You may have noticed in the last couple of weeks one of the augurs of summer- ants have started to appear. In fact they are appearing in numbers and at a time which is a bit unusual but I am reliably informed this is as a result of a mild winter and not a sign of impending environmental disaster.

Explaining the role and nature of ants to a very young child has been an interesting challenge for me over the last few days. They are both fascinating and annoying insects. They are on the one level irritating, getting into homes and places where they are not wanted or desired. But they also carry out a significant role in cleaning the environment. They have abilities beyond their size. An ant can lift 20 times its own body weight. They have a complex and developed sense of communication in that whilst they don’t have ears they nonetheless “hear” by feeling vibrations in the ground through their feet. As well as this when foraging, ants leave a pheromone trail so that they know where they’ve been. Most of all they are profoundly social insects, which means they live in large colonies or groups. Depending on the species, ant colonies can consist of millions of ants.

So what’s this all got to do with anything I hear you ponder. Well I’ve been reflecting a fair bit over the last week about the year that’s just passed. The reason for this pondering was that the 1st April has been the subject of much media reminiscing- chiefly around the first anniversary of Health and Social Care Integration.

It just seems like yesterday that the much heralded process of Integration started – never mind a year. Prominent figures have been making comment in the media.

Writing in Holyrood Today the Health Secretary Shona Robsion said she was ‘extremely proud’ of integration, stating:

‘I think it’s entirely reasonable to think that most of us would rather receive support and care at home or in a homely setting when we need it. Too often, frail older people in particular are admitted to hospital as an emergency when earlier provision of a package of care in their own home or community would have been better.

I’ve heard from people who have said they would have felt more comfortable in their own home rather than an unfamiliar hospital ward. We want to do all we can to ensure that care and recovery takes those feelings into account, which is what integration is all about.

It’s built around the needs of the individual, and it’s often not about medical needs –  it can be about providing support to people to remain part of and connected to their families and communities, allowing people to carry on doing the things they love with some additional help.’

I have written a number of times in the last year about the potential which Integration offers for achieving a truly person focussed approach to health and care. But the lessons of the last year show that for all the first steps of innovation there have been not a few stumbles and failings. So how might we avoid the second year toddler tantrums and blues? I’ll take some insight from my ant friends to make brief suggestions:

Shared vision: One of the real strengths of the ant colony is the sense of shared purpose, direction and vision. I’m not convinced that those of us who work in any health and social care sector have yet grasped the magnitude of the vision of truly integrating supports and care around the person. We need to start to robustly influence a debate which has to date been still dominated by the preservation of local health services at all costs. If we want people to be supported and cared for where they want to be rather than where another decides they should be, then that will involve some uncomfortable home truths and choices. We cannot keep preserving the acute health sector in its present composition at the cost of developing social care supports and provision. We need to own and share the vision.

Shared risk: Every worker ant in a colony shares in the risks of the whole. If the ant heap is attacked or at risk then all suffer. This doesn’t always feel like the reality for those who work in integrated health and social care. The protected terms and conditions of health and statutory social care workers are a life-time away from the often fragile experience of frontline staff in commissioned social care services. The largest social care workforce of over 100,000 staff is continually beset by changes in commissioning practice whereby providers, private or charitable, risk being unsustainable and going out of business. We desperately need continuity of commissioning beyond the vicissitudes of a tendering cycle to provide continuity of care.

Shared workforce: Every ant in a colony has a role, a value and a purpose. There may indeed be some degree of priority but there is a natural acceptance that there is an inter-dependency and relationship one with the other. We desperately need for there to be a whole systems approach to valuing the distinctive role of the social care workforce. It should not be that someone wearing a stethoscope is considered as more important in the economy of care than someone who is a home care worker or a care home nurse. Yet that is what it feels like to so many – that is what they have told Scottish Care staff over the last year. If we are serious about achieving person centred care for individuals then we have to work at person centred valuing of the independent sector care workforce.

Shared communication: The way in which ants communicate using sight, touch and pheromones is truly astonishing. This socialised communication means that subtle changes are instantly recognised and the direction of travel is literally altered and changed. Lets face it we are not good at communicating in health and social care. We need to get better whether that is through shared assessments, the development of anticipatory care planning or simply the development of shared collaborative working.

Shared resource: For any system to work there has to be a recognition not only of inter-dependency but the need to support all elements and parts of the system. We are not there and need to get there soon. Transferring resources to the community is one of the primary areas of focus for Integration. The independent sector is brim full of ideas around innovation and new models and forms of care and support. These need recognition and resourcing. Care purchased on a shoestring suffocates innovation and leads to poor quality provision.

So at the start of summer – let us learn from the ants in my back garden and make the second year of integration a success. Let’s communicate, share our vision, work collaboratively and resource equitably. Then we might get to what Ms Robison desires, namely pride in a system of health and care that puts the person as the driver of the support they need rather than the accidental insect caught in the system’s web.
Dr Donald Macaskill

@DrDMacaskill