This essay will focus on inter-professional working in health and social care delivery.

University Degree Subjects allied to Medicine

Essay title: With reference to a practice example of your choice, use the literature and seminar discussions to critically analyse inter-professional working with either:

Children and families

Adults.

This essay will focus on inter-professional working in health and social care delivery. The history of inter-professional working will be explored. The nature and types of evidence underpinning inter-professional working focusing on the practice area of protection of vulnerable adults will be discussed. The range of factors that promote and create barriers to inter-professional working will be discussed. The implications of this essay will be discussed in relation to my future practice as a qualified Social Worker as a member of an inter-professional team.

The concept of inter-professional working in recent years has been on the agenda since the 1940s and has been debated due to recognition of need (Quinney 2006). Since the 1970s government initiatives required different professions to work together to improve service delivery. More recently government legislation and policies have introduced partnership working for health and social care agencies, which led to inter-professional teamwork becoming the preferred model of working (Quinney 2006). Research indicates that, whilst there has been a generally held belief that collaboration is a very good thing and inter-professional teams have increasingly gained favour in recent years (Cartlidge et al 1991). There has been little evidence to substantiate the view that collaboration leads to an increase in the quality of care, which has furthered the well being of patients and service users (Leathard 1994)

This model of joint team working is based on the premise that when health and social care agencies pool their resources and skills the service users will benefit from an efficient service that meets the holistic needs of the service user. However in theory the notion of inter-professional working is reasonable but in reality it does not always happen (Coombs and Ersser 2004).

Hall (2005) suggests inter-professional working is about professionals carrying out their own role, while working in partnership with other professionals to achieve joint goals. Inter-professional working between health and social care agencies promote effective ways of meeting the holistic needs of a person.

Inter-professional working creates a wider safety net to avoid vulnerable children and adults at risk from slipping through the safety net between health and social care agencies. A collaborative approach provides a constant approach across all organisations (Quinney 2006). Irvine et al (2002) suggests that due to the nature of health and social care, Professionals have developed specialised skills. This means it is not possible for one professional alone to meet the needs of the service user without working inter-professionally to meet the holistic needs of the service user.

Quinney (2006) suggests that there is strong evidence from the Colwell Report in 1974 to the Laming Report in 2003, that failure from professionals in health and social care to communicate and collaborate can have tragic consequences. Reports into child abuse scandals of the 1980s highlighted the need to promote joint working between health and social care agencies, which influenced the current policy context of partnership working.

However there is still less evidence to support the idea that inter-professional working and an awareness of other roles and other professions promotes closer collaboration in joint working (Payne 2005). However prior to the 1980s research evidence had begun to be collected that supported the idea of collaborative working between health and social care agencies (Clare and Cox 2003). Research by Barr (2002) argued the importance of inter-professional education and joint working put the service user at the centre, while promoting collaboration and incorporating professional values to deliver a seamless service that meets the holistic needs of the service user. Research by O'Neil et al (2000) in the field of inter-professional learning discovered students who learn together develop a greater understanding of other professional roles, which develops skills in inter-professional teamwork.

Barr (2000) suggests that inter-professional education may be the way forward for professionals to learn to work inter-professionally. However learning inter-professionally can be viewed as risky as it brings us close to our boundaries and comfort zones Sills 2005 p92).

In England in recent years there has been emphasis on the government to promote joint working between health and social care. The National Health Service Community Care Act (1990), which stated local authorities were to deal with social care and health needs would remain within health care. There was then an introduction of multi-professional teams that undertook care management responsibilities, which involved making assessments and managing care packages (Frost et al 2005). Due to the complexity of service users needs there was awareness for joint working between health and social care agencies. The government have developed many policies to support collaborative working, which improves public services.

Coombs and 2004)

The Department of Health (1998) Modernising Social Services encourages joint education, employment and partnership working in order to meet the needs of the general population. Other agencies were acknowledged such as housing, employment, education as well as the voluntary providers who provide help and support for service users. It recommends that budgets should be pooled together and investment for health and social care, which was recommended by the National Health Service NHS Plan (2000), which looks at creating care trusts to improve the health service.

The DOH (2005), Independence Well-Being and Choice discusses adult social care and improvements that can be implemented to improve peoples lives. This could be achieved by giving and sharing information to give people choices to improve people’s lives. People who use social care services may be vulnerable and unable to speak for themselves and may need protection. A designated director of adult services was identified and it was recommended that services work together to provide the support people need to improve their lives.

