Health and Social Care Integration: seeking the ‘space’ and commitment to support complex local partnership-working

What Works Scotland Research Associate, James Henderson reflects on developments in Health and Social Care Integration.

The Health and Social Care Benchmarking Network's (HSCBN) national conference on 3 December (2015) provided a timely opportunity to learn more about developments in health and social care integration. Timely, in part, because of the publication on that same day of Audit Scotland’s progress report on health and social care integration and its challenges across Scotland’s 31 prospective Integrated Joint Boards. And, in part, for me as a researcher working within What Works Scotland in looking to understand those same challenges from the perspective of the people ‘doing the work’.

Given the 2011 Christie Commission’s emphasis on collaborative working, What Works Scotland and its four CPP partners – Aberdeenshire, Fife, Glasgow and West Dunbartonshire – are exploring public service reform through varied collaborative action inquiry and research activities. In Aberdeenshire, one of our first joint activities has been an action research project with the Health and Social Care Partnership (HSCP) – one that directly involves the CPP and third/community sector too. The Inquiry Team of nine has a breadth of skills and knowledge – community work and development; public health; improvement methodologies; policy and strategy; project management; collaborative leadership; and action research. Our focus is on community capacity-building to support integration by deepening understanding of both day-to-day practices and the wider policy context of integration. There is potential to use this ‘space’ to build understanding of this complex working environment and to share our learning with staff working across strategy, development, service-provision and community-engagement within the HSCP, CPP and third/community sector in the Shire.

In presenting on What Works Scotland’s broader research concerns at a workshop at the HSCBN conference, I had the opportunity to talk with participants and they were quick to raise a significant array of crucial challenges for integration: the need to learn more about experiences in other areas and to share data and information; the great complexity of working for culture change across institutions, partnerships and place-based approaches; the ‘how’ of doing prevention and ‘preventative spend’ and a lack of practical tools currently; and the pressures of tight deadlines, budgets and associated short-term thinking. For some of the participants a powerful sense, too, of the need for the space to think through and reflect on ‘the how’ of such culture change – to take a longer term, considered perspective. A conundrum recognised by ‘Christie’, too, in its discussions of urgent reforms, genuine local partnership-building and shifting away from short-termism in terms of outcomes.

Interestingly, Audit Scotland’s report points to a “pressing need for workforce planning to show how an integrated workforce will be developed” across public, third/ community and private sectors; one that can work with families, carers and community networks too. What Works Scotland’s own recent Partnership-working Evidence Review (Cook, 2015) argues that effective partnership working is indeed a complex activity needing to be built on, amongst other things, resourcing and commitment; engagement with strategic, operational and community stakeholders; and clarity of purpose and realistic expectations. Crucially it suggests that “successful approaches to improving partnerships engage with complexity, support staff to reflect critically on policies and practice and develop enhanced understanding.” This includes the need for partner organisations to learn together and deepen understanding of their respective working cultures and of how to work across their borders and boundaries.

The Scottish Government is pointing towards a complex, inter-relating set of outcomes for integration – the National Health and Wellbeing Outcomes – including contributing to reducing health inequalities. The ‘Christie Commission narrative’ is likewise concerned for a complex interweaving of policy and practice that brings together both processes – partnership, ‘community’, improvement and accountability – and outcomes – in particular, preventing inequalities, promoting equalities. If ‘we’ are to pursue collaborative approaches to integration, rather than largely top-down or market-focused ones, then collaborative action inquiry and research has the potential to provide such longer-term practical and reflective spaces.

Such inquiry work could both hold onto the focus of bringing together process and outcome, whilst providing a forum for developing an integrated workforce across public, third and community sectors.

What Works Scotland is working with the Health Economics Network for Scotland to support development of approaches to prevention, preventing inequalities and preventative spend through a series of learning events and activities across 2015, 2016 and 2017. To find out more view What Works Scotland events and past events pages, and/or sign up to our e-bulletin.