Crossing the Cultural and Value Divide Between Health and Social Care

Abstract

Introduction Collaboration between health and social care services is vital if we are to truly provide integrated care. Whilst structural barriers based on policy frameworks, resource availability and organisational difference contributes to fragmentation between these sectors, it is the clashes in organisational cultures and values that can often be the most divisive. Only by being honest about our own values and the underlying assumptions that they reflect, and by being willing to challenge ourselves and others about unhelpful cultures that have developed can we ensure integration that draws successfully on both sectors. Since qualifying as a social worker I have spent over two decades practicing, managing, purchasing and researching care services. The exact nature of this diverse and evolving sector and indeed the use of the term 'social care' itself varies between country and continent. It commonly includes the provision of personal care and domestic support to enable people to maintain their independence or recover from a physical or mental trauma, and services that connect excluded people with wider community resources such as housing, education and employment. Most of my career has been in the context of care services which work closely with those in health, and this has convinced me that neither sector can fulfil its responsibilities or indeed achieve the aspiration of integrated care unless they collaborate successfully. In this perspective I will reflect on my personal experience and the wider evidence regarding health and social care integration, and the central role that culture and values play within this. Structural divides The structural issues that commonly fragment health care services such as multiple organisations focused on discrete elements of a pathway, poor communication between patient record systems, and conflicting incentive and performance frameworks are also experienced between health and social care. In addition to these there are wider systemic differences which provide further divisions. The 'social care' sector incorporates a wide variety of services which seek to support people in improving their independence and social connections-training, employment, rehabilitation, carers support, safeguarding, personal care, statutory mental health assessment are but a few of the roles commonly provided. Such diversity is undoubtedly one of the sector's strengths, but can make it challenging for those working in health to gain a grasp of what actually is 'social care'. The organisations that deliver such services range from small volunteer run entities that work in a single locality and rely on charitable donations of time and money, up to national or indeed international social enterprises that draw on multiple and sophisticated funding streams. Again for those working in health care it can be bewildering trying to understand how such organisations are led, governed and organised. Finally there is also the issue of resources, and the reality that health services (and in particular clinical services) are generally better funded and their professionals more handsomely rewarded than those in social care. Differentials in service resourcing and individual salaries are of course found within the sectors, but social care often feels (and indeed is) the poorer cousin. Academic practice further reflects the wider resourcing and interest in health, with the numerous journals and funding streams relating to health care vastly outweighing those focussing on social care.