Integration, Conversation and Change

Some Random Thoughts about Making Things Better

I have spent a good deal of the last week thinking about the importance of building and making links across different parts of the ‘whole’ in terms of the way services are provided by agencies to us, the public. Some of the following thoughts may seem random but I’m trying to connect them in my head! Slowly but surely..


Last week I attended the Digital Health Conference and Hack in Leeds (which I wrote about here).  Without repeating myself too much, there was a programme around changes and new thinking in both health and social care that stretched over two days and involved a lot of conversations with people from many different areas – both in terms of place of interest and work and in terms of geographical area and level of authority.

The main theme I took from those days was around the important of connections and conversations. Ideas and innovation is not a top down, nor a bottom up flow. The channels and flows need to be horizontal – and across sector and areas of interest – as well as vertical. We need to look at ideas from outside the sector rather than only talk to ourselves and rely on well-meaning civil services to devise policies in London, particularly when ‘social care’ is often seen as an afterthought in the ‘health and social care’ agenda. When I look at models and policies developed for ‘health and social care’ and see that social care is little more than an afterthought with processes developed clearly by people who probably would find it difficult to define social care, let alone understand the messy way it is structured locally, I start to despair and then remember that if I invite myself to the table, I can make those points directly which may, possibly, make a difference.

I left Leeds with some glimmers of hope that as long as social care does continue to place itself around tables like that, we would be able to contribute and even, perhaps, influence thinking in a little way.

‘Health’ is universal, social care is not. The narrowing restrictions on access to funded social care is a massive challenge as access unfortunately can play into the government agenda of stigmatising those who need the provision of service. There isn’t yet a more general perception that social care is something for everyone and in adults services, anyway, the charging policies cause a great deal of anger and resentment when we are trying to offer them to people.


I had another conversation earlier this week too, with Mark Brown who is the editor of One in Four (highly recommended, I’ve been a subscriber for a while).  We come from different angles but want to find answers to the same problem of how t0 provide a better service to those who need it. While we haven’t (yet) found the answer, he’s a lot further ahead of me and I highly recommend looking at the keynote speech he recently delivered in Australia about new ways of delivering and providing mental health services.


In the background as well, I heard about the closing of Social Work teaching at the Institute of Psychiatry and the move towards outcome measurements based on clusters and quantifying diagnosis and recovery, I wonder if Mental Health services are moving backwards rather than forwards in terms of promoting and developing different ways of thinking about services and different ways at delivering which move away from ‘medical models’ which have not proved to be useful generally.


‘Integration’ is only integration if it actually brings people together rather than driving them apart which is what it feels is happening at the moment. The pots of money are split and the silos are created. This currently is in the interests of those who are working across the sector as they have their own fiefdoms of interest and can’t see new ways of developing practice that is based on unquantifiable aims.

So what do we need to challenge and change from within?

The current systems promote wrong thinking in a number of ways.

If we can’t measure progress, progress doesn’t exist.

We are expected to aim towards mediocrity rather than strive for excellence.

There is an emphasis of the ‘us’ and ‘them’ dichotomy of professional and user with little understanding of the user as professional nor of the professional as user.

Thinking of the tenets of personalisation and how the poor implementation has been managed in England, I can see both some rays of hope and some shadows of despair.

What was supposed to be a user focused attempt to shift power in social care services has, instead, imposed an attempt at new ways of thinking onto old models. We were told we had to ‘make things work’ but as we have seen in practice, the tools we were given were old and rusty. Local authorities were not able to shift models of commissioning nor of power structures rapidly enough to make the system a reality. We should be studying and learning from what has gone wrong with this model and pulling up the examples of poor practice to learn rather than constantly dwelling on the models of good practice.

Despite and because of the conversations I’ve had over the past week, I am learning that there isn’t enough different thinking within the systems I work in. The knowledge and desire to change is being paid lip service because there is a demand on time and money. The truth is delivering better is not only potentially further savings in the long run in terms of cash, the amount that can be saved in terms of quality of life improvements are priceless.

Social Work has the possibility to be at the heart of these conversations. We occupy the space around the ‘social’ which strides across health and social care – and across the life course.  However the profession itself doesn’t seem to welcome innovation itself and hasn’t been able to define a specific role which leads to possibilities for much confusion. The way out is for practitioners to develop a voice. Personally, I’m holding out that the College of Social Work will do a better job of it than has happened previously – but the need for innovation and fresh thinking is the only thing that will improve the outcomes for those who rely on us.

We owe it.