The last year has seen some major changes in partnerships between health and social care. At one end of the spectrum social service departments are pulling out of agreements with mental health trusts and at the other end social service departments are setting up new partnership agreements. The latest of the new partnerships is in Staffordshire county council plans to transfer 1,000 adult social care employees to NHS to create the UK’s biggest integrated health and social care provider. (Final confirmation of the agreement is awaited).
BASW has met hundreds of social workers in the last year who are and will be affected by these changes. The overwhelming view of social workers is that they want what is best for the service users and who they are employed with ultimately does not matter. Social workers are proud of their professionalism and their identity and feel strongly that partnerships can be great, but can also be disastrous for them and the service users that they work with.
Partnership can be of benefit, however there are some crucial clauses to this view:
- Social workers say that it is essential that there is good governance to support them. This includes having a senior lead manager, who is a social worker who can represent the views of social workers
- Social workers want the right to have support and supervision from a qualified social worker, particularly practice supervision
- Social workers are very worried about the Payment by Results (PbR) system that is getting embedded in health. Payments by Results means that the Trust will get money for certain outcomes and these outcomes can be defined in medical or clinical terms. For example in mental health PbR can mean that the “treatment” identified is defined by the clinical label, not by need. Someone with a “diagnosis”, of say clinical depression could be allocated x and y treatments, regardless of their social situation and their own resilience. Increasingly treatment for “psychosocial” need follows the PbR route of CBT. Social workers are experts in holistic care and do and should have a recognised role in psychosocial interventions, not just called in to arrange discharge.
- If “health” dominate the partnerships then the roles and identities of social workers could easily be further emasculated
- Social workers are far from mercenary, however they understandably are concerned about their terms and conditions of employment – are the partnership arrangements subject to TUPE, or are staff seconded. If the former what guarantees are there to ensure that in the long term they will not be sold down the river?
- Are the partnership arrangements a cover up for cuts? Health services have “pioneered” new ways of working, and aspects of that are great. However there are aspects that are very concerning. There is far more complex care being undertaken by support staff, with worrying consequences for the quality of care. Will there be the
- same number of social workers, or will chunks of the job be hived off to support workers, with consequent reductions in the number of social worker?
- What happens to independence? It is very hard as a member of a multi-disciplinary team to criticise professional decisions. Will the social worker be supported when they refuse to undertake something that is unethical, or indeed in some cases unlawful? The independence of AMHP is arguably more difficult to retain if they are employed by health and indeed some of the disintegration that has taken place has been because of these ethical concerns
- Social workers also are practical people and they know from bitter experience that so often partnerships have been set up without the infrastructure to support integration. I would be rich for every time I have heard that 10 years into a partnership social workers are having to operate two IT systems – the local authority and the health one and everything has to be duplicated. Or they don’t have access to the local authority intranet. Having to complete two lots of meaningless performance targets is another thing that social workers find particularly gruelling.
“The best thing that has happened to me in the last year was the local authority breaking off the section 75 agreement with health. I am now back working in the local authority, I have social work colleagues (I was very isolated), got now support for my professional identity and CPD when working for health and all I was called upon to do was section people under the mental health act and arrange packages of support once a decision had been taken by others to discharge someone”. Social worker Nov.11
“Being part of an integrated team is great. I now work alongside district nurses, GPs, community OTs and others. We have a much better understanding and appreciation of each other’s role and also respect for each other’s roles. I am sure the service user gets a better service” Social worker Dec 11
So is partnership a good thing or a bad thing? So much depends on what this means in practice. BASW has drawn up a charter for social worker entering into such relationships:
- The BASW Code of Ethics is adopted by Health Trusts and Social Service Partners to underpin the relationships within and between the partners
- Health managers must recognise that social work is a profession with its own principles and codes of conduct and unique knowledge and skill set. This knowledge and skill set includes safeguarding, the mental health act, case management and personalisation, but also relates to wider knowledge emanating from research and practice. This includes a high level of understanding of the social model of disability.
1. Practices and processes adopted in order to achieve the principles
It is recommended that the following practices and processes are adopted in order to ensure that social workers are well supported in integrated health services:
- The implications of the introduction of PbR are seriously considered by Health Trusts and Social Service Departments in order to avoid the disintegration of multi-disciplinary teams
- Interagency groups are established to oversee section 75 agreements
- Regular governance meetings at senior management level take place to monitor partnership arrangements
- There needs to be social work representation at Trust Board level. This representation should be from someone who clearly “owns” the local authority social care portfolio
- Social care and social work is included as an integral part of the health trust’s mission statement
- There needs to be strong on-going local authority engagement at senior management level with health services in order to ensure that the social care model, personalisation and the social work role are effectively embedded in Health Trusts
- Social care models are incorporated into the training of all health professionals
- That clear lines of accountability, leadership and support to middle managers are set up in order to take the social care agenda forward
- Promotion of the value of the social care workforce
- Everyone responsible for personnel issues – recruitment, disciplinary, grievance and absence are trained in the requirements of the local authority, Care Quality Commission, Social Work Codes of Practice and Social Work Task Force recommendations
- Social care leaders should ensure that that support services are in place for social workers – IT HR, finance, learning and development. This includes ensuring that social workers, whether seconded to Trusts, or directly employed have the tools to engage (such as access to local authority internet and intranet and recording systems) with social service departments
- Social workers and social work managers should be engaged from the outset in the development of plans to re configure and change services
- Robust arrangements are put in place to ensure that social workers receive good quality supervision from qualified social workers
- Professional supervision within the team from an experienced social worker
- Support for the experienced social worker from an external mentor
- There should be an adequate number of social workers in multi-disciplinary teams
- There should be a social work forum in each locality, that is separate from other professions in order to build and sustain identity.
Finally “integration” can work and does work without structural changes, partnership agreements etc. Social workers have successfully worked for years as part of multi-disciplinary teams in hospitals and in the community. Senior managers don’t get their brownie points however for encouraging that approach – making things work better as they are is not part of the performance agenda, it should be.
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