Collaborative Working

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Collaborative Working

• 21st April
• Working with Adults
• Rob Goemans

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Objectives

• To look at some of the common themes running
  through current policy that promote partnership
  working
• To look at some examples of partnership working
• To consider some of the barriers in the way of
  working effectively together
• To consider the important ingredients of
  effective collaborative working

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Quality assurance agencySubject benchmark
statements

• Contemporary social work commonly takes place in
  an inter-agency context, and social workers
  habitually work collaboratively with others
  towards inter-disciplinary and cross-professional
  objectives
• Honours degree programmes should, therefore, be
  designed to help equip students with accurate
  knowledge about the respective responsibilities
  of social welfare agencies and acquire skills in
  effective collaborative practice between these.

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What is it?

• Collaborative working
• Working in partnership
• Multi-disciplinary teams (MDT)
• Inter-disciplinary working
• Joint working

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Partnerships between?

• Providers users
• Health social care
• Statutory voluntary
• Commissioners providers
• Policymakers services
• Health mental health
• Different age based services
• Different geographically based services
• Different professions within same teams

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Policy

• OHOCOS, 227 pages
• Partnership 96
• Integrated 110
• Social in/exclusion 18
• Mental health 72
• Independence 184
• Choice 141
• Inequality 45
• Social work 18
• Nurse 67

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Our Health, Our Care, Our Say, 2006

• Health and social care working together in
  partnership
• The majority of this White Papers proposals for
  local authorities are about better partnership
  working with stakeholders to deliver more
  effective services, while also achieving better
  value for money from existing resources.
• Good partnerships are built on common aims.

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Our Health, Our Care, Our Say, 2006

• Good partnership working requires clarity about
  what each partner will contribute to joint work
  towards agreed targets and goals, and mechanisms
  that help them plan to achieve them.
• People with complex needs require an integrated
  service, involving support from both health and
  social care professionals.

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Putting People First, 2007

• Ultimately, every locality should seek to have a
  single community based support system focussed on
  the health and wellbeing of the local population.
  Binding together local Government, primary care,
  community based health provision, public health,
  social care and the wider issues of housing,
  employment, benefits advice and
  education/training.
• This will not require structural changes, but
  organisations coming together to re-design local
  systems around the needs of citizens.

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Darzi report, 2008

• The duty is based on a formal assessment of
  peoples needs developed between primary care
  trusts, local authorities and other local
  partners, including police authorities and local
  hospitals, to tackle the most important factors
  in improving health. These plans focus not only
  on tackling clear health priorities such as
  smoking, childhood obesity and teenage pregnancy,
  but also on broader factors such as poor housing,
  education, local transport and recreational
  facilities.

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Darzi report, 2008

• Partnership working between the NHS, local
  authorities and social care partners will help to
  improve peoples health and wellbeing, by
  organising services around patients, and not
  people around services. This will lead to a
  patient-centred and seamless approach.
• This is important not only for people regularly
  using primary, community and social care
  services, but will also help peoples transition
  from hospitals back in to their homes. It will
  also reduce unnecessary re-admissions in to
  hospitals.

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Older Peoples NSF Standard 3

• The NHS Plan set out a major new programme to
  promote independence for older people, through
  developing a range of services that are delivered
  in partnership between primary and secondary
  health care, local authority services, in
  particular social care, and the independent
  sector. One of the critical elements in this
  programme is to develop new intermediate care
  services.

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New Horizons, 2009

• only a robust partnership across the public,
  private and third sector working with local
  people will deliver the necessary change to
  improve mental health and wellbeing for
  individuals, families, carers and communities of
  all ages and backgrounds.

