By Elizabeth Rylan*
After almost two years of debate and delay, the local authority I work for has recently co-located with community health colleagues. It was a day that some of us – myself included – were sceptical would ever arrive with move dates set, then postponed to the extent that as I was packing up my desk, I wondered if I would be unpacking it in exactly the same place the following Monday morning.
The benefits for clients of closer working with colleagues from other sectors is well-known with improved outcomes achieved through professionals delivering a more streamlined, efficient and ultimately more effective service.
In my career so far, I have worked in a joined-up service that then split (or disintegrated, as we decided to call it) and later in a well-established, fully integrated setting. So I have seen for myself the pros and cons of different ways of working. This is my first time being in a service as it edges closer to integration, which has prompted me to pause and reflect on how I have found the experience from a practitioner perspective so far.
Environment is key
For me, co-locating involved a move to a different part of the building. I was initially apprehensive because the layout is completely different to our previous set up and I was dreading being in a loud, busy, hot-desking environment.
I was concerned that I was going to get distracted and frustrated by those around me, and that this irritation wouldn’t be very conducive to joint working. Fortunately, I have been proved wrong and, in fact, I have found that the way the space is organised has been one of the most useful parts.
It was surprising to find that paying attention to details such as which way the desks face can make a real difference. It might seem obvious, but sitting in small groups and facing each other does promote interaction. Also, it might sound like a small thing, but having communal areas has helped. As well as the ‘luxury’ of a proper kitchen and seating area, there is nothing like queuing for the kettle to make you realise how much people dislike standing in silence! Embracing the small talk is a great way to get to know each other and put faces to names, more so than a formal meet and greet.
Camaraderie through challenge
It is often said that understanding the roles and remits of other professional groups is a way of breaking down barriers and learning how to make best use of our colleagues. However, I have learnt that as much as we can talk about our experiences, it often isn’t until we see this in practice that we really grasp the importance of this principle.
Quite soon after the move, I had a situation arise with a client who is well known to both health and social care services, alongside his wife who was unfortunately critically unwell in hospital. An urgent call came through to the community matron who sits behind me from the health care support worker who was with the client at the time. The community matron’s mobile was passed to me to speak to the client with the health care support worker supporting him to convey his wishes, while one of my colleagues was on another phone to a care provider.
It was quite an intense, multi-way conversation but in the midst of a very sad and potentially distressing situation, together we were able to achieve an outcome in less than 30 minute, whereby additional assistance was arranged so that he could visit his wife for what would prove to be one of the last times.
Fears and frustrations
While it’s been enlightening being in such close proximity to my health colleagues and given me a real insight into the day-to-day activities of others, the flip side is that it can lead to some uncertain situations. One area in particular where we are more tentative is in relation to information sharing. There can be benefits to hearing snippets of other people’s case discussions but sometimes we may overhear more than we need or indeed want to.
We have generated questions about how much we can say, how much is recorded and if clients are or should be aware of these interactions, which can make people nervous about where they stand in relation to information governance. Unfortunately we are generating more questions than answers, but I am reassured that at the very least this means that we are all mindful of this as a potential issue, erring on the side of caution and not treating client information with any lack of respect. At the moment, queries tend to be raised on an ad hoc basis or in team meetings; I feel it would be useful for everyone to have a more formal review in the coming months.
Despite co-location, processes still lag behind our practice particularly in relation to referral pathways. It is great that I can simply swivel my chair and ask a physiotherapist or a nurse for their advice. But to request their formal input, I still have to go through a time-consuming process and suffer the vagaries of the central access point, for it then to be typed up by the call handler and sent to one of the people sat behind me. I appreciate that there needs to be a way of ensuring a consistency of approach and management of workflows, but this does seem rather ridiculous at times.
Overall, I am pleased to report that I have found co-location to be a positive experience so far and the benefits have far outweighed the annoyances. I am still disappointed that certain teams weren’t part of the co-location and cannot help but feel that there are some real missed opportunities, particularly as some of the services that we often find hardest to work with aren’t part of the set-up at this stage.
I don’t doubt there are several more political and logistical hurdles to overcome before fully fledged integration finally becomes a reality. However, it does now feel that the ultimate goal is in sight, not least in terms of a shared willingness from different sectors and an openness to consider alternative working practices. I’m sure this mindset will stand us in good stead for the future.
* Elizabeth Rylan is a pseudonym for an adults’ social worker based in a local authority in the south of England.