News and Comment

Shades of Grey – towards an integrated model of care

Monday 21 October 2013

It is always a privilege to spend time with clients in a transformational environment, but it’s especially rewarding when passion and commitment lead the way. Earlier this week, I was delivering a training workshop with front-line staff in Merton about integrated care. OPM is working with Merton Council, Merton CCG and local health and social care providers to implement a model of integrated care that rests on multi-disciplinary teams operating in three localities.

My learning from the workshop confirmed that making integration real is easier said than done. Integrating health and social care provides the vehicle for transforming service delivery, but to make it work, we also tackle some shades of grey to get front-line professionals working more effectively together (there are, no doubt, more than fifty!).

Senior managers and commissioners are driving this large-scale change, whilst practitioners on the ground are making integration real. This top-down-bottom-up approach should prove fruitful, as Merton’s practitioners’ desire to improve client outcomes is in abundance.

The participants at the training session included social care managers and brokers, occupational therapists, physiotherapists and GPs. It was evident that they were eager to grapple with the practicalities of multidisciplinary working towards creating the best outcomes for clients. They identified the key factors in making integrated care work:

  • Strong leadership,
  • Good relationships,
  • Shared values,
  • Engagement and communication, and
  • Education and training.

But what was also evident was that the boundaries between professional remits are not always clear – in fact, several grey areas persist, and these ambiguities interfere with the delivery of care and thwart practitioners’ ability to progress client referrals. For example, a client who has both physical and mental health needs can be “handed off” to one organisation, rather than “handed over” meaning that essential client information is not communicated.

Other grey areas relate to the current system’s complexity. One scenario raised is the Friday afternoon crisis, when a client who needs either an emergency package of care or medication is often admitted to hospital because the social care/primary care avenues have been exhausted, or the decision about whether the client “belongs to” health or social care has not been determined. Practitioners were also concerned about clients who have been diagnosed with dementia whilst in hospital and who, upon discharge, are then advised to access primary care. In some cases these clients cannot access primary care before their next spell in hospital, which means that they “bounce” around the system.

At the session, participants offered some practical solutions for tackling the grey areas – a willingness to wade into the uncertainties across health and social care, and working jointly rather than individually. A major recommendation was much more investment into practitioner training as well as team development.

Perhaps the best barometer of organisational success is its employees’ ability to learn and deliver new ideas and fresh thinking. I came away from the workshop inspired. I was reminded that putting client outcomes first always renders the best results and that by supporting the frontline workforce to perform their best will mean fewer shades of grey.