Integration in Health and Social Care
As health and social care continue to face overlapping problems, further integration and collaboration between the two services may provide a solution.
We’re hearing a lot about integration in health and social care and seeing headlines about policy statements and strategic initiatives across the UK; often linked with “pooled budgets”, “service redesign” and “new ways of working”.
So what does it all mean? Essentially it’s about responding to the holistic health and support needs of those accessing services; irrespective of whether they technically fit under health or social care, or even housing or employment. For individuals and families who need care and support, integrated care services improve health and wellbeing, through aligned workforces, structures, processes and budgets.
Shared learning across the UK Skills for Care and Development operates as a partnership of lead workforce agencies across the UK: Skills for Care, Northern Ireland Social Care Council, Scottish Social Services Council and Social Care Wales. The partnership collaborates to share approaches, challenges and experiences in the move towards integration, with a particular focus around the workforce.
Some of the recurring themes include that integration holds the key to truly person-centred services, improving and transforming the lives of individuals and families; people, families and communities must be at the heart of integration, rather than structures, services and systems; there’s no one-size-fits-all solution to integrated support, even where services are described as fully integrated; an aligned workforce with shared training and joint working is a significant step towards full integration, to benefit individuals and families.
Gwent Frailty Programme: a case study The Gwent Frailty Programme in Wales is a collaboration between the Aneurin Bevan health board and five local authorities in South Wales.
The project is based on listening to people and seeing them as individuals and aims to create a community-based integrated model of health and social care that achieves the key outcome of frail, older people being “happily independent”. This means being able to stay and receive services in their own home, being listened to by the people delivering services and having health and social care needs addressed promptly and holistically.
The programme’s objectives include:
To ensure people have access to the right person at the right time
To focus on preventative care, wherever possible, avoiding hospital admissions
To reduce the length of hospital stays
To ensure services are timely and responsive and promote independence
To provide coordinated communication by providing a named worker for contact with an individual
In 2014 an independent evaluation of the Gwent Frailty Programme found that “people are receiving a very good service, which is timely, responsive and helps them to achieve their aspirations for remaining independent.”
The person receiving support Mrs Williams (not real name) has lived all of her life in South Wales which is covered by the programme.
Mrs Williams and her husband have always supported each other, so found it hard when Williams was diagnosed with cancer. Chemotherapy was successful but led to a period of illness with Williams needing time in the intensive treatment unit at her local hospital. While in hospital Williams fell, so became anxious about getting around safely at home, when discharged.
Hospital staff sent a referral to the emergency care at home team, a part of community resource team (CRT) asking for carers to visit Williams daily at home and support with personal care needs and rebuild confidence towards her independence.
Within a week, the daily support arrangement passed from the emergency team to a reablement assistant, also part of the CRT. Initial reablement goals included supporting Mrs Williams to feel safe using the stairs, becoming familiar with routines and enjoying her home again.
After another week, Williams could manage her own personal care and was keen to be fully independent again, so worked hard on exercises to build her strength and confidence. She began to feel stronger and more confident with her mobility.
When Williams required further chemotherapy she felt low and demotivated. The reablement assistant appointed the CRT’s health and social care wellbeing worker to support these new emotional and physical changes through discussions about her health and wellbeing needs.
This real life account demonstrates how integration works around the person being supported. Integrated care continues for Williams’s long-term evolving needs, supporting the elderly couple to enjoy life. Integration has helped to shape the pattern of care and support, delivered in a holistic and integrated way.
Skills for Care’s Principles of workforce integration will help you to think through what is meant by workforce integration. There is also practical guidance to help you when thinking about the learning and development needs of your workers.