SCIE opinion - 3 August 2011

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Photograph of Lisa Bostock

Social care and health integration – the service user perspective

Dr Lisa Bostock, Senior Research Analyst

I was talking to a Professor of Primary Care about how best social care can work with clinical commissioning consortia. After a long and wide-ranging discussion, he said: “Of course, Lisa, you do know that it is in the GP contract to moan about social workers....” We laughed but this is a serious point. Many GPs remain mystified by what it is that social care actually does. Yet there is a clear message from the listening exercise on the NHS reforms, The Future Forum report that integration between health and social care is central to delivering improved outcomes for people who use services and carers, as well as saving money.

SCIE's work shows that when health and social care work well together, people who use services and carers applaud workers, appreciate being treated as a ‘whole person' and are more confident that they will receive the right care to improve their health, wellbeing and lives. We say this is: “because they are more in touch with one and other. Instead of saying that we have got to wait for a report to come from so and so, it all seems glued together” (SCIE 2009: module 1: 5) When social care and health don't collaborate well, people are burdened with closing the gaps for themselves. This is a task that can leave people frustrated and sometimes without the care and support they need.

Yet, is integrated service delivery always the right thing in every case? Well, it depends on what you want to achieve and for whom. In many cases, joint and integrated working between health and social care professionals is just what the doctor (or social worker!) ordered, but the measure of success shouldn't be how perfect the process is, but the impact of the integration on the lives of service users and carers. Many are now thinking that, for some people, having the choice and control that a joint health and social care personal budget gives may be the best way forward.

Personal health budgets (PHBs) for people living with long-term conditions are now being piloted, across 20 sites in England, including sites which are testing integrated assessment, self directed support planning and personal budgets between health and social care. In future, it may be possible to combine personal budgets in social care with PHBs. Because of the pivotal role GPs play in the community advising people about health, care and support it is likely that they will be in a good position to work with social work colleagues to advise people about personal health budgets and how they can be spent to achieve the best individual outcomes.

Revisions to the Health and Social Care Bill mean that integrated care should be explicitly promoted. Integrating personal budgets between health and social care could add a new dynamic to the debate on integration by putting service users in the driving seat, as they commission health and social care services for themselves. This exciting new development may mean that past moans and groans are put aside and traditional service delivery orthodoxy is broken down, seeing service users themselves having more choice and control over their healthcare. It may also mean that integration's measure of success may be seen in terms of outcomes rather than process, making it clearer to see when it's the right thing to do.

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