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Critically evaluate the strengths and weaknesses of interprofessional working within social work
Introduction
During the last thirty years there has been a lot of debate over community care. Policy in the 1970s and 1980s brought significant changes to services for people with disabilities, people with learning disabilities, and older people (Kirk, 1998). Many institutions were closed due to financial constraints and care was increasingly focused on the community. In 1988 the Government commissioned the Griffiths Report (1988) which advised that local authorities should be ‘enablers’, organizing and directing community care. Local authorities would have budgets with which to purchase care from the private and voluntary sector.
The 1990 NHS and Community Care Act established that provision of care was no longer the sole responsibility of the state. Care packages would be organised by local authorities with input from voluntary and charitable organisations. Care packages generally consist of one or more of the following; provision of services in a person’s home, residential care, respite care, day care and family placements, sheltered housing and group homes and hostels. The introduction of the 1990 Act increased the burden of care for the social work profession who had to make initial assessments and then refer clients to the appropriate services. This meant that social workers who had previously been quite autonomous in their practice (Challis, 1991). The introduction of new working practices and the necessity for a greater degree of inter-professional working has meant that this autonomy has been increasingly eroded. This paper will examine the strengths and weaknesses of inter-professional working for social workers in the health arena.
Since the introduction of the 1990 Care in the Community Act legislative and policy requirements have focused on health and social care agencies working collaboratively with service users and in July 2005 the Government produced a white paper on the delivery of integrated health and social care.[1] The main thrust of this paper is to establish effective inter-professional working and the means of evaluating working practice. This is probably in response to the fact that much of the literature concerned with inter-professional working concentrates on the difficulties surrounding successful working relationships between people of different professions and how these problems might best be resolved (Molyneux, 2001).
Molyneux’s (2001)[2] research into successful inter-professional working established three areas that contributed to the success of such partnerships. Staff needed to be fully committed to what they were doing and personal qualities of adaptability, flexibility and a willingness to share with others were high on the agenda. Regular and positive communication between professionals was seen as endemic to good working relationships and service delivery. This communication was enhanced (in the study) by the instigation of weekly case conferences which allowed professionals to share knowledge and experiences (2001, p.3). Creative working methods, where professionals responded to what was happening in non-traditional ways was also seen as a crucial element of good inter-professional relationships.
In order to be able to work successfully across professional boundaries people need to be confident of their own professional role in order to be able to step outside their professional autonomy and work successfully with others. It helps in inter-professional working if all members of the team are particularly focused on the needs of the service user. In this way people reach ‘professional adulthood’ (Laidler, 1991). Hudson (2005) found in his Birmingham study that inter-professional working went well provided it was based on a parity of esteem, mutual respect and a re-orientation of professional affinity i.e. team members first loyalty was to the team rather than to their individual professional bodies. Hudson also identified communication between members and creativity in working patterns as vital to effective inter-professional working. While Hudson (2005) maintains that there are grounds for optimism as to the future of inter-professional working, he nevertheless points out that it is not always easy. In some areas such as acute services, mental health services or services for older people inter-professional working can be problematic because it is not always easy to decide where one set of professional responsibilities end and another begins. These areas, along with learning disabilities, reflect tensions in integrated working because it poses a threat to established practices. Peck and Norman (1999) found that mental health professionals working within teams were reluctant to obey decisions taken by others because it threatened their own professional judgement. It does not help matters when the Government stresses the need for inter-professional working and then sets separate performance targets, rather than integrated group ones. At the same time as it emphasises collaborative working the Government is now intent on prioritising choice and competition and this leaves professionals with an unstable infrastructure (Hudson, 2001). As Hudson argues:
It would be a cruel irony if, having achieved the holy grail of local integrated working, the government, with Sedgefield’s local MP at its head, now puts in place measures that result in its dismantling (Hudson 2005 no page number).[3]
Conclusion
Clearly the issues surrounding inter-professional working are not clear cut for social workers. They have lost the professional autonomy that they had in the past and it would seem that some professionals in other areas of social care also find the issues problematic. Clearly professionals from all filed, including social work, do their best to comply with legislation and policy and to collaborate with other professionals. If the goalposts were not consistently shifting in Government discourse then the problems associated with inter-professional working may eventually be ironed out.
References
Griffiths Report (1988) Community Care; An Agenda for Action, London: HMSO
Hudson, B. “Grounds for Optimism” Community Care December 1st 2005
Kirk, S. 1998 “Trends in community care and patient participation: Implications for the roles of informal carers and community nurses in the United Kingdom” Journal of Advanced Nursing Vol 28 August 1998 Issue 2 p.370
Laidler, P. 1991 “Adults and How to become one” Therapy Weekly 17 (35) p.4
Molyneux, J 2001 “Interprofessional team working: What makes teams work well?” Journal of Inter-professional Care 15 (1) 2001 p.1-7
Norman, I and Peck E. 1999 “Working together in adult community mental health services”: An inter-professional dialogue” Journal of Mental Health 8 (3) June 1999 pp. 217-230
1
[1] http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4116486&chk=zOTHS/
[2] Molyneux is a social worker who was part of the inter-professional team on which the study was based.
[3] http://www.communitycare.co.uk/Articles/2005/12/01/51988/Grounds+for+optimism+.html?key=BOB+HUDSON accessed 4/4/06
