It is over 12 months since the Government published the Health and Social Care integration white paper ‘Joining up care for people, places and populations’. The document recognises that integration is needed across health, social care and housing to drive sustainable improvements in individual and population health and well-being. However, this can only be achieved through policy that strives to remove the barriers currently impeding systems, services and practitioners from working effectively together – which is what the white paper sets out to do.
This article looks at what the white paper means for us as occupational therapists and the communities we work with. However, at times this will not be a comfortable read because it will challenge and put under a microscope the silos of practice that have perpetuated the problem the white paper seeks to address. To explore what the white paper means for occupational therapists, we will take a closer look at the following four areas of the white paper:
- Shared outcomes which prioritise people and populations
- Ensuring strong leadership, accountability, and finance
- Digital and data: maximising transparency and personal choice
- Delivery of integration through our workforce and carers
Shared outcomes which prioritise people and populations
A clear message in the white paper is that collaboration across the different health, social care, and housing systems will be critical in achieving the Government’s vision of people receiving the type of services and support that will make a difference to their health and well-being. To achieve this goal, the Government proposes to develop (by April 23) collaborative outcomes that prioritise the needs of people and communities.
The white paper falls short of stating what those outcomes should be. However, it asserts that it wants any outcomes to be robust and meaningful to people, populations, and practitioners delivering services. To develop these collaborative outcomes, the Government plans to engage with the public, partners and stakeholders, including professional bodies such as the Royal College of Occupational Therapists (RCOT). But as a member organisation, RCOT is only as good as the members who engage with it. So if you are a member, what will you be doing to support the RCOT Policy and Public Affairs team to inform the Government on what shared outcomes would help you to work in an integrated way with other health, social care, and housing services.
Ensuring strong leadership, accountability, and finance
One of the positive things that the white paper does is recognise that integration can only happen in an environment with strong leadership, accountability, and flexible funding systems. Without these three elements, services and practitioners, such as occupational therapists, are impeded from working collaboratively and in an integrated way with colleagues from other parts of the system? The Disabled Facilities Grant (DFG) process is a good example of this, where the competing priorities of social care and managing the demand for occupational therapy assessments rub up against those of housing and their need to approve and spend the DFG allocation. Unfortunately, in many local authorities, these competing priorities lead to a fragmented adaptation process that older and disabled people struggle to navigate. The white paper is hopeful that these barriers that practitioners experience can be removed through strong, integrated strategic and operational leadership.
The white paper recognises the importance of removing financial barriers that can hinder the integration of services and the joint funding of care support for people. So while the paper recognises the positive outcomes achieved through current pooled budget mechanisms (Better Care Fund and Section 75 agreements), it also recognises room for improvement is needed. To do this, the Government wants to empower local strategic and operational leaders to have the flexibility and pragmatism to pool budgets across health, social care, and housing. This is potentially good news for occupational therapists who deal with complex adaptations where not all elements of the scheme can be funded through the DFG. In these cases, flexible pooled funding from housing, health and social care would provide a less fragmented approach to managing these cases.
Digital and data: maximising transparency and personal choice
Effective and meaningful integration involves sharing information across health and social care systems. However, it is clear that the Government understands that sharing information across organisations is difficult, which is why there is a strong focus in the white paper on digital and data transformation being a vehicle for supporting integration. While the white paper lays out the need for good governance around the sharing of ‘patient’ information, it also stresses that services should not have unnecessary barriers that hinder collaboration.
For example, a current barrier hindering the DFG process is sharing information between social care and housing when deciding what adaptations are necessary and appropriate. The issue seems to be that many occupational therapists are concerned that they share too much information about the service user. At the same time, grant officers complain they are not getting enough information. The white paper challenges us to seek a more integrated process. Thus, occupational therapists and housing colleagues need to work together (with the people who need adaptations) to better understand what information needs to be shared.
Delivery of integration through our workforce and carers
Occupational therapists are probably among the few Allied Health Professional (AHP) groups that work across health, social care and housing. Yet, in many places, these occupational therapists work in silos of specialisms, which seem to be more about protecting professional identity than it does about what is best for the person who needs support with their health and social care needs.
The white paper challenges this fragmented approach and recommends looking at opportunities for deploying the workforce more effectively. To do this, the paper suggests that teams across different sectors and professions learn together and then seek ways to avoid duplications and handoffs of ‘patients’ between those services. For occupational therapists, this is an opportunity to break down some of those silos of practice. For example, we can reduce the current handoffs around major adaptations, complex seating, and moving and handling cases through training and building trust between health and social care teams. Interestingly, it appears that the Government has recognised the issues of these silos of practice in occupational therapy. In the white paper, the Government has committed to commission research to examine how health and social care occupational therapists complement each other – see page 55.
At the heart of the white paper is the Government’s vision to:
support a better joined-up health and care system, with people’s wishes and well-being at its heart. Citizens with access to more information will be more empowered to make decisions about their care and have more choices about where and how they access care.
The white paper provides a real opportunity for occupational therapists to think in an integrated way and to provide interventions such as equipment and adaptations in a non-fragmented way. However, to make this change, we need practitioners and leaders to recognise that moving away from silos of practice is not a threat to our professional identity. Instead, it will strengthen what we do as occupational therapists and improve the health and well-being outcomes of people and communities we work with.