Features: February 27th, 2009

By Peter O’Hara

Ill health and disabilities come in different forms which are often complex and inter-related. For this reason, health and care services have been brought together to provide holistic support. But this integration has a long way to go because the culture in the health service differs from that in the care service. The author explores the barriers to cultural change and looks at ways to progress successful joint working.

It is widely recognised that fragmented services in health and social care create a barrier to effective care provision within both children and adult services. The way forward for health and social care, in order to transform existing services, is to adopt joint working approach. This improves the service user experience and outcomes through removing organisational barriers between the different services.

Benefits of joint working;

• Improves service delivery
• Economies of scale
• Efficiency savings through improved systems and practices
• Sharing of best practice
• Streamlines communication and information flows
• A more modernised, efficient and effective health and social care service
• Enhances public confidence
• Facilitates a co-ordinated, strategic approach
• Reduces duplication
• Improves credibility
• Creates cost and time savings

The benefits of a seamless joined up approach are undisputed and many. For instance, it enables the realisation of ideas more effectively and efficiently; it leads to a co-ordinated approach; and cross-boundary issues can be addressed in a coherent manner. However, most importantly, it provides a more inclusive and holistic service.

Obviously there are barriers and enablers to successful joint working. As an example, a long-term cultural change is necessary to support this new approach. Joint working is dependent on achieving a significant cultural change and also building on existing best practice. However, naturally it can appear an enormous task and perhaps even slightly overwhelming for those closely involved. The new situation may demand professionals work in a different way, they may have to work collaboratively across boundaries and they may have to use different systems and to work in different locations.

Public sector joint working

In the public sector change is particularly complex as organisations have to consider various other aspects such as performance targets, limited resources and a culture that is generally risk averse and cautious. Cultural resistance is one of the barriers to be confronted, and yet there is no doubt that a change in the manner in which health and social care work together is necessary.

Social care and health have a different culture and focus. Health is focussed on cure while social care centres on care. These professional divisions were created and reinforced through the way in which each area deals with various aspects such as training, structure and even the general approach to work.

In order to achieve successful joint working these cultural issues have to be recognised and addressed. The next step is for health and social care to collaborate to develop a single shared culture concerned with improving the health and well being of everyone.

There are many examples of effective joint working, and yet some local authorities report that their efforts are hindered by the fact that the divisions are working to different timescales and budgetary constraints. However, those local health and social care communities that are now examples of best practice have revealed an ability to transform existing professional cultures to reflect the developments in today’s 21st century health and social care sector.

There is a radical change emerging in both fields. The service is moving from one where help is given to a person, to a relationship where people agree themselves how best support is provided. Increasingly greater emphasis is being placed on the customer’s view of what is effective instead of solely the views of the professionals. This will be given added impetus in the year ahead as public policy evolves to embrace citizen’s choice as a core value in the public sector.

Change: embrace or resist?

As the biggest change in social services for over 20 years, a divide exists among social workers regarding the benefits of joint working. Some view it as an opportunity, others are yet to be convinced.

Those in the latter group may feel a sense of concern as the daily process that they have become accustomed to over the years suddenly evaporates, and leads to a loss of organisational power. Others may be concerned about their role in the programme and whether they will become surplus to requirements.

One of the reasons that people are reluctant to move out of their ‘comfort zone’ is that it generally encompasses traditional organisational roles and responsibilities whereas a new way of working opens the doors to the unknown. Therefore, for this group, accepting joint working may be a risky leap of faith.

However employees who resist this change could hinder its success considerably. In fact, the most commonly cited reason that such projects fail is the neglect of the people element. Local authorities must therefore invest heavily to engage the workforce, gain commitment and convince staff that the risks of standing still are greater than moving forward.

A change leader could be appointed to promote a culture of integrated working amongst staff at all levels.This needs to be completed at a number of levels, and consequently highlights the need to improve the extent of trust between organisations, individuals and groups of professionals.

Firstly senior leadership must demonstrate its understanding and commitment to the principles of the new approach, and recognise that service users have the right to choose, instead of being given a ‘one size fits all’ service. There is also a view that senior managers are often not sufficiently aware of what’s being undertaken in other organisations, and this results in missed opportunities for joining up. Hence the importance of sharing best practice between local authorities.

Secondly, for most people seeing is believing, so local authorities should aim to involve the workforce at all stages. They need to be freed up to create new approaches within a personalisation framework that are meaningful to them and the people they support. At this point many frontline workers describe a ‘return’ to the values and the practice that they were trained in and that originally attracted them to the sector.

Thirdly, staff need to experience a different relationship with people and their families; one that does not assume status as an expert with decision making power, but as a public servant, who understands what is required to support the individual to get the life they want. One team leader explained this process as needing to ‘unlearn’ many of the areas that the system previously expected of them in order to adopt a new approach.

This creates an incredibly vibrant and exciting environment that encourages fresh enthusiasm for staff as they begin to assist people to take both responsibility and control for their own lives.

Joint working: Cultural change for:

• Staff
• Public
• Families
• Individuals
• Suppliers
• Communities

So, cultural change needs to start at the top, with confident senior leaders setting out a vision and a journey towards personalisation. Frontline staff should be supported and involved, through learning and development programmes, and through permission to experiment with new citizen-led approaches. Doing this, and watching what people do with their freedom and decision making ensures that, from the bottom up, the adult social care system is transformed into one that truly supports the aspirations and hopes of the people it is there to serve.

Local authorities must champion the culture change necessary and successfully breakdown historical departmental barriers in order to transform the shape of the public sector and drive forward successful reforms such as joint working.

Peter O’Hara is CEO with the OLM Group, an independent supplier of information solutions for children’s and adult services.

For further information please visit www.olmgroup.com, telephone 020 8973 1100 or email info@olmgroup.com