We’re on the right road on the journey to integration

• Written by: Ruth Dorman — Deafblind Scotland — Chief Executive
• Published: 17th June 2018

As someone who has worked in both health and social care I have been on a remarkable journey.

My need to become dual qualified was in part (big part) due to the lack of integration within the sectors. The interdependence was always there however the ‘boundaries’ were ever present, right down to the differing languages and perceived cultures.

The NHS and Community Care Act 1990 (this link will take you away from our website) and subsequent Community Care and Health Act 2002 (this link will take you away from our website) provide a legislative framework for ‘joined up’ working where health and social care are obliged to share responsibilities and resources.  The then Scottish Executive accepted recommendations of the Joint Future Group which were reported in “Community Care: A Joint Future” in December 2000.  The key elements of which featured in “Our National Health: A Plan for Action, A Plan for Change”.  The main aim of this report was to find new ways of improving joint working and to rebalance services for older people away from institutional care towards services in the community.  With this as the driver I moved to work in a multi-disciplinary team which was co-located and joint funded, “integration was here”, although it has taken a further sixteen years for us to reach the point of integrated authorities.  Reflecting on this journey I can say “yes, we are on the right road”.

When I joined the world of sensory impairment seven years ago there was little, if any, concept of where individuals who lived with Deafblindness (severe dual sensory loss), sight or hearing loss/impairment, were considered in the world of health and social care.  These seemed to be ‘conditions’ which formed part of a tick box on an assessment forms, or where you attended audiology, ophthalmology or opticians. There was very little recognition that sensory impairment required to be recognised in a person’s overarching ability to live well, stay well and get well.  There was a lack of understanding that the impact of little or poor accessibility to information, whether this be spoken, written or visual information, had on a person’s ability to engage in their health and social well-being, e.g. how can you know you have a hospital appointment if you cannot see the letter to read it or hear the message?

I have observed, however, that in relation to integration, the progress of drawing the voluntary sector closer into planning and decision-making processes is happening, although there remains a perception that we are still viewed principally as ‘suppliers’ rather than partners.  I remain aware that what is required of us all by government is ‘public service reform, not simply public sector reform’.

Collaborative working remains very much a public sector development, rather than a public service development.  Although there are great examples across the country of collaboration I believe we have not yet found a satisfactory way of enabling Integrated Authorities to harness the expertise of voluntary sector organisations, far less of people who use services, in community-level needs assessments, planning or decision-making.

I continue to believe that certain statutory responsibilities could be placed upon the voluntary sector in its own right, with funding, and not just by delegation from public authorities.  There is, for example, a clear role for voluntary sector service providers to become much more involved in the assessment process for individuals, including acting as the ‘lead professional’ in relation to assessment for sensory impairment services, there is currently only one example I am aware of across Scotland, in Aberdeen City.

All of this said I am delighted to be in a position to claim that integration is helping ‘join the dots’ in the planning of how services and supports are being made accessible for those living with Deafblindness.  The British Sign Language (BSL) (Scotland) Act 2015 (this link will take you away from our website), and inclusion of tactile BSL within the body of the Act, means that in the development of National and Local Plans all public bodies, including integrated authorities, must set out their plans for ensuring that “Scotland’s ambition to be the best place in the world for BSL users to live, work and visit”.  The Scottish Government made it clear that it was not intending to impose change from above: rather, those involved in planning, providing and using public services had a significant part to play in collaborating to shape the way in which change happens.  True innovation and transformation in action, through not just how the initial National Plan was developed, but, how we take this forward to develop local plans.

It’s an inspirational time to be part of the journey of change, and I’m looking forward to the next 30 years.

Ruth Dorman can be found on Twitter at: @ruthdorman (this link will take you away from our website).

Ruth’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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