Health Service Focus

A better partnership approach for integrated health and social care

Sharon Allen OBE, chief executive of Skills for Care and the National Skills Academy for Social Care, talks to NHE about tackling cultural issues to deliver integrated services.

Delivering integrated health and social care services effectively will depend on partnerships rather than structural reorganisation, according to the chief executive of Skills for Care. 

Sharon Allen OBE told NHE that there are still large cultural issues to overcome to deliver a seamless experience for the patient and service user. 

“There is a massive cultural issue we have got to address, and I think the early evaluation of the work that has gone into the Integration Pioneer sites shows this very clearly and that the cultural issues are very often what trips us up,” she said. “But they are things we can address by learning together, by sharing information and by working from a basis of mutual respect and starting from the position of ‘how are we going to support the person in the community together’, rather than saying ‘my organisation needs me to do this, and mine does this’.” 

Most evidence suggests that while integration does indeed provide better outcomes and can reduce hospital admissions, it is not necessarily able to deliver the huge financial savings sometimes envisioned. 

But Allen told us of a project in Bath and North East Somerset where local nurses worked with care staff across three residential care homes. She said: “We skilled those staff up so they could undertake some of the more basic tasks, which might previously have been seen as a nursing task only.” 

An independent evaluation confirmed that project did save money, with the savings arising out of the workforce changes and reduced hospital admissions.  

Looking at the workforce 

The Integration Pioneers and the vanguards are already forcing new thinking about the workforce and what roles will be needed. 

Allen said: “We need to look at this both from the perspective of new roles that we might need – so people are looking at hybrid worker roles such as a care navigator – and thinking about how we use the current workforce, which is going to still be with us in 20 years’ time.” 

Allen, who has worked in social care across the public and voluntary sectors for nearly 30 years, said it is easy to think there just needs to be lots of new roles. Instead, there should be a mix of work and looking at how roles are best used. For example, can having a social worker in health teams enhance their capabilities and reach? 

Wellbeing fundamentals 

Allen is also an advocate of place-based integrated services to deliver and promote wellbeing for patients. 

“I don’t know how you can talk about promoting wellbeing if someone doesn’t have somewhere safe, affordable and secure to live,” she said. “Housing, social care and health, I would suggest, are the three absolute essentials if we are talking about wellbeing.” 

But having a fulfilled life also requires good access to things like leisure, transport and skills development, she added. 

Funding 

The funding gap for social care is estimated to grow by a minimum of £700m a year, chiefly as a result of rising demand, exacerbated by the introduction of the National Living Wage. Hitting NHS efficiency targets by 2020 will be impossible if social care is not properly funded, NHS England boss Simon Stevens says. 

Allen told us: “Obviously, what we are all trying to do is keep people out of hospital. And when people do need to go into hospital, we get them back home again as quickly as possible. But you can only do that if you have the services available locally, and we can only provide those services if you can recruit and retain a quality workforce.” 

The Spending Review had not yet happened when we spoke to Allen, but she said everybody was hoping to see a better settlement for social care. “This would mean that local authorities can fulfil their duties under the Care Act and they can work in true partnership with providers of social care, which are predominantly in the independent sector. [It would mean] work in partnership with their colleagues in health so we are not fighting over budgets but are actually using the resources we have together to produce good outcomes for citizens,” she said. 

We asked Allen to describe how the health and social care landscape could look by 2020. She said: “The ambition is that we will stop talking about the whole health and social care system and we will just have a system from the point of view of citizens. 

“I don’t think that this necessarily has to involve lots of structural integration. In fact, I think people are weary of reorganisation and structural change – but what we can do is have a much better partnership approach.”

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