Health and Social Care Integration

Following on from last week’s session on different perspectives on health and social care integration – use this space to share your own perspectives on what you have learnt, your previous experiences and thoughts on health and social care integration.

23 thoughts on “Health and Social Care Integration”

  1. Empowerment – overcoming disability as social oppression – physical, emotional and societal exclusion. Promotion of independence and citizenship. My thoughts: I wonder should opportunity to care be considered as a human right, a fundamental characteristic of what it means to be human? Care as a definition of dignity and sovereignty only works if it can be reciprocated. As communication is a two way process, so should care not be considered similarly? I actually feel that care and communication are innate (a baby seeks care and communication from an early stage and seeks to exchange messages in baby-like ways, from my own experience as a dad and foster carer), and are interactive in nature. Does a person who is being cared for feel disenfranchised by being able to return care? I feel strongly that the digital passport of the user of care needs to be reciprocated by the provider also providing equal information in the form of a reciprocal digital passport, otherwise we create inequality of exchange. Morris (1997) argues that you cannot have empowerment and care, as care dis-empowers. But my point is that if the care receiver can reciprocate and give care back, then a currency of care can be established, leading to empowerment.

    1. I’m in agreeance with Keith in regards to the digital passport. If the service user is expected to share their information, why shouldn’t they be allowed to access relevant information about the individual providing their care? I feel this would allow both parties to have a sense of equality.

      Yet, saying that, I don’t actually think a digital passport is a particularly good idea. Yes it is valuable as it is a quick and easily accessible way of sharing information – the service user would perhaps get a break from repeating their story over and over again to different people. However, I feel the digital passport brings more negatives than positives. It has a huge impact on the communication aspect of human contact. How can we assess the emotions and feelings by reading information provided to us on an ipad? I don’t feel this is a good way to get a full, in-depth idea of a person. Similarly, how accurate is the information on the digital passport going to be? And how often will it be updated? Can we really rely on this form of technology over our own judgement of a situation?

  2. correction “Does a person who is being cared for feel disenfranchised by being able to return care?” should read “Does a person who is being cared for feel disenfranchised by NOT being able to return care?”

  3. Thanks for your comment Keith. It got me thinking.

    My experience of statutory services has been that regulations are sometimes put in place that stop the service user from caring in return. Some people show care by giving of gifts but policy dictated we couldn’t accept. I remember a training session on how how to keep safe as a worker and sharing of personal stuff was very much discouraged. Personal information that might have led to the service user asking after family or health etc.
    I’ve seen regulations stop caring in the voluntary sector also. My gran had a befriender who was bound not to give out her phone number or address. She and my gran developed a positive and meaningful relationship, certainly as far as my gran was concerned. When the befriender was unable to come though gran would get a phone call from the agency to inform her. She was unable to contact the befriender direct to ask after her. How and when she could care was restricted.

    Thinking about what Morris (1997) said that care can not be empowering my initial thoughts are to I disagree. I did some work with adults with learning difficulties. It was precisely because they received care that they were empowered to get out and about and take part in meaningful activity.

    Being able to care is about fulfilling that basic need to have positive relationships on a human level. As far as it being a right it is only as useful as far as the subject of their care wants to be cared for. Care cannot be forced.

    I know from my own experience of caring if care is a two way process it’s easier to go into work and feel motivated to obtain the very best outcomes for someone. If I think a service user cares about me it is as an indicator that in someway I am doing a good job. It is after all harder to care when you are disgruntled.

