Out of site?

As consumers we are repeatedly enticed by businesses advertising the range of their wares as available “under one roof”. It’s an attractive proposition. Why make additional journeys when you can scrunch up the frozen peas in your trolley to make room for the DVD player?

For service users little can be more irritating than having to travel to different places, repeating stories just to get what they need. It would be like taking your trolley to different check-outs to pay depending on what you had bought.

Partly to combat this, the government is sold on co-location as the way forward. A special offer of this can be found at the Mayday University Hospital in the London Borough of Croydon. Although many other authorities have reduced children’s social work in hospitals or pulled out altogether, Croydon took the brave step to bolster it.

Dame Lorna Boreland-Kelly, group manager (hospital), assessment of child in need services, says: “Three years ago I was brought in to build relationships with the hospital and integrate hospital social work into the wider assessment services.”

Steve Liddicott, divisional director of Croydon children’s services, agrees: “The Laming report talks about the separation between hospital social work services and the rest of the department. We see the service here as an integral part of children’s social services.”

For health colleagues, the arrival of the primary care trust provided a means to establish joint working relationships. Briony Ladbury, child protection manager, Croydon PCT, says: “We put all the named and designated nurses and nurses for looked-after children, previously scattered around the area, together in one place for mutual support and supervision. There are tremendous advantages having the PCT’s community-named child protection professionals working in the hospital. It tightens the interface between the hospital and community services. Then we began building relationships with the social work teams.

“We set up a working together group which includes the senior professionals in the hospital, including social work, and practitioners from the community. Every policy, procedure and protocol is passed between this group – and it works well.”

On a practical level co-location improves efficiency. Helen Underhill, consultant paediatrician (and named doctor, child protection) says: “We have 30,000 children coming through casualty a year. If we have a child with child protection issues it’s much easier to liaise with our team based here.”

But if children are from outside Croydon it can be more difficult. Underhill says: “We can spend hours on the telephone trying to contact the relevant social worker. And the strategy meeting might be miles away – even getting across Croydon and back could take two hours. That, I think, shows how much children are better served when we can directly liaise on-site.”

Co-location also promotes inter-professional dialogue. “It allows those informal discussions as well as the formal ones,” says Liddicott. Underhill agrees: “Nothing can beat a face-to-face discussion – it just enhances the communication.”

Although staff seem to get on well, there is also a little professional heat sparking about. “We do have healthy disagreements, we debate and discuss – and we can thrash out the issues,” says Boreland-Kelly, with a smile. Check out that as a mark of a solid relationship. 

Learning power

Lessons from the Mayday

• Co-location can enhance a sense of teamwork – and this needs to be given time to develop.
• Although formal structures can encourage joint working at a strategic level, it is equally important to make yourself available for informal chats to talk things through.
• If services are to be co-located there is an accommodation need and financial implication.
• Although it makes sharing databases a clear option, this needs to be dependent on carefully thought-out protocols on access.
• But, as Ladbury says: “In some ways it doesn’t matter where you sit, it’s more about the way you link.”