Integration Made Possible: A practical manual for joint working – multiagency, multidisciplinary, transdisciplinary. For people of all ages. SECTION 6

SECTION 6: First Moves to Promote Integration

This Section is about tasks for leaders. The word ‘leader’ refers in this Manual to any person promoting an integration project for local group of babies, children, teenagers, adults or elderly people who have some sort of special needs. Project leaders can be: a person with special needs; a family member, carer or friend; a director, manager or practitioner in a public or voluntary agency; an organiser of a support or campaign group.

Whoever they are, leaders will have to learn as they go along. They must find a way through territory that has never been properly mapped and that changes as they walk through it. People’s views about integration are an important factor and these will change in various ways when the implications and advantages of joint working are brought into clearer focus.

The first essential requirement is for a leader to share the task with one or more other committed people. Joint working starts here. Then, some initial work is necessary to get the process of integration started and bringing it to the point where it will continue as a shared effort with its own momentum ̶ multiagency, multidisciplinary or transdisciplinary. Given the great challenge that integration presents and the many factors that can hinder it, there must be a continuing effort in this first phase to recruit people who share the passion for joint working, know intimately the ill-effects of fragmentation and are committed to work for change – sometimes against all the prevailing winds.

TOPIC 21: Tasks for leaders

I have described a wide scope of potential integration including public and voluntary agencies, private services and community facilities. It is not advisable to set out at the beginning to achieve integration at all of these levels. There will be more success if there is an initial focus on the elements of joint working that experience and local surveys have shown to be the most urgent as necessary antidotes to harmful fragmentation.

This graded approach applies also to inviting people and services to join the integration effort. Some people will already be committed. Some others will join when they are approached with the collected evidence about fragmentation and the good practice to counter it. Some at this stage will reject the invitation. I have seen rejections come from all quarters: from an education agency when invited by health and social care; from a health agency when invited by an education agency; from a voluntary agency when invited by another voluntary agency. I have seen keyworkers frustrated when no one seemed willing to join with anyone else in a whole approach!

A helpful attitude for leaders in this is to be calm and patient. Plan first for the integration that is achievable with the people who are already involved and, when it is up and running, disseminate information about the benefits it has brought. This will surely help some people re-think their stance. Coming back to personal attitudes, some people might decide to join in because they start to feel excluded. An example of this is a psychologist who becomes aware one of the children on their case list has a unified and coherent whole-child plan of action to which they have not contributed.

There will not necessarily be a uniform response to the invitation across an agency. The fact that a director has declined does not mean separate departments within the agency cannot be approached or that a director cannot be approached when a manager or practitioner has declined. This persistent approach aimed at various organisational levels merely reflects the fact that at each level different conditions apply.

For discussion

Note: Part of the task for leaders now is to collate information from all Discussion Topics to make a coherent whole and then to agree a prioritised action plan.

Is there clear agreement about which people are being focused on and the locality being focused on?
Can you report the ill-effects of fragmentation, perhaps with a single A4 page and a more detailed account? Can there be filmed evidence?
Is there clear agreement yet about the types of integration that are needed: across place; across time; to rationalise interventions; to harmonise interventions; other?
Is there clear agreement yet about the approaches to be worked on: keyworking; individualised multidisciplinary teams; integrated pathways; primary interventionists; directory and communication systems, other?
Which of these types and approaches are already in place to some extent and require enhancing?
Which need establishing as new initiatives?
Have you documented local good practice in integration for the people you are focused on and for other local people where it is relevant?
Can you collect published research data about the ill-effects of fragmentation for the people you are focused on?
Can you collect published research data about good practice in integration for the people you are focused on?
Can you identify yet a core group of people already committed to this work with you?
Are there any aspects fragmentation or of good integrated practice that the Manual has not covered?
Are you up to date on person-centred practice, co-production, horizontal teamwork, caring activism?
Other points?

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