Integrating health & social care
Integrating health & social care A public social services perspective IFIC 2016, Barcelona, Alfonso Lara Montero
esn-eu.org
• ESN is the independent network for public social services across Europe • Managers, funders, implementers & evaluators in public authorities, & research organisations Annual ESSC with EU presidency The future is local! Decentralisation, empowering communities, improving services • Find out online - www.essc-eu.org • On Twitter @ESNConference for all the latest news • Plenary session on integrated care essc-eu.org
Recent publication Integrated social services • Social services with education, employment and health • Systematic literature review • Practice review • How integrated are public services? • Most examples from health & social care • It is about structures but most importantly about people esn-eu.org
Introduction
esn-eu.org
Introduction What do we mean by integration? Across Europe, when people talk about integration, they may refer to: •
Improving cooperation between professionals from different sectors working with the same client
•
Structural reorganisation or improved governance
•
Integrating various strands of finance by pooling budgets
They are all integration on one way or another… But… Are they improving outcomes for people? esn-eu.org
Improving cooperation
A vision for health & social care integration existed many years ago Now, social workers work alongside health professionals in integrated teams: • Hertfordshire’s Homefirst Team in England (source BBC)
• MAIA (Maison pour l’autonomie et integration des maladies Alzheimer) in France • The Early Years Collaborative in Scotland • Network for early intervention for children with developmental difficulties in Andalucía, Catalonia (Spain)
esn-eu.org
Improving cooperation
What does this mean for social workers and the way they work? • More flexibility and more responsive to needs • Shift of responsibilities; for instance, in adult safeguarding
But not exempt of difficulties • Cultural issue about social workers & clinicians working differently • Prevention & promotion low funded (prevention: 3.3% Norway, 4% UK, 3.6% Germany)
esn-eu.org
Structural reorganisation Focus on organisational performance, risk asking ‘how well are we doing in meeting our own regulatory requirements?’ It’s been recommended that every local commissioning arrangement has same aims and desired outcomes However, “It (integration) comes down to how people understand their place rather than some arbitrary organisation design” (ADASS)
esn-eu.org
Structural reorganisation
Decentralised • Place Matters as do the people in it • “Whole system” place based approaches
Integrated • Health, Social Care & Other Public Services
Personalised • Individuals often the best integrator
esn-eu.org
Integrating budgets
•
Different funding streams hinder integration
•
New developments –Manchester
•
Healthcare -free at point of access; in social care there may be charges Lack of funding also risks integration: Due to budgetary cuts, 40% councils brought back social workers from integrated mental health teams in England
(Source: normanno.com)
Social care –poor cousin of national health system Social services chronically underfunded before the esn-eu.org crisis
Thoughts for the future… regarding integration •
Understanding the relationship between social care & health & differences in funding, commissioning, structure, culture
•
Differences in pay scales
•
Indicators of success matter: Not only reduction in emergency admissions also satisfaction and wellbeing
•
Role of technology key to deliver better quality of life: Recognised by both health and social care professionals
•
Also across other public services Boiler on prescription: health, social care & housing Increasing need to deliver a personalised approach esn-eu.org
Final word on personalisation
• Service user led and relation-focused approach • Moving from a deficit to asset/strengths based approach • Cooperation, participation and inclusion • Lead on protecting human rights • Holistic, person-centred approaches promoting independence and balance care and protection • Empathy can help to establish and sustain positive inter-professional networks to advance to outcome-focused approaches • Manner and end result is what matters most
esn-eu.org
Thank you! esn-eu.org
esn-eu.org
• ESN is the independent network for public social services across Europe • Managers, funders, implementers & evaluators in public authorities, & research organisations Annual ESSC with EU presidency The future is local! Decentralisation, empowering communities, improving services • Find out online - www.essc-eu.org • On Twitter @ESNConference for all the latest news • Plenary session on integrated care essc-eu.org
Recent publication Integrated social services • Social services with education, employment and health • Systematic literature review • Practice review • How integrated are public services? • Most examples from health & social care • It is about structures but most importantly about people esn-eu.org
Introduction
esn-eu.org
Introduction What do we mean by integration? Across Europe, when people talk about integration, they may refer to: •
Improving cooperation between professionals from different sectors working with the same client
•
Structural reorganisation or improved governance
•
Integrating various strands of finance by pooling budgets
They are all integration on one way or another… But… Are they improving outcomes for people? esn-eu.org
Improving cooperation
A vision for health & social care integration existed many years ago Now, social workers work alongside health professionals in integrated teams: • Hertfordshire’s Homefirst Team in England (source BBC)
• MAIA (Maison pour l’autonomie et integration des maladies Alzheimer) in France • The Early Years Collaborative in Scotland • Network for early intervention for children with developmental difficulties in Andalucía, Catalonia (Spain)
esn-eu.org
Improving cooperation
What does this mean for social workers and the way they work? • More flexibility and more responsive to needs • Shift of responsibilities; for instance, in adult safeguarding
But not exempt of difficulties • Cultural issue about social workers & clinicians working differently • Prevention & promotion low funded (prevention: 3.3% Norway, 4% UK, 3.6% Germany)
esn-eu.org
Structural reorganisation Focus on organisational performance, risk asking ‘how well are we doing in meeting our own regulatory requirements?’ It’s been recommended that every local commissioning arrangement has same aims and desired outcomes However, “It (integration) comes down to how people understand their place rather than some arbitrary organisation design” (ADASS)
esn-eu.org
Structural reorganisation
Decentralised • Place Matters as do the people in it • “Whole system” place based approaches
Integrated • Health, Social Care & Other Public Services
Personalised • Individuals often the best integrator
esn-eu.org
Integrating budgets
•
Different funding streams hinder integration
•
New developments –Manchester
•
Healthcare -free at point of access; in social care there may be charges Lack of funding also risks integration: Due to budgetary cuts, 40% councils brought back social workers from integrated mental health teams in England
(Source: normanno.com)
Social care –poor cousin of national health system Social services chronically underfunded before the esn-eu.org crisis
Thoughts for the future… regarding integration •
Understanding the relationship between social care & health & differences in funding, commissioning, structure, culture
•
Differences in pay scales
•
Indicators of success matter: Not only reduction in emergency admissions also satisfaction and wellbeing
•
Role of technology key to deliver better quality of life: Recognised by both health and social care professionals
•
Also across other public services Boiler on prescription: health, social care & housing Increasing need to deliver a personalised approach esn-eu.org
Final word on personalisation
• Service user led and relation-focused approach • Moving from a deficit to asset/strengths based approach • Cooperation, participation and inclusion • Lead on protecting human rights • Holistic, person-centred approaches promoting independence and balance care and protection • Empathy can help to establish and sustain positive inter-professional networks to advance to outcome-focused approaches • Manner and end result is what matters most
esn-eu.org
Thank you! esn-eu.org
