Critical Factors of Integration-UK & Learning from Wales

Wendy Harrington; Policy Manger ADSW Amira Irshad; Social Services & Integration Directorate; Welsh Government

Background

• • • March 2013- collaboration Gap in evidence - literature -UK practice SW contribution 2011-12 England - 1.5m service (1.23m community) - 1m staff. £16 b budget.

Wales - 78, 000 service (82% community) Scotland - 198, 000 staff; 684, 000 home care hrs per week for 63 500 people.

NI - 12, 421 staff; 41, 534 supported.

Aim - identify critical factors of success (common denominators) -unique, positive contribution of social care services.

‘ready reckoner’ for change managers - establish UK network to build capacity for change.

Organisational factors

-whole system working - avoid destabilising good arrangements.

“small- scale pilots focused on the needs of people with single diseases & conditions are unlikely to deliver benefits on the scale needed” . “Leaders need to plan over at least 5 years..& be willing to adjust direction” Ham C (2011; 2010)

-organise support around individual not targets.

- place based partnership.

- coherent local & national context.

“investment will need to be made in new innovation before funds are released from existing models..

Little evidence that integrated care can be delivered more cheaply.” Ham C (2013)

- realistic scale, pace & cost of change.

Culture, leadership & governance

- culture- binds; values; behaviours; performance.

- persuasive vision – why , how & for what purpose..

- collaborative leadership- joint financial governance frameworks/ strategic plans.

- empower staff; users; communities –identify outcomes..

- culture of learning and clarity.

- leadership- common causes; multi lingual.

- Public health approach.

“conveying knowledge to patients, who are the most undervalued resource in our system, is key to managing long term conditions” Sir John Oldham (2011) “Securing the understanding & commitment of staff to the aims & desired outcomes of new partnerships is crucial..particularly amongst health professionals.” Cameron et al (2012)

Professional issues - stratify population needs; data - risk profiling vs prevention - target workforce & skills - engage champions -multi- discipl teams/ jointly commissioned services

“ a hallmark of a maturing & self confident profession is the ability to transcend a task- based approach to focus on broad themes & principles of professional practice” NISCC(2008) “need (for) high quality, large scale research..test the underpinning assumptions..in a more robust manner & assess from the perspective of service users & carers as well as from an economic perspective” Cameron (2010)

Social works services contribution

promote human rights & citizen contribution…………

(social justice) -

engage assets…………………………………………

(community development) -

provide clarity locally on implications of policy

(democratic engagement)

- prepare culture; staff; organisation

(collaborative leadership & professional governance) -

shared mandate for public health …………….

(constructive alliances)

safeguarding; risk enablement …………………….…...

(risk management)

Self directed support……………………………………….……...

(self management)

engagement with users/ carers…

( informed planning/ outcomes) -

assessment of need/ charging policies…………………….…

(gatekeeping) -

understanding wider influences……………………...

(whole life approach)