The DOH (2006), Our Health, Our Care, Our Say, discovered the need for people ...

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The DOH (2006), Our Health, Our Care, Our Say, discovered the need for people to have more information to make choices about staying healthy and well. This also identified how it will give protection to vulnerable adults with the highest level of need by applying a social model of care for adults, which promotes inter-professional working.

Adult protection has not been thought of as on the same scale as child protection due to the lack of media interest and awareness of adult abuse. (Neno and Neno 2005) suggest adult protection was first recognised as elder physical abuse in the 1970’s. In recent years there have been sexual abuse cases involving adults with learning disabilities including, Garlands Hospital, 1996-1998, Long care Inquiry, 1998, Olive Garvie (2004) and the Sutton & Merton Primary Care Trust (2007).

Adult protection was divided between, older persons and persons with learning disabilities. This gave the impression that abuse was only taking place in institutional settings and all other adults could protect themselves. However, research of abuse of vulnerable adults in other settings began to occur and further research was carried out this area (Sumner 2002). The government is committing itself to promoting awareness and protecting those deemed as a vulnerable adult, there is now a generic adult protection approach to adults who are elderly, learning disabled, physically disabled, sensory impaired and mentally ill, Ruston et al (2000).

Department of Health No Secrets (2000) guidance promotes empowerment and well-being of vulnerable adults and states the importance of raising awareness of vulnerable adults. The need for multi agency working in order to achieve support for service users was highlighted. The document also states that local authorities should develop their own codes of practice for the protection of vulnerable adults. Social services should also act as lead agencies in respect of coordination for safeguarding adults. No Secrets guidance has been interpreted in the way that it is every person’s duty to report suspicion of abuse to Social Services. However a qualitive research study carried out by McCredie et al (1998) discovered that partnership working when investigating abuse is not always easy, due to different professions having different ideas about what constitutes abuse. Other supporting legislation includes the Human Rights Act (1998) and the Care Standards Act (2000). The Domestic Violence Crime and Victims Act (2004) (Brammer 2006).

The Association of Directors of Social Services has produced a document called Safeguarding Adults (2005), which outlines good practice for adult protection procedures for professionals in health and social care. These guidelines demonstrate the need for multi agency partnership and raising awareness. The implementation this guidance has created a format to follow to help protect vulnerable adults in England and Wales.

Research using both qualitative and quantitive methods, in the area of service delivery in adult protection, have been debated by Wishart (2005), Douglass (2005), Slater (2005), Frost et al (2005), Parsons (2006) and Davies et al (2006). They explored the significance of adult protection and its impact on service users. Davies et al (2006) suggests that adult protection is a new area and awareness of abuse needs to be raised.

Davies et al (2006) and Parsons (2006) both agreed that for adult protection to be successful joint working is essential. Reports of abuse have increased as a result of greater awareness and from training.

Davies et al (2006) discussed the role of police involvement and the protection of vulnerable adults. The police has recognised the benefit of doing joint training and working as this breaks down barriers between professionals. The police value working with professionals from social services to increase their understanding of working with vulnerable adults who may have learning disabilities or mental health problems. Collaboration between the police and social services can be seen by,

The Home Office Achieving Best Evidence (2002). This helps police officers to achieve improved results and this highlights the need for joint investigation training for police and social services, which help to clarify the different professional roles involved in adult protection.

Robinson and Cottrell (2005) suggest that there are benefits and barriers in respect of inter-professional working. However they have identified that the joint interprofessional working has not been supported by the necessary resources. Parsons (2006) recognised that key agencies in adult protection are expected to work together, however the additional resources have not been provided. Robinson and Cottrell (2005) investigated interprofessional working and discovered that joint working between health and social care can cause conflict and barriers to effective joint working. Collaboration between both professions could be negatively affected by the medical profession using the medical model and the social care profession using the social model resulting in barriers created by different attitudes to practice.

Newton and Copperman (2005) identified an issue of different professions stereotyping other professionals. This has lead to certain professions holding distorted views of other professions that created barriers.

Payne (2005) suggests that different professions have their own models of practice, values, beliefs, culture and specialised roles. Each profession will have its own interests, jargon, and professional boundaries, which creates barriers to interprofessional working. Rost et al (2005) discovered findings to suggest that there were barriers to interprofessional working caused by issues of power and status in multi-professional teams. Different professions have differing views on status, which could and did lead to clashes in communication and joint working. Irvine et al (2002) suggested interprofessional relationships are distorted by mutual mistrust and hostility.

