Unlocking the role of key worker
The concept of a key worker is central to many models of integration. Indeed it is a requirement of the Better Care Fund that where there is an integrated package of care, there should be an accountable professional for it. Whether this is the same or different from a key worker and whether the Government’s ambition suggested in the GP Mandate that a GP is the named accountable professional in all cases, is still unclear. Nevertheless many integrated care models are pushing forward in establishing multi-disciplinary teams, both actual and virtual, with the key worker holding the central position. And yet, there is not one unified perception of the role.
I was reminded of this during a training session for the role of key worker held at the end of last year in a London locality. There was a distinct split between the different professions about the key worker concept.
Health clinicians expressed concern that a key worker without a health background was unlikely to identify health needs in a patient. This role would still need to be done by a colleague from health. If this was the case the participants argued, then the appointment of a key worker was an unnecessary additional layer of bureaucracy and an additional professional for the individual patient to relate to.
Social care professionals, both social workers and occupational therapists, found the concept much easier to accept. They had no difficulty with the idea that a key worker may not be from their own discipline.
Social workers were generally accepting that the role would extend beyond the period of active intervention from them in their professional capacity. They shared this acceptance with GPs who were clear that their responsibility was for the lifetime of the patient and thus being a key worker did not conflict with their clinical responsibility.
Both therapists and nurses found the extended responsibility of a key worker at odds with their usual practice of closing their involvement with an individual when their treatment plan was completed. They struggled with the notion that the responsibilities of the key worker were not necessarily related to their own clinical responsibilities.
All participants worried about the additional duties the role of key worker would add to their already pressured professional lives and the accountability for others actions (or lack of action) which may come with the job.
Perhaps considering the key worker role as that of the skilled helper may help to deconstruct the responsibilities a key worker would hold. For those of us who were trained in social work with G. Egan’ s The Skilled Helper as our core text, this will not be too difficult to do. Egan talks about a skilled helper who can support an individual ‘to manage their problems in living more effectively and develop unused opportunities more fully’, and to ‘help people become better at helping themselves in their everyday lives.’
Such a definition of the work of the key worker still leaves each profession with their own responsibilities, but ensures each individual patient is provided with someone who will help them explore their needs, seek support to meet those needs and take control of their lives. It does seem that this uncomplicated view of the key worker which focuses on the needs of the patient is what health and social care integration really wants to achieve.