Social work: a missing voice of integrated care?

Collaboration is at heart of integrated care. Responding to the differing needs, aspirations and contexts of individuals and their families is beyond the gift and expertise of a single profession. Multi-disciplinary teams, care co-ordination, shared electronic records, co-location and inter-professional education all seek to facilitate better collaboration between practitioners from different backgrounds. As integration incorporates consideration of the social determinants of health and wellbeing, it is engaging with a greater range of services and professions, including those based in the community sector, and other welfare areas including employment and housing.

This broadening of focus and diversification of professional perspectives has led to different voices within integrated care debates. It is much more common to hear the perspectives of practice nurses, physical therapists, psychiatrists along with the traditional foundation of nursing and medical professionals. Social work is one of these voices, but generally as a complement to health, and in particular doctors, rather being than a strong principle contributor.

Is it an issue that social workers seem rarely to be leaders of integrated care? In some ways not, as all professionals must be willing to play their role alongside others in supporting people and their families. However, I would argue that the nature of social work mean that is should be a central catalyst for integration. Its core distinctiveness, its traditions, its future vision as a profession (see example here) are founded on elements that we know are important for person centred and co-ordinated care.

Values-driven? Social work is a profession founded on principles of human rights and social justice.

Community orientated? Early social work was rooted in locality-based development to encourage reciprocity and strengthen informal networks within deprived communities.

Person centred? Good social work case work has always begun with what matters to the individual and their family as the starting point for support.

Co-produced? Social care (the wider sector in which social work usually sits) has long understood the necessity and benefits of designing services and the outcomes they are to achieve with the communities who are expected to benefit.

If this is the case, why has the social work voice been so quiet? Integrated care (and in particular in relation to adult populations) largely began as a health endeavour centred on doctors and nurses. Whilst in some countries health bodies employ social workers, in many they are based within local government or voluntary organisations. This places them outside the organisations that will generally be instigators of integrated care (and on a practical note places them within sectors who rarely have funding for international conferences and events). Social workers are commonly expected to provide a contrasting view to that of health professionals. This can be invigorating but also waring if one is always seen as an ‘outsider’ in a world dominated by disciplines with more similar paradigms. Social work continues to fight in many systems for full recognition as a profession– this may encourage those who are more active to coalesce around the social work cause rather than integration. This contrasts with more established professions such as nursing and medicine who are more confident in their status.

Ultimately, it is the responsibility of social work to decide how much it will seek to lead integrated care practice, policy and study. As an integrated care movement we must also be aware of the potential for bias in our discussions and debates, and be willing to challenge established norms and perspectives. If not, we will struggle to fully embrace the views of other professions, people and communities – such diversity will be vital to us maintain our relevance, focus and impact.

Dr Robin Miller is Co-Director of the Centre for Leadership in Health & Social Care and Head of the Department of Social Work & Socal Care at the University of Birmingham

Robin’s new book Social Work and Integrated Care is available here