Two questions for #NCASC13

It was great to read Jon Rouse’s blogpost ahead of the National Children’s & Adult Social Care conference (commonly referred to as NCASC).

In his blog, the Director General for Social Care, Local Government and Care Partnerships at the Department of Health talks about topics he hopes will be debated alongside the biggies:

High on my wish list would be discussions as to how we improve mental health services for children and young people, challenging whether we are truly changing commissioning practices post-Winterbourne View and seeking to advance the personalisation agenda.

All very good stuff (and not just because all 3 are close to my own heart and work.)

What, though, of those biggies? Perhaps the biggest of the biggies is Integration – so important it is regularly capitalised (cf Internet circa 2001).

SCIE’s research briefing on the factors that promote and hinder joint working and integrated working between health and social care services (pdf) is a fantastic overview of a good portion of the evidence on integration at all levels (such as multi-agency teams, co-located teams, intermediate care and structurally integrated services).

It’s also realistic. For example, it notes (p6):

Improvements in quality of life, health, wellbeing and coping with everyday living are reported across a number of studies. However, where evaluations are based on a comparative design which assesses different types of joint working, including integrated and non-integrated care, no significant differences or only marginal differences were reported.

Similarly, it notes (p8):

Sophisticated analysis of costs across four districts providing community mental health services illuminates the impact of service need – rather than service organisation − on costs… Differences in costs reflect case mix, with services targeted at people with severe mental health problems increasing costs by 50 per cent.

The briefing’s discussion on the factors that aid or hinder joint working is excellent. A reasonable amount of the evidence it cites comes from integration in mental health services – which is relatively well advanced – and, to my mind at least, offers pause for thought when it comes to integration.

I say this because there’s a strong argument that integration across health and social care in mental health services – symbolised by Section 75 agreements (see this scintillating Audit Commission report, pdf) – has created an environment which is less conducive to personalisation for people with mental health problems. The numbers of people with a mental health problem who have a Direct Payment is one measure of this. It makes you wonder if hindering integration factors like (1) cultural differences in professional groups; (2) different philosophies of care or treatment; and (3) placing different value on the inclusion of users have contributed to this.

If those hindering factors have contributed to slower progress on personalisation in mental health than for other people, then what might the drive towards Integration across the piece mean for social care in the world that’s currently being created?

The two questions I’ll thus be interested in people’s views on at NCASC are:

  1. What can we learn from the impact of integration on personalisation in mental health services and on people with mental health problems?
  2. How can we work to ensure the same doesn’t happen as the biggest biggie show (aka Integration) rolls into town?

If anyone wants to share their thoughts before NCASC, feel free to comment below or tweet me (@rich_w).

(By the way, if I was being cheeky, the third question ahead of NCASC I’d want to ask is: just what the hell is the hashtag for the conference? Despite George’s best efforts I’m still not quite sure! Let’s go with #NCASC13 and see what happens…)