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 decision- making 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.

NHSSocial Services TreatmentCare National targetsLocal needs Must dosLocal discretion Universal servicesFocus on vulnerable Procedurally regimented and very top-down in style Practical focus but has difficulty with strategy and planning Differences in characterisation of NHS and social services partners

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