  4. Some very in depth and eloquent discussions to initiate my thoughts for this part of the blog!
    I have a spit opinion on the digital passports. I do not feel it is appropriate that a service user would have any personal
    information about a staff member. This is because maintaining professional boundaries are crucial to a good working relationship with a service user.
    In addition, although we are mindful of any biases that we have as social work students/ social service workers, a service user may not be. For example, if a service user holds homophobic views, and that service user is made aware that a staff member is in a relationship with a same sex partner, this could create difficulty in building a good working relationship with that service user.
    Furthermore, I have read digital passports of other staff members, and found that staff members have listed their own positive skills and attributes. I feel as though this could be concerning to a service user as it may not have crossed their mind that their social service worker would not have good listening skills for example.
    On the other hand, sharing information about ourselves with a service user can be an opportunity to show that we are indeed human, and not the ‘perfect robot’ which we could be perceived as when performing in our working role. I feel that we must be very mindful with the amount of information and sensitivity of the information that we share.
    I can also see that depending on the role that we are working in would depend on how much is appropriate to share with a service user. I can completely see that in the role of a foster carer, sharing a lot of information with the child can ensure that the child feels secure and as part of a family in the absence of a biological family for a given duration. Thus the amount and sensitivity of the information shared depends on the working relationship.
    I would also like to echo Gwen, in that good practice allows staff to provide support in a way which is empowering for the individual. The level of empowerment that can be achieved for an individual who is being cared for on the other hand, I feel is debatable.

    1. Hi Abigail,

      I intend to agree with your points about appropriateness of sharing information about professional with service user.

      I find it hard to make my mind about Digital passport at present as it is not something I came across in professional encounter yet and I will keep a position of ‘reasonable doubt’ at present.

      I personally felt that the session we had with CU group did not provide us with an opportunity to fully discuss DP positives and negatives as I clearly felt that the members of CU group came into class with their minds made up about it and they were sharing their concerns about it.
      My current opinion, DP was intended primarily as a helpful tool to both practitioners and families and should be treated as such – it is a summary of the background information that can be helpful at the familiarizing stage, keeping in mind the importance of maintaining position of clear mind and ‘non presumption’. This is something we will have to develop as a skill in our practice as we will be reading background notes on SUs files left by other professionals and our colleagues daily prior to making direct contact with them. Obviously, real person and their live situations can only be discovered via face to face contact, exchange of communications and inter-involvements.
      In line of my previous experiences, I would like to say that it is important to find the way to save families and SU time and need to repeat their basic details (like previous medical history and care needs) over and over again during each stage of assessment to various professionals and than going through the same process again if a need for re-assessment rises at a later date. Many times, I heard SU telling me over the phone ‘ But you should have all this information’, ‘We have already provided it’…ect
      So, there is a need in finding the way to share this information, but if DP is the answer I am not convinced at present and look forward to spending time with the families and finding out their opinions.

  5. Hi guys, enjoyed reading your posts.

    Keith, you are raising important issue and I am agreeable with the thinking of empowerment via development of two-sided relationships between care-giving and care-receiving.

    How can this be achieved?

    I would like to share my thoughts about SDS assessment (drawn on Personalisation theory) as one of the options involving service users in decision making about their services.

    I found it peculiar that despite 4 available options of SDS most of the Local Authorities use only one type, the option which keeps LA in control of assessment and finances – basically LA assesses, approves funding, and money are being paid directly to privately sourced carer or service; so in reality it appears to me that SU’s involvement is only in the process of choosing the care provider (agency or private person). Does not sound very empowering to me. Only one LA in whole Scotland choose a different path, I think it may be interesting to find out how their SU finding SDS experience and compare to the rest of Scotland.

    Drawing on my personal experience of working in a Social Work Contact centre in Fife and advising SUs about various options of assessment I can say that general awareness of the SDS as an existing option increased since about 2014, however level of understanding of the process and what it means for the family or SU is not sufficient. What can be asked of the SUs if I am as a professional advisor only learned about all options of SDS during last weeks module readings.

    However said that, I will advocate for SDS wholeheartedly as I have witnessed how it could be applied in practice and can make significant difference in the way SU experiences care. For example, a person with a very private nature (adult or elderly) often finds it very difficult to except help with very private tasks like washing, dressing, toileting from ever changing amount of strangers coming through their door at different times on different days. I spoke to family members stressed and upset by the fact that carers come at 9am on one day and around 11am on next to help SU to get up, get dressed and have a breakfast. Or about someone who is no longer able to wash and dress independently and goes on without change of clothes for days, however is reluctant to let strangers into their house to help them. In these cases, an implementation of SDS can lead to a very positive outcomes – one person will be able to negotiate guaranteed 9am visit daily with a privately employed carer, another may consider excepting help from the person (again private carer) who they will have a chance to became familiar with and build a better rapport, ultimately leading to the better experience of receiving care.
    It is certainly a ‘well intended’ policy, implementation of which can lead to some positive outcomes, however in my opinion it has its limitations especially for service users with learning difficulties or any type of mental capacity impairments.

