Catherine Mangan

The latest guidance on the health and social care integration transformation fund emphasises the need for ‘genuine commitment to partnership and recognition of the challenges’ to ensure success. We all know that successful integration will rely on genuine, positive relationships between health and social care professionals in the system. But are we taking these positive relationships for granted?

The early findings from iMPOWER’s Home Truths programme suggests that we are, and that we face some fundamental challenges around levels of understanding, and, ultimately, levels of trust between professionals in the health and social care sectors.

The original Home Truths report was published in September 2012 and suggested that GPs were inflating demand for residential care because they didn’t understand the alternatives and that by failing to address this issue, local authorities were failing to manage demand for residential care. Since then, six geographical areas have been working with iMPOWER to explore these issues further, with the University of Birmingham acting as a critical friend.  The sites have conducted surveys of GPs and older people, interviews and data analysis; culminating in an action plan. This week sees the launch of the interim evaluation report on the work of the six sites. The initial findings make for interesting, albeit uncomfortable reading:

• Over half of GPs rated their relationship with adult social care as poor or unsatisfactory. 41% of GPs felt they could make a better assessment than social workers about a patient’s need for residential care.

• On a more positive note, 92% of GPs wanted closer links with Adult Social Care staff to better understand local service offers and 76% of GPs said they could be helped to do more to intervene earlier to delay or avoid the need for residential care admissions.  A third of GPs felt that at least some of their patients who had gone into residential care had been admitted before they needed to be.

• GPs lack knowledge and understanding about social care and prevention type services. Half of GPs who took part in the surveys knew nothing about telecare services (even though they were available in their area), whilst a third knew nothing about the available exercise classes or social support networks. Even where GPs do know about social care services there is a strong perception that these services are not good quality.

Sites also discovered that GPs have a significant influence on older people’s decision-making about care options, with the survey of older people showing that after family, most older people would turn to their GP for advice.  This is perhaps made even more significant by the finding that older people don’t pre- plan their entry into residential care, so may be turning to GPs in a moment of crisis.

For the sites these findings made difficult reading, but most of those involved admitted they had a ‘gut feeling’ about the problems. They have started to address the issues by developing a variety of approaches which aim to:

• Improve communication about social care referrals
• Improve access to information about social care services
• Train GPs and consultants about social care services and processes
• Embed joint working between social workers and GPs
• Influence the influencers of older people’s decisions about care

For the sites involved, the Home Truths programme has acted a useful catalyst and provided a focus around which health and social care professionals can begin to converge. The work has acted as a first step in understanding and addressing the relational challenges of integration that lie ahead.

We suggest that all Health and Well Being Boards would benefit from thinking about how these issues might apply within their health and social care systems and ensure that alongside structural plans for integration, fundamental issues around trust and understanding are recognised and addressed.

The Home Truths evaluation report will be launched today at the NCAS conference #ncas and will be available at www.impower.co.uk.

Catherine Mangan is a Senior Fellow at INLOGOV.  Her interests include public sector re-design, outcomes based commissioning and behaviour change.  Prior to joining INLOGOV she managed the organisational development and change work for a not-for-profit consultancy, specialising in supporting local government; and has also worked for the Local Government Association, and as Deputy Director of the County Councils Network.  She specialises in adult social care, children’s services and partnerships.