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Im depraved on account Im deprivedThe
interface between health and social care

• Jan Cubison
• Sheffield Perinatal Mental Health Service
• 0114 2716069
• jan.cubison_at_shsc.nhs.uk

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A romp through 4 decades

• 1970s Nature v. nurture
• 1980s C/conservatism
• 1990s Integration of health social care
• 2000 on

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1960sChild care officer

• 1968 Seebohm Committee
• Recommended that the specialist areas of local
  authority social work should be fused
• Single community based response to the range of
  needs that individuals, families and communities
  presented
• Probation still separate

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1970sGeneric social work

• 1969 Children and Young Persons Act
• 1970 Chronically Sick and Disabled Person Act
• 1970 Local Authority and Social Services Act

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Health

• Health was another country

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Mental Welfare Officer

• The 1959 Mental Health Act encouraged the
  development of community care
• End of moral defect, lunacy and mental deficiency
• psychopathic disorder had to be susceptible to
  medical treatment

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Debate mad or bad or sad?

• 60s R.D. Laing The Divided self
• T.Szasz The myth of mental illness 1960
• Strong debates between role of social worker as
  radical activist for social change or social
  police
• Autonomy of the medical profession

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Cycle of deprivation

• 1970s dissertation
• Explanation of structural factors leading to
  cycle of poverty and poor mental health
• Politicised to blame behaviour of parents for
  passing on poverty and deprivation to their
  children

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1980s

• Individualism
• Making money
• High unemployment
• 1983 Mental Health Act
• Approved social workers

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1990sBack to specialisation

• 1989 Children Act emphasised need for
  partnerships with
• 1990 National Health Service and Community Care
  Act introduced internal market
• 1994 Diploma in SW replaces CQSW
• Social workers - Adult or Children

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2000

• 2000 new post working with pregnant and new
  mothers with mental health problems
• Employed by NHS Trust
• Across mental health and child care

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2000 and on

• Set up and manage small perinatal mental health
  service
• Little health treatment for personality disorders
  
• Social workers offer support and behaviour
  modification
• Training in therapies

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National Institute forMental Health in
EnglandPersonality disorderNo longer a
diagnosis of exclusionPolicy implementation
guidance for the development ofservices for
people with personality disorder

• 2003 Development of treatment services for
  personality disorder
• Multiagency teams
• Psychological therapies available across primary
  and secondary care
• NICE guidance

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What works well between health and social care?
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What does not work well between health and social
care?
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How can the interface between health and social
care be improved?
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Joint work in perinatal mental health

• All cases discussed jointly psychiatrist
  social worker
• Joint care antenatal clinic
• Joint training
• Multiagency meetings
• Joint CPA / CIN meetings
• Involve service users, volunteers
• Postcode, ethnicity audit

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NICE guidelinePregnancy and complex social
factors due Sept 2010

• Rigorous methodology
• Dearth of evidence
• SCIE involved
• Not joint guidance
• Health employs specialist midwives in domestic
  abuse, safeguarding children, asylum seekers,
  teenage pregnancy, substance misuse

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Integration of research and practice

• Research traditionally led by health
• RCTs gold standard
• Social care research often qualitative

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National Institute for Health and Clinical
Excellence (NICE)

• NICE is an independent organisation
• Their work is underpinned by the need for
• transparency
• collaboration
• involvement of stakeholders
• NICE provides national guidance, sets quality
  standards and manages a national database to
  improve peoples health and prevent and treat ill
  health.

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Social Care Institute for Excellence (SCIE)

• Registered charity
• On line database
• Joint NICE and SCIE guideline
• Parent-training/education programmes in the
  management of children with conduct disorders
  July 2006 (TA guidance)
• Dementia Supporting people with dementia and
  their carers in health and social care Nov 2006
• Looked after Children September 2010

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The White Paper, Equity and excellence
Liberating the NHS July 2010

• "no decisions about me without me
• NICE to develop quality standards for social care
• NICE on a firmer statutory footing, securing its
  independence and core functions
• Extend NICE remit to social care
• care services minister Paul Burstow has made
  clear SCIE ... continue to have a role but it
  wont be the same role they played directly
  alongside NICE in the past