Bob McDougall: Integrating services could require new law
More than 20 years ago I used to attend conferences with colleagues from the health service and local authority social work departments on how best to integrate social care.
Introducing ourselves around the table I would say I worked in housing at which point my fellow attendees would ask, “What are you doing here?”
How disappointing then to attend another conference on integrating social care last year to be asked where I was from, and on being told housing, to be asked “What are you doing here?”
Trust Housing Association celebrates its 40th anniversary next year; the following year will mark my 40th in the housing sector. But how much has really changed over that time? How integrated is social care now compared with the early 1970s?
The history of collaborative working is piecemeal. The Change Fund Partnerships, set up to help stimulate innovative and joint approaches, have a chequered history with continual criticism of the third sector’s inability to participate as equals. Likewise the joint commissioning of services between health and social work and the moves towards greater integration of services seem to make sense. So why is it not happening more?
For me, it is a problem of power and culture. Despite our best efforts we still have fragmented services in which people receive separate visits from health, social work and housing staff. How can this be the best use of resources?
A recently widowed pensioner living at home with no family support doesn’t care what organisation their visitor represents. All they want is the most appropriate support to allow them to live a good life with assistance for their needs, proportionate to their circumstances.
If we are serious about integration we need to be prepared to give away power and budgets in the interests of the customer, to be less precious about protecting empires and more willing to accept cultural change with a new ethos of comprehensive, co-ordinated and collective customer service.
After 40 years, the voluntary drive towards this new Eden has not worked – perhaps it’s time for government to legislate for it.
• Bob McDougall is chief executive of Trust Housing Association.
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