One profession can suspect another profession of having their own interests at heart, this can lead to professionals trying to maintain their own independence and professional bodies by setting boundaries against other professions.

The issue of information sharing and confidentiality can cause barriers to interporfessional working as different professions have different views on information sharing and confidentiality. The sharing of information between different agencies raises problems due to the wide range of different guidance for professionals to follow, which creates barriers to sharing information and working collaboratively. The Laming Report (2003) highlighted how inadequate information sharing had to be improved to stop such tragedies as the death of Victoria Climbie. Research by Robinson and Cottrell (2005) discovered that certain professions are excluded from sharing information or being unable to access information because of different computer systems. Social workers had found having limited access to information as an obstruction to their way of working in a holistic way with service users Frost et al (2005). There are social workers who are part of integrated services, as part of an interprofessional team, which leads to the delivery of a seamless service (Richardson and Asthana 2005). Payne (2000) suggests that in interprofessional teams professional overlap will occur due to different professionals carrying out similar tasks. However this needs to be clarified to maintain professional identity.

Copperman and Newton (2005) published findings from interviews to record the views of social workers and interprofessional working. Many respondents who were interviewed had seen their role as been a facilitator across different sectors and felt in many ways their unique skills were undervalued and being eroded by the move to interprofessional teams.

Richardson and Asthana (2005) published findings that collaborative practice can improve services by stopping service users from missing out on services and reducing role overlap. Research findings from Newton and Copperman (2005) suggested by working interprofessionally, services can be delivered taking into account service users views to meet individual need. The model of inter-professional working is preventitive as it promotes improved information sharing systems that are more cost effective by ensuring gaps and duplications in service provision are reduced to a minimum.

Molyneux (2001) discusses autonomy and the importance of a professional being confident in their own role. However professionals should be able to put autonomy to one side to be able work interprofessionally as part of a team.

As a social worker I will be accountable and responsible for my work (General Social Care Council 2002). It is important to be able to justify my actions to justify and be accountable for your own contribution to my team. Payne (2005) suggests that you need to value your own role as part of a multi professional team so you are able to work with other professions to make informed choices. (Farrel et al 2001). I recognise the need and importance of inter-professional working, which, I will utilise, to promote and respect other professionals (GSCC 2002). I agree with interprofessional working as I recognise the benefits of working together as it benefits the service user, the professionals and other agencies involved in interprofessional working. It is important to be aware and challenge barriers to interprofessional working to promote the needs of the service user (GSCC 2002). As a social worker you have a responsibility to demonstrate life long learning and ongoing professional development, which means when I undertake interprofessional education I will be enhancing my own skills by learning with other professional groups (GSCC 2002).

Joint training can be an effective way to meet other professionals, which can enhance communication and interprofessional working (Torkington et al 2003). The use of supervision and team meetings will help my professional development as a social worker working in an interprofessional team. I am aware of supervision being an ‘an effective tool for staff development’ and as a social worker I will use supervision to identify my future developmental needs I have already begun using a model of reflection by (Schon 1983). I have reflected on action in supervision to learn from my experiences of interprofessional learning from university, training courses and in my interprofessional team I work with. I have become aware I have not experienced any barriers to interprofessional working due to close working relationships I have developed in interprofessional education and practice situations. I will have an understanding of the issues affecting professional relationships and I will be able to think ahead to for see potential difficulties and implement measures to promote effective inter-professional working. In the future I will gain experience of working with other professionals, which will enable me to apply my knowledge. Copperman and Newton (2005) suggest there is scope for further research in the area of interprofessional training and education. I believe at this present time there is a need for further research into adult protection and the effectiveness of collaboration in adult protection, which should become available in the next 10-15 years.

Coomb

04)

This essay has demonstrated an understanding on inter-professional working in health and social care delivery. The history of inter-professional working has been explored. This essay has demonstrated an understanding of the nature and types of evidence underpinning inter-professional working focusing on the practice area of protection of vulnerable adults. The range of factors that promote and create barriers to inter-professional working have been discussed. The implications of the essay have been discussed in relation to my future practice as a qualified Social Worker as a member of an inter-professional team.

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