It's not about reinventing the wheel

We were trying to integrate social care and health services in my first job in the sector nearly three decades ago, although we've undoubtedly made progress there is still much to do.

The pressure on both sectors to work together continues to be driven by two main factors - the tight economic climate and, more importantly, people who need care and support being much more demanding about having joined up provision that meets their individual needs

They are dead right to demand more. Care and support must be about choice and control and, for me, the starting point is encouraging people from the social care and health sectors to actually talk with each other more.

In fact talking about the two sectors as two separate sectors is in itself unhelpful which is why Skills for Care's Workforce Innovation Programme has been supporting projects that look at what happens when social care and health professionals do work together. We've pulled together the findings from a number of projects across England and the results give us plenty of food for thought.

A good example of doing something really simple was the JackDawe project in Nottingham where home care workers and managers work with mental health nurses and occupational therapists to support some 180 people living with dementia. Their answer to working together better was straightforward - they simply moved into the same building. This not only led to the teams working in a much more joined up way, but the service forged links with the centre that takes the telecare calls, the fire service, the Alzheimer's Society, meals at home and- critically - carers.

So my vision of a personalised world is the individual who needs care and support is at the centre of a network of support who are all talking with each other to ensure people have real choice and control.

TLAP has rightly put this sort of joined up approach at the centre of its thinking and I think another area of work we need to focus on in the coming year is how people who need care and support fully engage with the community they live in. ADASS President Sandie Keene, who co-chairs the TLAP Programme Board, put this idea in the spotlight in her address to the NCAS Conference in October and she was right to do so.

If we're genuinely committed to personalised services then we can't have people sitting in their homes hoping to live a full life - we have to work together to make it happen. Skills for Care's Workforce Innovation team have been doing a huge amount of work to test what that looks like and, the good news is, it does work.

I visited a social care project recently where they have put community assets development at the heart of their work. They told me about a man with alcohol dependency issues who was calling the emergency services 10 times a month because he was lonely. The ambulance service referred him to this project and he told one of their workers he 'just wanted to die.' That social care worker took time to listen and simply asked him what he liked doing and he said fishing so they got in touch with a local fishing club run by volunteers and they agreed he could join them.

The result was he now calls the emergency services once a month with legitimate health related issues. Not only has that person's well-being been enhanced giving him choice and control over his life again, but local people are actively engaging with social care in a way they never thought possible, Oh, and the other by-product is the significant amount of money saved as he doesn't make inappropriate calls to the ambulance service.

TLAP is a key player in driving forward the personalisation agenda, and this year should be about drilling down into what make joined up services work across social care and health, and also housing, understanding the links to the communities people live in and sharing the best practice as widely as possible.

It's not about reinventing the wheel, but nurturing and spreading the innovation already happening on the frontline.


Posted on by Old Site User

Completely agree especially 'If we're genuinely committed to personalised services then we can't have people sitting in their homes hoping to live a full life - we have to work together to make it happen'
Loss of confidence can be a huge factor in older people not engaging in (potentially preventative) services. I carried out a survey in Herefordshire recently of around 250 older people I had visited through a DH project. 90% of these stated they felt a loss of confidence. In some cases personal care needs had been addressed but didnt solve the confidence issues which were the main barrier to older people living a full life and having choice and control. To me a person-centred approach involves conversations around what really matters to people and building circles of support as well as having a choice of providers and a discussion about direct payments.

Posted on by Peter Feldon

When I started work four decades ago we did have integration of community health and social services, and it was a backward step when district nursing and other personal health services were transferred from local government to the NHS in 1974.

It's great if health and social care services can be co-located, however I agree with the ADASS/NHS Confederation statement in its briefing on Joint Personal Budgets, that "as long as care is coordinated well behind the scenes, full integration of the health and social care system is not required". But coordinating behind the scenes is a tricky business. I'm hoping that the guidance being developed for the implementation of the Care Bill in relation to preparing care and support plans will be helpful in setting out some detail about what is meant by the duty of the local authority to "involve any person whom the adult asks the authority to involve or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult’s welfare".

Posted on by Pam Quick

As a service user I am the person that needs the care and I want to be central to the discussions. I find I am very much discussed about at Multi Disciplinary Team Meetings and so are people like me, but when it is to do with my Health why do I have to be looked after by x number of people who I talk to, share my needs and it is them who decide how they will deal with it? it needs be my needs with support ie co-production so that I can live the life that is my life rather than others decisions. I have lived through social services giving me points and if I don't achieve their criteria I didn't get help. I was involved with Direct payments choosing the people I wanted to work with me. I was then introduced to Personalisation and provided with a list of suggestions of how I might want to personalise my care. I was left to fill it out myself but no-one told me that I didn't have to achieve certain standards to get personalisation. What it made me do was look at all the negativity I have in my life and how it affected me, rather than how I could look positively to make my life better. I wept when they sat down with me and I read it through. I needed support to have a new bed through community loans, and they could lend me a bed if I fulfilled the need for Continuing Health Care. Again the challenge to achieve to conform. I passed. But if forms were shared between personnel so that you don't have to repeat and repeat, then sharing of information between different parts of the Uk would be so much easier.

Posted on by Old Site User

Social care often starts from the assumption care is needed and focuses on existing solutions.

In my experience, there is not yet a full commitment to outcomes. The outcome every person is entitled to is an independent life. Social care has to be reflective about how they disrupt this outcome by taking decisions away from the individual.

Tweaking existing services may suffice but more often than not I would welcome to see a more honest commitment to supporting the right to an independent life and use the Mental Capacity Act to support those who may need support making decisions about their independence.

This commitment comes from starting with a blank sheet of paper. Connect with your local Organisational Development Team (Systems Thinkers) and see how they can help facilitate this commitment.

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