Friday, 19 April 2013


We often hear the terms, integration, connected thinking, joined- up thinking etc. when talking about providing the best possible care services yet perhaps the most important thing we need to develop is “CONNECTED UNDERSTANDING”.

Because different aspects of the care system work in different ways it means barriers are created through a lack of understanding how other elements of the system work and because social care is such a fragmented wide-spread system it means opportunities for not understanding are immense as points of view differ drastically.

An example, some see social care as a public service. In one sense this is right, social care is organised by central Government, commissioned and paid for through local Government, Social Workers, employed by local authorities are public servants etc. Yet the bulk of social care is actually delivered by private sector organisations, where the motivation of those who own the companies is, ultimately, profit and compliance with regulation about achieving it at the lowest possible cost in order to protect profit. Those, usually low paid workers, who are actually responsible for delivering intimate care services would hardly class themselves as public servants, a term which is generally associated with better working conditions (e.g. pensions) than those in the care work sector.

Another aspect to this gap is that those who receive care services funded by local authorities may well be receiving a public service, albeit provided by the private sector, but there are many more people receiving care services from the same providers who are having to pay for it themselves, and often paying more to make up the LA shortfall in funding. How does their care equate to public service provision?

Yet even between ‘public service’ elements of care provision similar barriers of understanding exist. Not simply because of different ways of working between sectors, e.g. between Social Service departments and the NHS, but also current economic conditions which create misunderstanding. Local authorities are having to cut their spending yet NHS funding is not under the same pressure and it is important that both sides understand what the other are doing and, more important, are able to do over the coming few years.

Beyond this is the fact that public service integration needs to go beyond just health and social services, it needs to include housing, welfare etc, again a lack of understanding which can create barriers that impact on the lives of those who actually need to access services.

Obviously this nit-picking difference between those various elements who deliver social care services pales into relative insignificance compared to the lack of understanding faced by the general public about social care, a situation generated by the fragmented system which sends out mixed and confusing messages. Who is eligible for care? What is the difference between Local Authority funded care and NHS Continuing Care? How much do I actually have to pay?

If we are to really deliver quality care services we really need to begin to start working on connected understanding, we need those at the top of the chain to have a greater understanding of actual care delivery and we need those who deliver care to understand why Government, Local Authorities and Health Services operate in the way they do. Naturally the most important thing is that those involved in all aspects of care delivery understand the needs of those who need care services and understand how to connect with them.