Integrated services: (how) does it work?
Local public social services rise to the integration challenge. John Halloran, CEO and Alfonso Lara Montero, Policy Director, The European Social Network share their experiences from a recent seminar on integrated services
On 5-6 November, more than 100 participants from 24 European countries joined our annual seminar in Manchester, which looked at how local public social services are addressing the concept of integrated care in their countries.
Across Europe, when people talk about “integration” they may refer to structural reorganisation and improved governance; for instance, having a single accountable agency responsible for commissioning services. Others mean improving cooperation between professionals from different sectors working with the same client. There are yet more who refer to integrating various strands of finance by pooling budgets or creating specific integrated funds to support specific groups with complex needs. They are all important and in some form or another they are all integration, but do they improve people’s outcomes?
That’s why, if we are to use the word “integration”, we ought to have some common definition. In the European Social Network (ESN), we have defined the term “integrated services” as the range of activities, (depending on sectors, target groups and governance contexts), implemented to achieve more efficient coordination between services and improved outcomes for service users.
At the seminar we listened to various experiences, which highlighted how changes in the care landscape may benefit service users as support becomes more holistic. New integrated support requires new skills and new ways of working. Therefore, new roles are emerging, new career paths are being developed, joint training is taking place to enhance mutual understanding as public social services, education, health and employment rise to the challenge of integrated services.
In Manchester, public service reform revolves around integrated, co-ordinated and sequenced bespoke support packages; family based approaches to changing behaviour; and choosing interventions on strength of the evidence. An evaluation following the first phase of the Troubled Families (TF) programme demonstrated that 67% of the children assessed as children in need, had that status removed within 6 months of the end of their key worker intervention (compared with an estimated 50% without TF intervention).
In Andalucía, Spain, the network of early intervention for young children with developmental problems has developed a software that is available for all professionals from education, health and social services working with these children. This tool allows all professionals working in the region to access the unique records of each child to ensure continuity of care and prevent the need for individuals to have to repeat their story to other professionals.
In Renfrewshire, Scotland, the co-location of the day services for adults with learning disabilities has been a collaborative effort between social and leisure services to develop facilities that provide a platform for the promotion of healthy lifestyles, integration and inclusion in the community. Social services, health services and a third sector partner are working collaboratively to establish an accessible garden space where adults with learning disabilities can have training and employment opportunities through a social enterprise.
In many jobcentres in Germany, several organisations have been merged into one single agency for service delivery, including traditional job-seekers’ support such as advice, counselling and training, but also housing support, mental health and childcare support. In addition, there is a network of cooperation with a variety of organisations, including schools, immigration offices, housing organisations, youth welfare services, employers’ associations and third-sector organisations.
The Finnish service integrator –Kotitori- gathers all older people’s services from public and private providers that are available in Tampere, and provides guidance for service users so that they can choose the most suitable. This is a public-private partnership where a private company provides the software whilst the municipality covers costs for needs assessment and advice. According to self-reported evaluations, service users are highly satisfied as the integrator helps them access all necessary services through a single point.
These examples show that integration is certainly about making organisational, governance, budgetary, structural or cultural changes but most importantly the ‘i’-word is about the individual, whose needs are placed squarely at the centre of their support. There is a need to invest in the organisations’ learning environment, joint training and skills development but also in the human side of professionals’ relationships, such as trust-building, common understanding and assessment. Ultimately, the aim is to ensure that the move to integration improves people’s outcomes and their quality of life.
The European Social Network (ESN) promotes the exchange of knowledge and expertise of professionals working in public social services across Europe to shape policy and practice at national and European levels. ESN has been working with Vilans, the National Centre of Expertise for Long-term Care in the Netherlands to review current literature and practice on integrated services in Europe. The seminar was organised to collate the inputs of the members of the European Social Network. A report summarising the findings has been published recently and can be accessed here