Here is the feedback from our day looking at Adult Health and Social Integration

 39 people came along

These were the general comments

• Integration should focus on outcomes rather than structure

• Are new structures being just as bureaucratic with resources wasted on setting them up. Will it create another tier of middle management instead of resources required at the coal face

• Listen to carers

• Carers need to be equal partners

• Feel carers issues are tagged on at the end, need to be a partner at the table

• GP’s need to be embedded in the structure. A GP should be attached to service user services and provide 6 monthly health checks. The same should happen for carers.

• Where is self directed support in all of this. Says a discretionary power regarding carers- should be equal rights. Also currently only for social care

• Difference in vision versus reality

• Transition can be a major issue for carers, which may be made more difficult with different structures for over 65 and people under 65. Children with autism when moving to adult services are in learning disability services, as don’t ‘fit’ mental health, but shouldn’t be in this service.

• Integration should be for adults and not just older adults

• Issue of charging and eligibility criteria for social care and not health services

• Concern in new structure as health employees cannot be made redundant that experienced social care staff may be lost or not given key roles

• To look to systems which have worked in other areas

• If not enough resources burden will fall to carers

• If shared budgets will acute health take priority as life over death and community services suffer

• Carers identified and needs identified embedded at hospital discharge

• Concern frontline services will be affected as focusing on re structuring

• Areas such as housing , transport need to be included

• Still need acute hospital services in emergencies

We asked "Do you think the governments proposals will bring about improvements to the services that you use? Or do you think they need to be strengthened in anyway?" This is what people said:

• Down to frontline staff who have a lack of time

• Lack of following up from services

• Aimed at older people, lack of focus on learning disabilities etc – others could lose out

• When carers are present, there is an assumption that less support/services/finances are required.

• When the person cared for is deceased, there is no follow up, support for the carer.

• Should be a seamless transition from childhood to adulthood. Get it right from the bottom up

• Needs to be a joined up I.T system inclusive of all services to improve information sharing

• A big change x2 authorities working together

• Budget – how much

• Effect on NHS services

• Improved communication

• Carers involvement in process/consultant/care

• Specific to mental health patients

• Age group (what happens to people in 18 – 50 age group)

• Carer involved at committee level locally and nationally

• All ages should be included

• Carers should have a voting right @ board level

• Right services in

• Lead has to be independent not coming from health/social work

• Making and strengthening outcomes all carers being involved

• Welfare reform and the implications on changes to caring role

• SDS and charging

We asked "What contributes to services working better together? and do you have any concerns?" This is what people told us.

• If Social Work and Health are joined; will it lead to more bureaucracy, fighting amongst each other?

• Will this result in job losses at a time when we need more?

• Could be conflict due to resistance to change. Information, communication must be bottom-up

• Need Holistic I.T system

• Concern Learning disability + current multi – disciplinary teams could disappear

• Example of services working well together is Renfrewshire Learning Disability Team

• The right people in the right jobs should not be lost – keep what is already good.

• Right services in the community

• Make sure there is a personal service

• Consistency in personnel

• Valuing what carers contribute

• Not presuming

• Evidence that it will work

• Why it didn’t work in Glasgow

• Changes to structures are confusing (Just get to grips with something then changes e.g homecare)

PEOPLE WHO PROVIDE UNPAID CARE TO OTHERS ARE SUPPORTED AND ABLE TO MAINTAIN THEIR OWN HEALTH AND WELL BEING

We asked carers if they supported this outcome? And If so, did they have suggestions to make it better? If not, what outcome(s) did they think should be included for carers?

• Investing in respite care

• That somewhere on doctors records its noted that you are a carer

• Appointment flexible for carers

• Take into account carers needs

• Annual health checks

• Carers health checks – both physical + mental

• An increased awareness of carers issues/needs.

• An increase in respite support – carers need a break

• Carers have a RIGHT to health and wellbeing

• Carers have a right to a carers assessment, although this is often overlooked

• Proposal supported

• But must include information

• Personalisation

• Rights of carers

• Human rights

We asked: What can carers and carer organisations do to heelp achieve better integration. This is what people said

• More communication

• Help highlight areas where services are not working well (what key issues are)

• Carers need to voice opinions

• More support groups in the community for carers

• Carers must be involved in decision making

• Carers often know more than the professionals and should be treated as such

• Carers need to be recognised, valued + heard

• Carers should have a guaranteed place around the table in the new integrated structure

• Must be a carer rep in committee at national as well as local level

• Carers have a right to individual advocacy

• Individual advocacy is not in the proposals – carers have the right to support if required to have their voice heard / views expressed

People siad that these were their worries and concerns

• Financial worries

• Carers will be left behind all changes to finance and staff

• Unidentified carers (being noticed)

• How it will work in practice

• Policy makers often are realistic enough about all challenges

• Rural issues re integration

We asked if carers should have a guaranteed place around the table in the new integrated structures.

 YES x 30

NO x 0

DON’T KNOW

We also asked if people thiought that the greater integration of health and social care will lead to an improvement in the recognition and support of unpaid carers.

YES x 1

NO x 20

DON’T KNOW x 5