‘At the heart of it is a person’: how do we integrate health and social care?

As our population ages, the traditional dividing line between health care and social care is blurring, with many older people needing both medical attention and help with personal tasks such as getting dressed and preparing food. Despite the overlapping aims, health care and social care operate as two separate systems, often leading to practical problems. When an older person becomes ill or falls, for example, they may be admitted to hospital – but, having recovered, they may be unable to leave because there is no social care package waiting for them.

To provide effective care, we need the systems to work seamlessly together. But how can we achieve this? This was one of the topics discussed in an event in May, titled Health and Social Care Workforce: Wellbeing, Integration and Sustainability, and organised jointly by Care England, Future Care Capital and Talent for Care. The event drew participants from across the two sectors. As well as hearing from prominent speakers in health and social care, participants discussed topics at their own tables and reported back.

Common pay and career pathways  

Social care is very much the poor relation when it comes to both pay and career development, and several speakers drew attention to the difficulty for staff in moving between sectors. Martin Green, chief executive of Care England, said there should be “central direction from government in terms of skills and competency frameworks, portable career qualifications and career pathways in social care.” One suggestion from the floor was to replace the Skills for Health and Skills for Care bodies responsible for workforce planning with a single body called “Skills for Integrated Care”.

David Nicholson, chair of the Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust and former NHS chief executive, argued that it was essential to introduce a common pay system for health and social care. “It will increase our ability to move people in the system,” he said.

One speaker, reporting on a table discussion among those in the care sector, spoke of how a lack of funding made it hard to retain staff. The result was that patients could not be discharged from hospital because there were no carers to look after them.  Another speaker gave an example of keeping a residential home bed open for a patient for three weeks while waiting for the funding to be delivered.

Green also noted the disparity in funding for training and career development between the two sectors, describing the government money allocated to social care training as “minuscule” compared with that available in the NHS. He suggested introducing a “training and development pot that could be accessed by everybody who works in that health and social care space.”

The nature of the training – currently “too focused on organisations and processes” – should also change, Green added: “We need to train people to have the autonomy and skills to respond effectively to what people need. We need to be sector-neutral.”

Good leadership is essential 

Last year saw the introduction of integrated care systems (ICSs), partnerships of local organisations designed to deliver joined-up health and care services. Nicholson said that good leadership was necessary to make integration work: “When you’re working in partnership across a system the most important thing is mutual accountability.” It was essential to have a senior management team that is “vibrant and useful, not paralysed with governance or organisational challenges.”

Some speakers from the floor noted, however, that some ICSs were dominated by NHS representatives, and that it was often hard for social care providers to join. One speaker mentioned that he had only been able to join an ICS because he had a contact in a senior role in the NHS.

A number of speakers from the floor noted that differences in processes and in IT systems made integration very difficult. One pointed out that, even within the NHS, there was still a lot of silo working, with different hospitals in the same trust “not having the same records, not having the same information, not knowing what each other was doing – and it also translates to parts of the same hospital.” Another speaker suggested developing a “joined-up integrated technology to monitor, record and modify the [patient] journey all the way through to social care.”

Building trust 

There was widespread agreement that the two sectors needed to have a better understanding of how the other worked, with one table speaker suggesting joint training and the use of secondments to “build that understanding and trust”.  Another suggested shared measures of success to make sure staff in both sectors were “all heading towards those agreed measures.”

Some speakers who reported on table discussions cited examples where health and social care had worked well together by focusing on the needs of the patient. In one case, involving a Transforming Care Partnership, a multidisciplinary team had worked on moving patients from hospitals to community settings. One high-risk patient who had been in hospital for 40 years had been successfully moved to a community setting and was now “living a meaningful life”.

Another example was that of a palliative care patient who had been cared for by health care and social care staff collaborating. “All parts of the system worked perfectly,” the speaker said. The joint focus on an individual had led to seamless integration. “When you strip away those systems and bureaucracy, at the heart of it is a person,” she said. “It’s not about systems, it’s about the person who needs support and about keeping the question ‘What works for you?’ in mind at all parts of their journey through health and care services.”