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Examples of collaborative working

• Within one organisation
• MH partnership trusts, CMHTs
• Phys. Dis. teams
• Between similar organisations
• MH liaison teams in AE
• Primary care
• Between different organisations
• private sector/NHS joint tendering
• YOT teams, MAPPA, adult safeguarding boards
• SAP, CHC, ICS
• Embedded housing workers

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Partnerships for Older People Projects (POPPs)

• A two-year programme led by the Department of
  Health with 60 million ringfenced funding for
  local authority-based partnerships to lead pilot
  projects to develop innovative ways to help older
  people avoid emergency hospital attendance and
  live independently longer. The overall aim is to
  improve the health, wellbeing and independence of
  older people
• For every 1 spent on POPP, an average of 0.73
  is saved on the cost of emergency hospital
  bed-days. People using the services see their
  quality of life as improved. The POPP programme
  appears to be associated with a wider culture
  change within their localities, with greater
  recognition of the importance of including early
  intervention and preventative services focused
  toward wellbeing.

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Mental Health

• Section 31, Health Act, 1999
• Section 75, NHS Act, 2006
• Pooled funds - the ability for partners each to
  contribute agreed funds to a single pot, to be
  spent on agreed projects for designated services
• Lead commissioning - the partners can agree to
  delegate commissioning of a service to one lead
  organisation
• Integrated provision - the partners can join
  together their staff, resources, and management
  structures to integrate the provision of a
  service from managerial level to the front line

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Section 75 Partnerships

• Who can be involved?
• Health bodies, such as strategic health
  authorities, NHS foundation trusts, NHS trusts
  and primary care trusts, together with any
  health-related local authority service such as
  social services, housing, transport, leisure and
  library services, community and many acute
  services.
• How will this help improve services?
• The aim is to enable partners to join together to
  design and deliver services around the needs of
  users rather than worrying about the boundaries
  of their organisations. These arrangements should
  help eliminate unnecessary gaps and duplications
  between services.

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• Next 8 slides courtesy of Ruth Allen

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Models of integration 1 ditch and run!

• Local Authorities gave mental health over to the
  NHS and got the hell out!

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Models of integration 2 the narrow funnel

• TRUST COUNCIL

HR/ INVESTIGATIONS/COMPLAINTS/FINANCE/
GOVERNANCE/ STANDARDS/ KPIs.
HR/ INVESTIGATIONS/COMPLAINTS/FINANCE/
GOVERNANCE/ STANDARDS/ KPIs.
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Models of integration 3 tug of war
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Models of integration 4 amicable divorce

• Emerging models of de-integration
• Prompted by e.g.
• Safeguarding concerns
• Budget management and pressures
• LA Dissatisfaction with community care planning
• Personalisation challenge
• Risks e.g.
• Maintaining seamless services?
• Managing risk across service and information
  systems?
• NHS no longer pressured to become more socially
  focused
• Bad feeling

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Models of integration 5 solid partnerships

• Full devolution to Trusts ie TUPE, full budget
  devolution/pooling, joint commissioning, LA
  performance management
• Interwoven systems ie 2 systems working in close
  harmony, seconded staff, variety of budget
  management arrangements and commissioning,
  partnership problem solving

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New forms of integration

• Improving mental health outcomes is about the
  whole system
• Health care specialist and other
• Social care across the spectrum
• Welfare benefits
• Housing
• Education
• Community organisations
• Business and employment
• Citizens

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(ADASS, Mental Health, Drug and Alcohol Subgroup
2008, Into the Mainstream p 5)

• Over the last decade, many Councils have
  devolved significant areas of mental health
  commissioning and service provision
  responsibility to NHS organisations
  increasingly mental health has been seen as a
  health issue ... we believe that social cares
  retreat from mental health has gone too far and
  that we need to re-assert the connections with
  the wider local government agenda and Local
  Strategic Partnerships so that people with mental
  health needs can have better access to housing,
  education, work, leisure

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Ingredients for a successful social work and
social care workforce

• - Clarity of role and purpose
• Commitment to practice excellence rooted in human
  rights, equalities and distinct skills
• Understanding of the evidence base
• Good quality management
• Practitioners willing to innovate and be flexible
• Staff feeling valued and appreciated
• Career and practice advancement structures
• Leadership

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How do you do it?

