Integration from a social worker perspective

Written by: Trisha Hall, Social Worker and Manager, Scottish Association of Social Workers

Published: 17/06/2018

Working towards integration requires strong, positive and transparent relationships based on mutual respect.

Social workers – the obvious clue is in the name – work to improve society and the circumstances of people who live within it.  Comprising approximately 5 per cent of the 200,000 plus people employed within the Scottish social services workforce, we are a rather small but beautifully formed cog in the proverbial wheel.  The integration vehicle would struggle to make any traction without us!

Working in an integrated setting following the 2016 implementation of Integration Authorities wasn’t new; social workers were used to and skilled at working with the NHS, Education and Third Sector colleagues.  Information from SASW members suggests it works best if the partnerships are based on mutual respect for each other’s professional roles, and a joint commitment to putting people who use services at the heart of the support or intervention. This requires strong, positive and transparent relationships based on mutual respect.

Social work has protection of title, and with that right come important responsibilities. The BASW code of ethics (this link will take you away from our website) and the SSSC social services code of practice (this link will take you away from our website) informs all our work.  Social workers uphold rights through practice skills and their statutory authority.  We balance the needs of the people we work with and for, with the need to protect individuals and/or the community they are part of frequently within the same situation.  This is done against a backdrop of the “having to do more with less” mantra which can be quite restricting but can also allow creative work and solutions, if appropriate autonomy is allowed.

At our MHO (Mental Health Officers) annual conference in October 2017, participants discussed changes in health and social care integration and the double-edged sword of the potential loss of identity as social workers, and an opportunity to show more leadership in the mental health field in integrated management roles.   Having a voice within multi-disciplinary teams allows us to be vocal about how resource implications often sit at odds with people’s rights.  MHOs have legally enshrined autonomy but might find themselves subject to subtle pressures if the manager of the integrated setting is mandated to prioritise the budget.

Within the complexities of “delayed discharge” scenarios we have heard from social workers who have had trouble in advocating the needs and interests of people and their families, sometimes being instructed to justify placement moves which, may not have been in the best interest of a person.  This is not acceptable, and we have acted on these matters.

Some social workers who have become part of some integrated teams struggle within a culture, which is not conducive to the best outcomes and fear the profession will be eroded.  Receiving an email, which says “you must do” is never the best way to get practitioners to engage in a positive way….

There are however many examples of good practice and well established positive partnerships, and the buzzword within these is “relationships”.  It starts with strong leadership and a good management structure, so that staff aren’t being left to “sort it out”.  Initiatives such as single access points, e.g. referrals to community care with GP alignment and linking with hospital discharge, are evident across the country.

Health and Social Care Partnerships that are creative, where middle managers have had time to be proactive and have been able to work to stop crisis through reablement, where supervision for social workers and sound workload management is in place and reflective practice opportunities are encouraged – these partnerships are the ones that will stand the test of time.

A great example of this can been seen following the horrendous weather in late February 2018, which saw fantastic examples of social workers working in close partnership to support hospital-to-home care packages to allow beds in hospitals to be freed up.

Best practice in children’s services is when prevention happens instead of “early intervention”.  A solid “team around the child” means multi-agency practice so that the child’s plan is focused on best possible outcomes as opposed to only managing potential risk.  Person centred care must not become jargon, but the reality for people who need us.

To illustrate what is meant, I refer to a nomination for our annual SASW Social Worker of the Year award of a complex case with a young person and their family.  This person had been in hospital critical care for two years. The work was described as resembling a “Clash of the Titans” at the beginning of what was a long journey; two worlds colliding to work through a process to facilitate their safe discharge a year later.  The social worker’s skills in bringing the family into the care and decision making process, which ensured that the person’s wishes for themself and their family were given the utmost focus, her sensitivity and support and her communication skills played a huge role within this process.

Despite fears it may not work, the person managed to spend a very happy, settled and enriching year with family and friends.  The social worker managed to make this and many more achievements possible by practising social work values of respect and diversity, but most importantly by regularly challenging human rights in terms of what the person wanted for themself and their family. The social worker’s influence in strengthening a multi-disciplinary team in unchartered territory (there had never been a discharge from a critical unit straight to home) was described as “phenomenal”.

This reflects the uniqueness of a proud profession, which should thrive within integrated settings if the culture is there.

The Scottish Association of Social Work can be found on Twitter at @ScotsSW (this link will take you away from our website).

Trisha’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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