, but a large part of it is getting to know each other personally.

Anonymous, 55, social worker with older people

‘You cannot ask professionals to collaborate when they lack basic understanding of each other’s roles’

While we work together, health and social care are never a unified workforce due to having separate employers, separate targets and separate budgets. Social services and the NHS are not seen as the same, nor are they seen as equal. The professions do not train together, we have different professional standards, distinct knowledge sets and different training models. You cannot ask professionals to collaborate when they lack basic understanding of what each other’s role is and where they fit into the partnership. Many of those I work with are sceptical and fear the changes are more about cutting costs than actually making integration a success.

Anonymous, 31, social worker

‘Different workplace cultures can lead to defensiveness, suspicion and scapegoating’

I have spent 17 years as a housing occupational therapist, rehousing disabled people into appropriate accommodation. I therefore work for the “forgotten” statutory body out of the three, but one which is absolutely central to any discussion about health. Part of my role is to straddle the three organisations and come up with solutions to issues that cannot be solved using existing services. The very different statutory duties and workplace cultures of each of the agencies means that whenever our work overlaps, there are significant assumptions made about each other. This can lead to defensiveness, suspicion and scapegoating. Any solution which does not take this into account – and the relative financial power of the health service – is going to struggle.

Anonymous, 50, housing occupational therapist

‘The lower down you go, the less people are on the same page’

Where I work, senior management at the local health trust, council and clinical commissioning group are broadly on the same page. They have regular meetings and consider health and social care as one system. But the lower down you go – to more operational frontline staff – the less it is that people are on the same page, know what the other is doing, or even have any awareness or understanding of these issues.

Anonymous, 26, preventative services commissioner

‘There remain insurmountable barriers to integration’

There remain insurmountable barriers to integration between health and social care. The NHS faces the same pressures as social care as it is understaffed, under-resourced and confronting high demand. I believe that pooling budgets would increase integration and foster stronger partnerships, and if the NHS and social care used the same IT system it would facilitate information sharing. It would be useful if local authority responsibilities for social care could be outsourced to the NHS. We would therefore have the same organisational culture and adhere to the same procedures.

Anonymous, 38, social worker

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