  6. Hi Nadiya,
    Interesting comments about the needs and experiences of the service users themselves and the barriers to them receiving care or utilising their SDS. I agree with your points raised and think they are important points to consider. Routine in my experience is very important for people who require support and my limited knowledge of SDS makes me think that there will more continuity for service users if they can employ their own carer and therefore set the boundaries or framework of their own care. In your experience are people assisted to create care plans which incorporate their wants and needs in a person centred way?

    1. Dear Erin, unfortunately I do not know enough to answer your question, as I have no experience in taking part in actual assessments. In my role, I offer people first advice on existing assessments and support services and help them to make decision of what referral they need to make. You can say that I and my colleagues in Contact Centre are mainly helping people to “open the door” into future services of support. Actual assessment than carried out by the various practitioners in locality teams, who I am hoping to join after completion of this course.

  7. I found an interesting article regarding the social model, it offers a critique and a wider discussion.
    http://disability-studies.leeds.ac.uk/files/library/Shakespeare-social-model-of-disability.pdf

  8. Hi all,
    I was involved in research on Direct Payments (DPs), alongside Dundee Carers Centre, Age Concern and Dundee Healthy Living Initiative. We investigated why, when DPs have the potential to promote positive options of control, choice, independence, flexibility in how services are provided and the delivery of better quality service, there was such a low uptake.
    There are many well know barriers as to why individuals are reluctant to take the DP option such as fear of responsibility, difficulties managing money and a lack of administrative support. Dundee Carers Centre believed that some people are better informed than others, suggesting that the majority of their clients who receive Direct Payment are from more affluent areas of the City. Research by Spandler (2004) and Leece (2004) would seem to agree with this theory. They argue that DPs may be offered to and taken up disproportionately by well educated, more affluent, middle-class people, who are seen as and feel able to take advantage of the opportunities offered by arranging their own support as opposed to accepting traditional service provision. Inadequate support from social workers and local authorities have also been cited as major barriers to implementing DPs throughout Scottish Local Authorities (Ridley et al, 2011) and it was found that people with mental health needs were rarely offered DPs, often because of concerns by social care professionals around how people will manage their money when they become unwell.
    Direct Payments were fashioned as a way to enable disabled people to achieve ‘independent living’ on their own terms through maximising choice and control in their everyday lives. The uptake of DPs should be greater but we found it was restricted by barriers of inequality such as a lack of resources and a lack of skills and support to access information, preventing the very people who would benefit the most from choosing self-directed support.

  9. Hi Laura
    Do you have a copy of the research or a link to where I could find it?
    Thanks to you and Naydia for sharing your experiences, it’s helpful to hear first-hand from people working in the field, it brings a different perspective to discussions. Having no previous knowledge of SDS or working in a care environment, I thought what an amazing concept, people can take ownership of their own care. However, it seems the reality is something different. DP has been in place for a number of years and the uptake as mentioned in the above posts is limited, therefore what has/is been done to rectify this? Do service providers really want service users to take control of their own care? Is it easier for Local Authorities/service providers to still have control? There are definitely winners and losers here.

  10. In my understanding “Health and Social Care integration” is driven by the ideas of promoting better health and care experiences for both care-givers and care-receivers (in both, paid and non-paid care provisions), for example: streamlining the processes of care assessments, improving the communication between professional bodies ( Health and Social Care in particularly), addressing the issues of delayed discharges from hospitals and so on.
    “Shared values and cultures are important for such a whole-systems approach. Taking values of empowerment and participation of service users and carers into a different paradigm is necessary in care if an integrated approach is to succeed” (Judith Phillips, Care, 2007, p134)
    Chapter 8 “Professional Debates Surrounding Care” also discusses the integration of health and social care and potential clashes with the policy for integration and partnership for the two arenas based on the following:
    – its location (health care being located within the National Health Service while social care lies within the scope of the local authorities)
    – its professional and knowledge base
    – and, interestingly, the division that steams from the different philosophies of care underpinning these two orientations – the medical and social models (covered in our recent lecture)

    This book was published in 2007. We are in 2017. What changed in 10 years? Anyone has some thoughts, experiences of integrated services to share?

