Organisational Issues in Health and Social Care Services

“People do not care about organizational boundaries when seeking support or help and expect services to reflect this. From

Our Health, Our Care Our Say

(DoH 2006)”


Since the introduction of the 1990 NHS and Community Care Act it is no longer an option for human services and public sector organizations to work in isolation. Handy (1997,p.18) has argued against the introduction of market principles into areas that are generally regarded as the responsibility of the state welfare system, because this could harm those who most needed the help. This merging of human services with public sector organisations has meant that an increasing number of human service workers are employed in the private sector. Human Service organisations are comprised of medical staff and others such as administrators, cooks and cleaners employed by the NHS or in private practice, the police and probation services, the prison services, social services, and to a limited extent those working in education. This assignment will look at some of the effects of current policies on the organisational structures of health/social care and partner organisations. There will be an examination of issues of power and inequality in organisations and an exploration of the notion of partnership working. The success of such policies will be explored through the experiences of people with mental health problems. Partnership working is most especially relevant to people with mental health problems and the Government has promised greater concentration on this in the White Paper that came out this year,

Our Health, Our Care, Our Say.



Social services and Health Care are what as known as human service organisations, that is to say they are there to help people in need.. People working in social services generally do so because they are motivated by a desire to see that people receive the kind of help that they need in times of crisis. Human Services operate in the public and the private sector. Which ever area a person chooses they are more likely to find work in the human services if they have had some prior experience either work placements or some other voluntary role. In social work prior community involvement is seen as an asset. Most social workers work in the public sector. Social Services used to be known as personal social services because social workers are most often concerned with individuals and the care they may need.

Social work is both typical, and untypical, of the human services in general, firstly its aim is just that, providing a service that benefits other people, in the second instance social workers are more likely to be involved with people on an individual basis and often for a prolonged period of time. This last is not always the case in other areas of the human services (Postle et al, 2002). A social worker who works in mental health may find themselves attached to a hospital as well as to social services. This means inter-agency working which is becoming more common in the human services especially as the legislative and policy requirements of the1990 Care in the Community Act have increasingly focused on health and social care agencies working collaboratively with service users. This is more common since the Government directive ofJuly of last year.


Parliament decides what social work consists of. This is because the Government defines the statutes that outline social workers responsibilities. This includes the people that social workers have a responsibility towards, the manner in which such responsibilities should be undertaken, and the legislative framework that underpins the professional practice of social work (Brayne and Martin, 1995). Social workers have to abide by the code of practice of the General Social Care Council and are bound by the 1970 Social Services Act as it applies to local authorities. Since 1998 social workers are bound by law to respect the inherent rights and dignity of every human person. Social workers also have to be familiar with the 1990 Community Care Act and subsequent legislation. Local Authorities are bound by the Disability Discrimination Act and a social worker working with people with mental health difficulties would also need to know the terms of this Act and the Chronically Sick and Disabled Persons Act of 1970. These inform social workers’ decisions. These may involve having to define mental health difficulties and in what ways their needs might best be addressed. This is particularly so for Approved Social Workers. The social worker has a duty to perform an assessment of need for anyone in the local area who is defined as having a disability, including mental health difficulties, whether the or not the person requests a service.

Ongoing training and development for professional social workers is a requirement of the job. If you work in disabilities, particularly mental health then some social workers may specialize in mental health and work towards becoming an Approved Social Worker. Social workers operate within a framework that is informed by human rights and social justice and they need to be aware when the code of practice within which they carry out their duties, is contrary to the values underlying this framework. Within social work it is generally accepted that all people are of value and are entitled to be treated justly and humanely. Social workers who deal with users who have mental health problems now have to work closely with the NHS and with Voluntary Organisations such as Mind.

Partnership Working

The Griffiths Report (1988) which was commissioned by the Government recommended that local authorities should be ‘enablers’, who organized and directed community care. Local authorities would no longer be the sole providers of care, but would have their own budgets to purchase care from the private and voluntary sector. This became law under the 1990 Act the terms of which resulted in an increase in the burden of care for the social work profession. The Act emphasized partnership working in all areas and social workers now have to consult with professionals from all walks of life in order to adequately provide for their clients needs.

The introduction of new working practices and the necessity for a greater degree of inter-professional working has meant that the autonomy that social workers once enjoyed has been increasingly eroded (Challis, 1991).

Molyneux’s (2001)


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). Handy (1993) has argued that in order to work successfully together organisations need to find optimal or win/win solutions rather than have their discussions end in wasteful conflict. A major problem with inter-professional working in organisations is that both sides can become defensive of their positions (See Handy, 1993 ch.12). This is particularly the case when people are asked to do something that goes against their professional ethics and beliefs (see ch.15). Thus a social worker would not be happy with solutions that did not, in their view, serve to empower clients with mental health difficulties. The inclusion and empowerment of this client group is a central feature of the 2006 White Paper which promises ongoing care not just for those with mental health difficulties but for their carers as well.


These arguments are endorsed by Laidler (1991) because in order to be successful 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’. According to Norman (1999) 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. Hudson (2001) maintains that because government has been concerned to prioritise choice and introduce competition in public services this has left professionals with feeling of insecurity and a lack of faith in organisational infrastructure.

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).


At the same time Government expects social care and health professionals to work closely and collaboratively with service users. In social services there is quite an emphais on encouraging the user to participate in decisions regarding their care. In the NHS however, many professionals still work with the idea that the patient does as the professional tells them. This makes it difficult for social workers who are encouraged to lessen the power differential between themselves and service users, this means engaging in anti-oppressive practice e.g. accessible language, and doing what they can to empower individuals.

Social Services and Mind

Mind is a charity that works for those with mental health problems. The charity points to the fact that the right kind of social care can go a long way to alleviating the stress that mental health difficulties may bring, and which are often ignored. Until recently mental health users received only a small amount of social care and were often referred for medical help alone. However, this course of action neglected the enormous social consequences that mental health difficulties can have and how it affects family units. This is beginning to change and there is an acknowledgment that greater availability of social care would go a long way to alleviating such difficulties. This has been recognised to some extent in the Government paper

Our Health, Our Care, Our Say.

The increasing Government emphasis on partnership working should lead to a greater connection between those who work for social services, the NHS and the charity called Mind.


This assignment has looked at organisations and the structure underlying social service departments and other human service organisations such as the NHS and the charity called Mind. It has looked at the legislative and policy contexts as they apply to people who need social care and who may also have mental health problems. It has looked at partnership working and how the responsibilities that are incumbent upon social workers are intended to minimalise inequalities and to substantially lessen the power differential between service users and service providers.


Griffiths Report (1988)

Community Care; An Agenda for Action

, London: HMSO

Handy, C 1993

Understanding Organisation

London, Random House

Handy, C 1997

The Hungry Spirit

London, Random House

Hudson, B. “Grounds for Optimism”

Community Care

December 1



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

Our Health, Our Care, Our Say





Molyneux is a social worker who was part of the inter-professional team on which the study was based.



accessed 4/4/06