Scottish health and social care integration must heed lessons from abroad

Plans to integrate Scotland’s health and social care services by 2014 must learn lessons from similar efforts elsewhere in the world where successes and failures highlight the perils of attempting to merge the two entities. Delegates to the Scottish Association of Social Work’s (SASW’s) World Social Work Day event heard how the plans launched by health minister Nicola Sturgeon on 12 December to replace community health partnerships with health and social care partnerships would fail if integration isn’t based around the needs of service users rather than crude attempts at structural reform.

Professor Alison Petch of The Institute for Research and Innovation in Social Services (IRISS) told the event: “We’re not talking about integrated structures but integrated care around the person who needs it. Integration is only a means to an end – it is not about people working together nicely but about whether it delivers better outcomes at the end of the day for people that organisations are seeking to support. The reason it keeps cropping up is that there are some issues that seem enduringly difficult to get right.”

Professor Petch pointed to the example of Sweden for evidence of the limitations of organisational reform alone. “In one geographical area they developed a comprehensive model with one organising body and one provider. But here there were some important lessons that need to be born in mind, caveats as we take this agenda forward. The structural integration alone didn’t deliver what people hoped for. It didn’t on its own lead to improved care co-ordination on the frontline – issues of tribalism and all the difficult things we know about partnership working can get in the way.”

Professor Petch also suggested that repeated references in Scotland to the experience of integration in Northern Ireland needed to be treated with caution: “Northern Ireland is often presented as an example of a really integrated structure of health and social care but let me disabuse you as the research seems to show it doesn’t work too well at all.

“Health in Northern Ireland appears to continue to dominate the agenda, despite the joined up structure – the hegemony of health and the focus of resources on acute care and health targets lead the way, rather than broader social care concerns. There is little development of important agendas such as personalisation and children’s services, and very little attention paid to more creative opportunities that integration might offer.”

If policymakers in Scotland look further afield, however, Professor Petch said excellent examples could be found globally of positive integration. She pointed to an initiative in the US, Pace – an all-inclusive programme for care services for the elderly – which has reduced hospital admissions and left service users more satisfied.

In Quebec, a model called SIPA has reduced delayed discharges from hospitals by 50%, in part through financial integration between health and social care. The model centred on charging institutional bed costs to local services “so there was a real incentive for local services to support people in local community”, Professor Petch explained.

She concluded by suggesting the cornerstones of a successful model are multi-disciplinary teams of clinicians and social work professionals leading integrated working together, the creation of a single entry point for accessing services and undertaking joint assessment work.

Scotland’s chief social work adviser, Alexis Jay, offered the event an analysis of the opportunities of integration. Looking ahead to the proposed health and social care partnerships, she also recognised the need to protect the independence of mental health officers and ensure criminal justice social workers don’t lose the links they already have with colleagues offering addiction and mental health services.