• Knowledge of professional roles
• Willing participation
• Confidence
• Open honest communication
• Trust mutual respect
• Power
• Conflict
• Support commitment at a senior level
• Professional culture
• Uncertainty
• Envy
• Defences against anxiety
• Barrett Keeping, 2005

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How do you do it?

• Define roles boundaries
• Be aware of power dynamics
• Taking decisions
• Different professionals have different views
• Input from service users
• Payne et al, 2005
• (Comm. Care 27/10/05)

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Barriers to collaborative working

• Defining roles responsibilities
• Developing skills for effective collaboration
• Working with people from a range of social
  professional cultures backgrounds
• Differences in terms and conditions
• Adapting to a new organisational culture
• Working with new systems processes
• Quinney, 2006

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Problems

• Collaborative advantage v collaborative inertia
• Conflict v challenge
• Soup v salad

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Is it working? (CSCI, 2009)

• Joint working arrangements with health and other
  partner organisations are seen as a strength in
  one-third of councils but as an area for
  improvement only in three. In councils judged as
  excellent or good there is evidence that
  development of intermediate care services is
  helping prevent admissions to hospital and
  maintain low levels of delayed discharges.

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• The great majority of councils have partnership
  agreements in mental health (81), learning
  disabilities (85) and integrated equipment
  services (94). Just over half of councils (53)
  have agreements for older people with mental
  health needs and delayed transfers of care.
• Councils with adult social services
  responsibilities are the predominant leads for
  learning disabilities and equipment services, and
  NHS agencies for mental health. The lead on
  delayed transfers of care is more equally shared.

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• Coordinating services and taking an effective
  whole-person approach to support people with
  multiple and complex needs was challenging for
  all the councils in this study.
• Although there have been steps to improve the
  transition from childrens to adult services for
  people with multiple and complex needs, some of
  the key agencies (particularly health) tend to
  take a very rigid approach at odds with the
  personalisation agenda.

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• People with multiple and complex needs frequently
  have needs that cross established professional
  and organisational boundaries. A CSCI inspection
  report noted that 10 agencies and carers had been
  involved in one project for people with high
  support needs. Developing an effective
  whole-person approach to support people with
  multiple and complex needs proved to be very
  challenging for all the councils in this study.
  Several key boundaries were identified at the
  transition from adolescence to young adulthood
  between adult social care and the NHS and
  between individual budget income streams.

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• The problematic area is getting the involvement
  and commitment from health colleagues around
  anyone moving from childrens services into adult
  services. They have different criteria that Im
  still not clear about. It just all works so
  differently.
• There is now an expectation that we will
  contribute. The standard formula is 30 from
  social care and 20 from health if the person has
  a significant health need. We pay but some
  authorities dont.

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• Given the high cost of supporting people with
  multiple and complex needs, it is unsurprising
  that where disagreements arose they tended to be
  about funding. Typically, Continuing Healthcare
  was reported as an area of ongoing contention
• There is a real steer coming from the SHA saying
  that people with learning disabilities probably
  generally wont be eligible under CHC. I find
  that bizarre and we will be resisting that
  manfully.
• Thankfully we now have a little more consistency
  since the National Framework was introduced.
  Prior to that it was a nightmare, an absolute
  nightmare. But a lot depends on each nurse
  assessor team. You can have very different types
  of people, sometimes leading to very different
  types of working relationships and different
  decisions.

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Carpenter et al, 2003

• Integration showed little effect on professional
  identification
• Staff in integrated non-integrated services
  identify with team rather than with profession
• Social workers
• Identified less strongly with profession
• Perceived teams as less participative
• Experienced higher role conflict and stress

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Conclusions

• As problems are viewed more holistically,
  interventions need to be provided by a wider
  range of services working closer together
• Economic downturn requires efficiencies to be
  made, services can be provided cheaper by
  organisations working together
• Tendencies for defensive practices and loss of
  professional identities need to be avoided
  through strong leadership and cultural change