I travel the length of the country to visit an authority that is the leading light on integrated practice and management in Wales. I am greeted with enthusiasm and the day goes incredibly well as I am introduced to community mental health staff of all disciplines and management levels. I spend the whole afternoon with my approximate equivalent who enlightens me as to how they have integrated so successfully. They are so far ahead in terms of practice that the integrated management arrangements seem so logical.

Arrive late into work, as I didn’t get home until 3am. I haven’t had enough sleep. The senior management team ask how I enjoyed my “jolly” yesterday. I promise to write it all up by the end of the month. I know we have much to learn and a huge distance to go before we are even close to the quality that I observed yesterday. I feel a mixture of despondency at our own situation yet am reinvigorated by having seen the potential of our future work.

All day is spent sitting on a panel that examines the quality of assessments and care plans for the purchasing of care. Sadly, so few are mental health service users. I hope that this is because we have so successfully enabled our users that we do not need to purchase this care. But I worry whether the volume of paperwork to achieve such care may seem prohibitive to mental health staff. An emergency call for them is never far away and inevitably paperwork takes a lower priority. I reflect on my attempts this year to turn the social work service away from crisis response and towards forward planning. I feel that we have made substantial improvements to our focus on intervention.

I meet with a psychiatrist and senior nurse to tidy up some loose ends about an investigation we jointly completed about a woman who took her own life. Over the months it has taken, we have formed a close bond based on mutual respect. I have been amazed at their knowledge base and at times surprised by my own. This is the first time a health trust lead investigation has involved a social services lead in the investigation. If only integrated management worked like this. There are no power games here we are all equal and the value that we bring is our difference. There is no highly esteemed leader, just a team of professionals with varying backgrounds. I yearn for flatter, less hierarchical structures that would support this model in the teams.

The local health trust holds a meeting and integrated management is discussed. I endeavour to impart my new-found knowledge but it appears the direction of travel for them is already cast. Worryingly this appears to look like a hostile take over. I can’t understand why they seem so desperate to proceed in this way and with such haste. No plausible explanation is given and my suspicious mind considers that the motivation may be empire building. Next week and the forthcoming months will undoubtedly be rocky.

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