    1. Hi guys, me again.
      Just sharing my experiences on integration between Health and Social Care in Fife during the years of my Employment.
      1. Home care assessments for support care packages were carried out by the Home Care Managers in 2007. Their role changed and they are now called Assessment and Review Practitioners (ARP)
      2. “Home Care” team was re-named to “Care at Home” around 2012 and split into to different sectors. Assessment & Reablment team (focusing on provision of short term, 4-6 weeks, support with personal care, meal preparations, medication prompting…etc following a discharge from the hospital). and Care at Home team (providing support where long term packages required). Word “reablement” was introduced and it was attempted to re-train carers to mainly prompt, guide and encourage SUs to carry out tasks independently under the supervision.
      3. Social Work Contact centre was re-named into Health & Social Care and Children services in 2014.
      4. Children and Families, Criminal Justice moving under the same directorate as Education and Adult and Older People service merging with Health.
      5.A team of Social Workers were placed directly in the Hospitals across Fife, and a split in assessment for care packaged happened between Hospital Social Work teams and Community Social Work teams (clearly dividing responsibilities and enabling closer co-operation with Health Professionals in Hospital Discharge teams)
      6. STAR Beds introduced in the Care Homes to allow SUs with complex care needs to be transferred into Care Home for the period of assessment and care package implementation, freeing the acute medical beds and streamlining discharge process.

      These are just a few things I witnessed as a person in the middle of communication links between all SW departments in Fife. Being more knowledgeable about theory of delivering an integrated care and latest policies and legislation it is interesting to reflect on everything that was happening during the last 8 years.
      Not all attempts were and are successful at present, but the change is visible.

  11. Hi Catherine,
    thanks for your reply.
    Yes, I will look out a copy for you.
    Although my blog was quite negative towards the barriers in accessing Direct Payments (DPs), I wholeheartedly agree with your initial thinking of Self Directed Support (SDS) as a beneficial and positive concept. It can be an incredibly effective way for services users to achieve independence and autonomy. Imagine the following scenario; you are a service user and you require assistance at bed times. You have difficulty sleeping and have a routine that helps, this includes going to bed after 10pm. If you choose DPs you have the freedom to employ a carer of your choice, who will attend to you at your chosen time; if however, you decide to go with the status quo and allow the local authority to manage your care, there is every possibility that you are helped to bed at 7pm irregardless of how this will affect you. This is just one small example of the power of choice and autonomy that DPs can provide.

    As you rightly point out Catherine, there are definitely winners and losers here. It has been found that when given the opportunity, DPs are an effective tool in meeting a range of needs for service users. Indeed, evaluations of DP users report very high satisfaction rates in comparison to conventional services (Spandler et al, 2006). The difficulty is addressing the barriers of inequality for individuals who would clearly benefit from DPs but lack the skills, resources and support to access the information in doing so.

  12. The research you mentioned seems really interesting Laura and rings true with my personal experience of DP’s.
    I think so many SU’s are completely terrified by the thought of DP’s and having the responsibility of managing their care. I think that this is mainly due to a lack of understanding and I don’t think that enough is done to ensure that SU’s fully understand their options. Also as Erin said routine is so important to many SU’s and they often worry that changing payment options will mean that routines / staff etc. will have to change and this can cause a great amount of anxiety. Sadly I also often got the impression that people were being discouraged from choosing direct payments as it was too much bother for LA and as Catherine mentioned a loss of control.
    I think DP’s are a great idea in theory but more needs to be done to make sure they are a practical option.

