Transcript Document
Critical Factors for Referral and Case
Management between Social Services
and Primary Care
There is very little published information
identifying critical factors for referral and case
management between social services and
primary care in relation to single point of entry
integrated services for children
Community Health
Partnerships (CHPs)
Community Health Partnerships (CHPs) were
established in Scotland in 2004 to “deliver
services more innovatively and effectively by
bringing together those who provide community
based health and social care”.
A review of the early progress of CHPs identified
the following facilitators and barriers (Watt et al
2010).
Facilitators of CHPs progress
• The qualities of the CHPs management team
• A tradition of close partnership working with the
local authority and leadership from key individuals
• Co-terminosity of local authority and other
agencies’ boundaries
• Co-location of staff
• Being an integral part of the Community Planning
Partnership
• Political buy-in from elected members
• Positive engagement with GPs
• Strong links with the voluntary and community
sectors
Barriers to CHPs progress
• Poor relationships with health colleagues, the
local authority and the Health Board; engaging
effectively with GPs was commonly acknowledged
as a challenge for CHPs
• Differing perceptions about the role of the CHP
• CHP structures and governance arrangements
• Organisational differences between the NHS and
local authorities
• Capacity and financial resources to deliver the
work
Children’s National Service
Framework
Facilitators and barriers to interagency
collaboration were also identified by Patricia
Sloper in a literature review carried out to
inform the Children’s National Service
Framework in England (Sloper 2004).
Facilitators of interagency
collaboration
• Clear and realistic aims and objectives
• Clearly defined roles and responsibilities, and clear
lines of responsibility and accountability
• Commitment of both senior and frontline staff
• Strong leadership and a multi-agency steering or
management group
• An agreed timetable for implementation of changes
and an incremental approach to change
• Linking projects into other planning and decisionmaking processes
• Ensuring good systems of communication at all
levels, with information sharing and adequate IT
systems
Barriers to interagency
collaboration
• The opposite of the facilitating factors on the
previous slide, and in addition
• Constant reorganization
• Frequent staff turnover
• Lack of qualified staff
• Financial uncertainty
• Differing professional ideologies and agency
cultures
A review of integrated medical and social
services in the United Kingdom and USA
(Leutz 1999) identified five “laws” for
integrating medical and social services for
people with disabilities and chronic illness.
Although this is a different focus from the
“Right Service Right Time” initiative, the
insights gained from this review may be
relevant to integration of services for children
and their families.
The 5 Laws
• You can integrate all of the services for some of the
people, some of the services for all of the people, but you
can’t integrate all of the services for all of the people
• Integration costs before it pays (the costs of integration,
such as staff and support systems, services, and start-up
must be found before any benefits and/or savings can be
seen)
• Your integration is my fragmentation (for providers, it is
simpler if they only need to worry about their own service)
• You can’t integrate a square peg and a round hole
(cultural clashes may occur; for instance between medical
and social service staff)
• The one who integrates calls the tune (joint
commissioning may be a more successful approach than
fund-holding by a single organisation)
Recommendations derived
from the 5 Laws
• Involve service users, carers, and community
service providers in planning and oversight
(successful integration will occur only if all
parties participate in planning and
implementation)
• Develop systems to integrate, coordinate, and
link services for persons with disabilities
• Clarify borders between medical and other
systems
Effective interagency working
(Tomlinson 2003)
• Full strategic and operational level commitment
• Shared aims and values; clear roles and
responsibilities
• Good management
• Involving relevant people
• Funding
• Data sharing
• Training (ideally joint training)
• Team commitment
• Communication
• Location
• Creativity from adversity
The importance of culture
A review of the international literature on
health and social care partnerships (Peck and
Dickinson 2009) identified “culture” as playing
a vital role in creating effective partnerships.
Culture is described as “an influence which
promotes integration within organisations
(thus two divergent cultures may need to be
reconciled when organisations work in
partnership).”
The review emphasised that concern about
culture in partnerships is not confined to the
public sector; with culture also recognised as “a
central issue to the success of alliances,
mergers, and acquisitions in the commercial
field”.
Integration may fail if too much attention is paid
to the structure of the integrated service and not
enough to the cultures of the partner
organisations.
Differences in characterisation
of NHS and social services
partners
NHS
Social Services
Treatment
Care
National targets
Local needs
Must dos
Local discretion
Universal services
Focus on vulnerable
Procedurally regimented and
very top-down in style
Practical focus but has
difficulty with strategy and
planning
Consistent facilitators of social
services and primary care
integrated services
• Shared objectives and timelines, and a
shared understanding of the role of the
integrated service
• Strong leadership
• Clear roles and responsibilities
• Recognition of the differences in culture
between the participating organisations, and
implementing strategies to address these
differences
• Adequate resources