Integrating Social Care and Health Care in Australia

In 2016, the World Health Organisation came up with a ‘framework on integrated people‐centred health services’ as a standard against which we can evaluate the performance of the different programmes. At its core are three aspects:

·????????patient‐centred healthcare,

·????????community‐centred health services and

·????????improved coordination across providers and sectors.

Patient‐centred healthcare is a critical element of the framework. It is not focused on provider interests, anatomy, specific diseases, or particular technologies. Rather, it focuses on the integration of different services around the needs and wants of patients. It is care which understands and responds to the family and social context. It is also respectful, participatory, and accountable service delivery. To me, this implies the integration of social care and health care, and my vision is to see this implemented in Australia.

At the beginning of the Covid-19 pandemic, many governments, including ours, made decisions that resulted in widespread deaths of the elderly in care homes. This revealed serious ignorance about how the care sector works and highlighted the challenges of managing public services and responding to unending uncertainty. Included in this is ensuring that different but connected services, such as health and social care, work together seamlessly.

The idea of integrating social services and healthcare services has been a European trend for some time. For example, in Scotland a flagship social policy is centred on the need to integrate healthcare (managed by the NHS) and social care (managed by local governments). The wish to integrate these two key services started in 2016, and commands widespread political support. Research all over Europe has emphasized the leadership and management challenges around the issue. Seven key lessons emerged from these studies, which will help to ensure the successful integration of these two most important public services in Australia.

1. The need for proper political support

If there is insufficient federal government support, innovative and creative attempts to integrate will fail. This happened with the UK’s Sure Start Children’s Centres designed to improve the future of children in deprived areas. The ring-fenced budget was removed and the programme suffered cuts in the funding. This resulted in a sharp decline in the numbers of children who benefited from Sure Start who, unfortunately, lived in the poorest areas of the UK. The same thing can happen in Australia if the central or local government takes a detached approach to the integration of social and health care and fails to take responsibility for its progress. This implies government must be willing to be held accountable for the way integration rolls out and must maintain national public policies.

2. Involvement of communities is key to success

Community involvement and support from local groups can ensure success in integrating these services. We wrote before that whole community involvement in aged care can increase life expectancy because the elderly associate their happiness with being active members of their communities. The same applies to disabled people and anybody who is sick. It is wise, therefore, for government to acknowledge how communities can shape health and social care.

3. Health and social professionals must be prepared to integrate

Health and social professionals are sometimes reluctant to integrate. Differences in status can create professional boundaries that cause friction. Also, differing health backgrounds, some based on social care training and others based on medical training, can become barriers to professionals working together. Even a mismatch in behaviours, cultures, and understanding of services can divide health and social care, making it harder to establish a clear purpose and agree on long term objectives.

To manage this, multi-agency team managers need to approach local communities to develop broader partnerships. Staff development opportunities to work across this divide will also improve understanding of other disciplines.

4. Shared goals and values are fundamental to success

Strong and effective partnerships depend on the strong commitment of the partners. Therefore, for social and health services to work together successfully, they must have a common purpose. It is crucial to define a clear purpose at all levels and to clarify roles and responsibilities to engender trust, respect, and understanding.

5. Clarity: communication, accountability, and data sharing

Successful integration depends strongly on strong relationships and effective communication at worker-to-worker level and at worker-to-client level. For the two groups of professionals to collaborate and share relevant information, they require shared management systems with common IT systems. They also need formal agreements on things such as constructive performance management and data sharing.

6. Long term funding is key

Short-term funding has been proven not to work for inter-agency programmes; in fact, it is a barrier in the long-term. Therefore, a long-term funding model is very important for success. For effective integration, sustained funding through budget-sharing and realistic staffing is crucial. There is also need for time to be built-in for planning and proper support. Scotland is a good example in which there is no sustainable funding due to public finances that are linked to austerity measures as well as an ageing population. Australia, with its ageing population, can learn from the Scottish case.

7. The integrated team needs to know if they are getting it right

Not everyone possesses the tools to evaluate what really works, therefore it is important to develop the skills of managers in health and social care. It is natural to focus heavily on performance monitoring while forgetting to investigate the actual changes that have emerged from the integration initiative. In Australia, the federal government has agencies which regulate and inspect health and social care. Such agencies must begin to provide practical ongoing research support to help professionals to continue learning and to access the requisite expertise and resources so they can know what works.

When it comes to integration of public services, the “how” is as important as the “why.” Also, strong leadership is important. Policymakers have to listen to people who do the work and show them that they value their knowledge and experience.

Conclusion

Integrating social services and health services is a good idea that may prove to be difficult to implement effectively unless we follow these guidelines. Integrating these two services will mean that Australians can finally receive joined-up care and support when they need it most.?