  13. In 2014 my family had experience on being on the receiving end of Direct
    Payments when my gran became ill. Through my work I had become aware of a service which proved to be suitable and could come in at the times Gran wanted them. The Direct payments were problematic in that it seemed the council had little experience of the system. As a result, my gran had to pay for the service out of her own pocket for a few months before receiving any money from the Local Authority. When the money did arrive, an overpayment was made which meant for a few months no further payments were made until the overpayment cleared.

    Gran gave up the service when she moved into Very Sheltered accommodation and for a period council services were employed to meet Gran’s needs. Fortunately, Gran got better and needed less support. Later however she had an informal arrangement with a woman to shower her. This was someone Gran had a good and trusting relationship with. Again, Gran got poorly and needed more support and Direct Payments were put in place again. The rules, however, dictated that in taking the Payment Gran would have to employ the woman showering her officially and the woman didn’t want this, hence she stopped doing it. Gran lost the care from a trusted individual she had built up a positive relationship with. She had to start over having a shower with the support of a stranger. Abiding by the rules meant losing a bit more of her dignity.

    My Gran was fortunate that she had the support of my mum and dad, both educated and retired from employment. Whilst my Gran remained as sharp as a pin until she passed away just short of her 96th birthday when she was ill she was less able to manage her finances. Had she been left to deal with the non-payment and then the overpayment I think it would have been too much for her to manage. My Gran was a terrible worrier and such a situation would have caused her distress. She was also fortunate to have finances to pay the agency. Had she not been in that position and with the agency’s cash flow aside, I think gran would have felt very uncomfortable being in debt and this too would have been a source of stress at a time when she was physically unwell.

    I understand why SU and their carers decide not to opt for Direct payments. Dealing with a loved one’s deteriorating health is a stressful time for a family. Having to make decisions and arrangements to pay services direct is another thing to have to concern oneself with.

    If, as Laura has already highlighted, Direct Payments are not so often taken up one can understand that when that option is requested those administering them, and who are more used to dealing with another system, might not always get it right first time. This said if the Local Authority are offering a service they have a duty to ensure it is delivered well especially when they are dealing with vulnerable Service Users and their emotionally burdened carers.

  14. Hello to all,
    I read really interesting points of all and I want to express my thoughts as well.
    I was happy to see that many of you share the same concern about sharing carer’s information to the service user in order to make him feel safer and to be fair after all. During the discussion in class about Digital passports I ended up feeling that we should use them as a helping tool but at the same time try not to rely only on them.
    Concerning direct payments it sounds like a really innovative idea to me because I considered that it would be helpful mostly for enhancing service user’s confidence. Apparently though, this is not always the case. I will agree with Emma’s point that most SU find it terrifying. I think though that this feeling does not derive from lack of understanding but due to unconscious views about disability that society provides us with (Michael Oliver, 1990). Hence, it is easy for me to understand that disabled people were not used to be more independent.
    Moreover, I will like to add a recent and interesting article about Service User’s views on direct payments:
    http://dx.doi.org/10.1080/09503153.2015.1039973 .
    In this survey which conducted in 2015 there were a few things that concerned me. For instance, among 30 SU only half of them have been introduced to DP straightforward by a social worker while the others had other sources of knowledge. So, are DPs an information easy to access or is it still a privilege of affluent areas citizens like Laura mentioned?
    Another key point of the results that caught my attention has to do with the difficulty that 11/30 individuals met with paperwork of the DP procedure. And I am thinking, does the bureaucratic system hold back the new ideas and schemes like DP that could help the development of social work field?

  15. https://www.theguardian.com/society/2017/oct/24/dementia-tax-tory-mps-labour-debate

    Interesting read for anyone interested.

  16. Thankyou Jessica I found that article very interesting. From what I have gathered from DPs in theory they are a good idea. They empower the service user to make decisions and tailor their care and support to suit their needs however I feel there are a number of negatives to this approach that may be coming to light. I think they would suit someone who is very swithched on and has a good understanding and knowledge of the local authourity and service provisions out there with all the different rules and loop holes however for the average service user I don’t see this as practical. The legal aspect is also a problem. I know of a situation where a man has had to take a carer to court (for reasons I don’t know) due to the fact he was legally this carer’s employer through DPs.

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