Find the connections

    Few would argue against the desirability of an evidence-based
    approach to policy, management and practice. Yet it is unlikely
    that the explicit and rigorous use of evidence is widespread. At
    the most recent Integrated Care Network (ICN) national conference,
    delegates examined the evidence-based approach to partnership and
    integration issues.

    One of the difficulties in bringing research and practice closer
    together is the belief that research is an elitist activity that
    can only be undertaken by academic researchers, which reflects the
    dominance of the randomised control trial method. While the latter
    may be the most appropriate method for medical research, it is
    difficult to use it in researching partnership and integration
    where the variables are harder to control, the context is more
    complex and causation is hard to determine.

    Sometimes the evidence-based approach is thought about in linear
    terms -Êresearch generates ideas that are implemented by the
    field. But practitioners often turn to research to validate an
    approach that has already been decided.

    Partnership and integration provide a case in point. Theories
    and empirical research on these areas have been around since the
    early 1960s, especially in the USA, but the belated interest in the
    UK stems from the current policy emphasis on joint working.

    There are three levels at which research can help our
    understanding about partnership.

    First, there is the level of grand theory – playing with
    abstract ideas to develop general ideas about how things work, such
    as societies, organisations and welfare states. Marxism and
    feminism are examples of grand theories. Probably the best-known
    debate is around the nature of market, network and hierarchy as
    different – though not mutually exclusive – ways of co-ordination.
    Much is made of the extent to which, for example, we have moved
    from a hierarchical approach (command and control of “Old Labour”)
    to one based upon the market (privatisation seen under the Thatcher
    and Major regimes of the 1980s and 1990s), and now the network
    model (partnerships based upon goodwill and trust as part of New
    Labour’s Third Way). But this debate is in danger of being too
    general to be of value to practitioners.

    The second level (and the strongest tradition in the UK) is that
    of empirical research – fact-finding with a view to seeing if joint
    working is effective. There will be countless examples of this
    approach across all user groups, conducted by academics and
    “in-house” staff. This can generate useful data for local purposes,
    but runs the risk of resulting in a lot of facts but not much
    explanation. So we know what happens but not why. What can be done
    with this information depends upon whether empirical research is
    part of a bigger picture.
    It is at the third level – middle range theory – that the most
    fruitful intersections between research and practice can be found.
    Here concepts are devised so that they help in day-to-day
    understanding. All agencies, for example, are exhorted to use a
    “whole systems” approach, but there is a lack of understanding
    about what this means. If policy managers and practitioners looked
    at the relevant research a whole systems approach would make sense
    and practice and management would be more coherent.

    Three workshops at the conference looked at ways in which
    research, policy and practice had come together . What is evident
    from these examples is that researchers and practitioners have
    worked together in fruitful ways.

    With the partnership and integration agenda affecting all parts
    of public sector activity, practitioners also need to make
    connections to wider experiences and ideas. Moreover, the move
    towards registration status for social workers surely carries with
    it an obligation to take greater responsibility than in the past
    for personal professional development. The message for any local
    practitioner is “your problem is almost certainly being faced by
    someone else”. Failure to make the right sorts of connections runs
    the risk of re-inventing the partnership wheel, and failing to
    maximise the likelihood of effective practice.

    Durham access programme: older people and people with a
    physical or sensory impairment
     

    The practice

    • Spans social services, community  health services and
      housing.
    • Co-located integrated teams with  common policies and
      procedures.
    • Single team management.
    • Integrated support services, joint information systems, and
      joint performance management review.
    • Partnership board setting strategy and priorities.
    • Pooled budgets.

    The research  

    • To see if integrated teams are making a difference.
    • Used a whole systems framework.
    • Partnership assessment tool to measure interagency
      working.
    • Team assessment process to measure inter-professional
      working.
    • Documentation, questionnaire, semi-structured
      interviewing.
    • Internal data on performance management. 

    Cumbria: mental health services for older
    people

    The practice

    • Aims to increase the range and scope of community-based
      services.
    • Aims to reduce excessive reliance on institutional care.
    • Aims to achieve greater territorial justice in service
      provision.
    • Aims to change the local balance of care. 

    The research

    • To find out if the mix of services available is correct.
    • Local data collected of the experiences of clients, carers and
      practitioners/clinicians.
    • Data collected on current service patterns and
      allocations.

    Reorganisation of children’s services in
    Northumberland

    The practice

    • Review of services for children, young people and their
      families.
    • A focus on the intersections between services.
    • Identification of key themes: integrated services,
      localisation, information sharing, joint HR and performance
      management.
    • Creation of Northumberland Families and Children’s Trust.

    The research

    • To find out pressure points on services such as loss of support
      when child changes schools
    • Questionnaires sent to schools, voluntary organisations and
      public sector teams to see where joint working was successful,
      followed up with case studies.
    • Focus groups.
    • Performance data.

     Abstract

    This article reports on a Good Practice: Developing an Evidence
    Base conference held by the Integrated Care Network to develop
    effective working in partnership and integration. The need to take
    a broad interpretation of what constitutes research is emphasised,
    and three levels of thinking about joint working are identified.
    Examples of local practitioner-researcher programmes are
    outlined.

    Further Information

    Presentations and papers relating to this ICN event are
    available on the website: www.integratedcarenetwork.gov.uk

    For further information on the Durham Access Programme contact
    Alan Inglis, project manager:  Alan.Inglis@sedgefieldpct.nhs.uk.

    For further information on the Cumbria Mental Health Programme
    contact Sue Tucker: sue.tucker@man.ac.uk 

    For further information on Northumberland FACT contact Jeremy
    Cripps: Cripps@northumberland.gov.uk

    ICN has recently published a series of Briefing Papers that
    explore key partnership and integration issues. These are freely
    available as downloads or as hard copy, and include: Culture in
    Partnerships by Professor Edward Peck and Alix Crawford, Integrated
    Working: A Guide by Peter Thistlethwaite, Whole Systems Working by
    Professor Bob Hudson

    Contact the Author

    Bob Hudson can be contacted at:  Bob@bobhudsonconsulting.com 

    Bob Hudson is visiting professor of partnership studies
    in the school of applied social sciences, University of Durham. He
    has written and researched on partnership issues for the past 20
    years, and is a specialist adviser to the House of Commons
    education and skills select committee on issues relating to
    partnership and integration. This article was co-authored with
    Maureen Allan, director of the Integrated Care Network and Alix
    Crawford, manager of the Integrated Care Network.

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