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This blog post was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Joint working and cultural change are vital components for integration

Posted by: , Posted on: - Categories: Care and support, Guest author, Integration

It's not just about changing structures says Ewan King, Director of Business Development and Delivery at the Social Care Institute for Excellence.

Ewan King: 'Ensuring good joint working is in place, is at least as important as agreeing to pool budgets and work differently at the senior level.'
Ewan King: 'Ensuring good joint working is in place, is at least as important as agreeing to pool budgets and work differently at the senior level.'

The plan to develop a single budget worth £6 billion for Greater Manchester, involving 10 local authorities and 12 clinical commissioning groups (CCGs), has rightly created a great deal of excitement.

But, as the architects of this plan no doubt acknowledge, structural change, even at this scale, is insufficient on its own to improve people’s lives. What’s also required is good joint working between different professional groups, and between people providing care and support; plus citizens. And this involves much deeper cultural and behavioural change.

Developing effective joint working is the subject of a new how to guide that we at SCIE have contributed to. It talks about the need for us to shift our focus from the traditional ‘supply’ side of health and care service provision, to a ‘demand’ side, where people and citizens themselves can help us achieve better outcomes. This is all part of the National Better Care Fund Support Programme.

What does this mean in practice? Firstly, it means we need to find concrete ways to involve citizens as equal partners in defining, commissioning and delivering better integrated care. Simon Stevens, Chief Executive of NHS England, recently talked about the renewable energy of carers, volunteers and people themselves. This means there is a need to develop, as part of the vision for local integrated care, a clear strategy for building community capacity. This should include investing in schemes such as time-banking, befriending, community navigation, peer support and volunteering.

The ‘Working Together for Change’ approach is one model that can be developed to ensure that change locally is co-produced with people and families. In Lancashire, for instance, this model is now embedded in the commissioning cycle, and has recently been used to review how well direct payments are working for people locally.

Secondly, we need to find better ways to encourage joint working between frontline staff in our quest for better integrated care. Getting this right is crucial, as frontline staff – along with many managers – operate at the join between the citizen and services, and therefore can directly champion their involvement in helping to integrate services.

Of course, doing this well will be challenging. Frontline workers may feel that they are taking the brunt of change hitting the sector and are suffering from ‘change fatigue’. So as a first step, it’s important to acknowledge the significance of the change and to ensure that frontline workers are able to articulate their views; and can help design the new joint working arrangements. It’s better if the intended change is communicated in person, alongside a clear plan for how staff can co-design the new joint working processes; that is, involving them in this plan from the outset.

Thirdly, we need to ensure that managers are driving change. It’s really important to have a clear plan as to how they can target, address and engage operational management in joint working. Even if senior leadership is clearly committed to driving forward working in a new way, success can be impeded by a lack of understanding or buy-in at this level. Managers benefit from having a clear mandate for change, and need to be supported to communicate this to their staff. Managers will need to spend more time gaining a real understanding of where the people in their joint team have come from, and what they have been accustomed to in their previous organisations.

What Greater Manchester is planning is at least having a short-term galvanising effect on health and social care. But ensuring good joint working is in place, is at least as important as agreeing to pool budgets and work differently at the senior level. As our Chief Executive Tony Hunter said on Radio Manchester on the day of the announcement: “From the point of view of the average person, they don't care where that money's coming from. They just want a clear, simple, easy-to-access system that helps him or her to live the best life possible.” Better joint working will help us deliver the services that people need and want.

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  1. Comment by Mrs Maureen RichardsMBE posted on

    Why over the years do we hear the same plans for change but no one seems to look beyond the words to the practicality of making it work in real life experiences that the people with high care needs and high expectations which has been promised to them in words for years.
    My perspective of life in the hard lane is first as a carer for twenty two years then as a Development Officer for sixteen years who has fought for the right for people with varying levels of care needs ages 0-16 then 16-64.

    My eldest son was damaged at birth - in short - left in labour until both my son and I were near to death. He was already a good size baby I looked after myself and him almost too well, because when suddenly Matthew broke an arm and shoulder he was strong and just survived be that good or bad. What changes with time is his disappointment with what his life has left him with and my sadness at times when I face the truth that even after fighting for 46 years for his independence he is still left short of what he could have made of his life.

    It was due to lack of oxygen which affected all four limbs and his speech, but [he is] perfectly normal in every other way, be that good or bad as I say, for he is fully aware of his shortcomings when he looks at the lives his sister and brother have made for themselves.

    So during those years I fought for every single thing to make him independent of me and his siblings, which he is. But he is never really ever there because his care is like quicksand.

    After getting independent living accommodation built for him and 30 other disabled young people back in 1990 and independent living training set up by raising enough money and planning to sell these ideas to health, social services,education and housing associations in five years and by getting other parents interested in facing up to the fact that if they did not join my parent pressure group then their young people had no future unless they themselves made it happen.

    So here we were with a set of aims and objectives and determined to make a better life for our children, determined that the powers that be realise we were not going away until these aims were achieved and funding found. In one meeting, a manager from social services was making the right sounds but when I asked for his thoughts of how he could help us achieve some of our plans in writing he then said there was no money. Well, we did achieve all of our aims [including] the idea of Direct Payments which could give a person with a disability the opportunity to purchase services which weren't out there to buy.

    So many years later, Matthew now does control his budget and has to employ his own personal assistants (PAs) as there is no agency out there which will enable him to interview and choose who will form part of his team.

    So we are here, which on paper sounds very good but in reality is not an easy job. Matthew was telling me how he not only has to balance the books, which isn't easy, but also manage a team of five PAs, some of whom have been with him through thick and thin for at least 14 years. I think he does a wonderful job - I am sure I could not do it as well as him.

    Matthew can fight his own corner now. The only problem he has is getting managers to understand him when he needs a meeting to iron out any problems. His speech impediment makes this difficult. These are the only times he has to call me to arrange these meetings, which is such a shame as these are the people who should understand him better than most. Greater awareness and understanding from these people would make all the difference in arranging meetings to help him get the support he needs.

    Once arranged, Matthew can manage these meetings better than anyone I know. He will have all the paper work and bank details ready for any questions that may arise. Hopefully, this small amount of insight into one type of care for someone with similar needs might help influence the development of services in the future.