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Structural change ‘too simplistic’ – SASW restates concerns about health integration

The Scottish Association of Social Work (SASW – part of BASW) has reiterated its concerns about wholesale restructuring of health and social care after it was criticised in the Scottish parliament by an NHS leader.

In a Health and Sport Committee debate on the proposals the chief executive of NHS Highland, Elaine Mead, said she was “disappointed in the Scottish Association of Social Work’s submission”, in which SASW expressed serious reservations about moves to integrate health and social care without significant prior effort to understand the roles of all the professionals involved.

The SASW Response to Health and Sport Committee Scottish Parliament Inquiry into Integration of Health and Social Care stated how, ‘Structural change rarely produces the anticipated improvement that policy makers and managers seek. It is often expensive and reduces morale at the front line.’

The document, submitted to the committee on 29 February, continued: ‘In trying to work out how to achieve our joint objectives do we really understand what each of the many professions bring to this integration agenda? Who takes the responsibility for co-ordinating complex health and social care services with individuals and their families? Whilst each of us has individual needs, we are also interdependent and interconnected in our families and our communities.’

The submission also questioned the extent to which it is presently understood that ‘the protection of children or adults from harm will often require professionals from criminal justice, mental and universal health care services to work with social workers who may have the statutory powers to instigate action through the court system’.

Responding to the SASW document NHS Highland’s Ms Mead told the assembled MSPs and stakeholders: “Structural change is not necessarily right for all areas, but I am delighted to report that, yesterday, I was in front of at least 48 of my social care colleagues who welcome the opportunity to practice in a different way.

“The issue is not just about the structure. Fundamentally, it is about focusing on what is right for us in the Highlands and the people of the Highlands. Although there are sensitivities and anxieties because we feel that we are breaking new ground, I have been extremely impressed by how well health and social care colleagues are embracing the new way of working.”

Speaking after the committee hearing on 14 March SASW manager Ruth Stark emphasised again the importance of collective working in order to secure best outcomes for service users: “SASW fully supports any reform that will help people find a simple path through the complexity of health and social care services. However, the real issue is that we have to have an understanding of co-practice before integration will really have any impact for service users – that means understanding what each of us brings professionally to the table. It is only in conjunction with cultural change that structural change can deliver the desired results.”

The final results of the inquiry, designed to outline the barriers facing reform, are due to be presented to government at the end of the month.