Guest blog from Dr Michelle Cornes
Blind faith
“And so the dance continues: professional goods and services are exchanged, but the net result is a zero sum game in which there is no movement, no change”
(Scanlon and Adlam, 2011 p167)
Making Every Contact Count, the latest government strategy in England to prevent homelessness encourages local authorities to pursue a joint approach in which locally designed integrated services will step in when things go wrong (CLG, 2012, p5). Integration has long been the ‘holy grail’ of UK social policy, but is such blind faith warranted?
Following on from the Multiple Exclusion Homelessness Research programme, I have been working with colleagues at Revolving Doors Agency to develop six Communities of Practice across different locations in England. This has allowed us to ‘magic-up’ some integrated working by providing a small amount of resource to local voluntary agencies and asking them to convene an interdisciplinary group tasked with looking at some of their most ‘challenging’ priority needs cases. Some localities have fared better that others but most have achieved a healthy mix of professionally qualified staff (nurses, social workers and offender managers) who are happy to work in a non-hierarchal way alongside support staff from a range of services including housing and homelessness services, drug and alcohol and mental health. The theory goes that the outcome of these encounters will be enhanced capability, coordination and new and innovative practice.
The evaluation of the programme is just about to get under way and I am sure this will show many positive benefits such as opportunities for shared learning and strengthening of networks and relationships. However, what most often emerges from these interdisciplinary conversations is a sense of mutual frustration about the intractability of many of the problems being discussed – whether this relates to a lack of suitable accommodation for a young person leaving care or a ‘refusal’ to engage with support on the part of the women being beaten by her partner. Indeed, it is easy to see why practitioners quickly lose faith with these kinds of integrative processes, given that they can sometimes feel benign (like a ‘talking shop’).
Scanlon and Adlam (2011) have written extensively about this phenomenon from a psychosocial perspective and how it can quickly lead to further fragmentation within the system as workers start to disengage and feel burnt out. They pinpoint what they see as a stubborn and institutionalised refusal to face up to the complex reality of the problems facing people at the margins of society.
This begs the question as to how we might move beyond the rhetoric of integration to address this complexity in more meaningful ways. One solution currently being heavily proposed across a number of sectors is capitation and consortia-based commissioning. However, I think the danger is that if we address this complexity with ever more complexity we can confuse and unsettle the system in such as a way as to detract from the issues at hand. For the front line practitioners engaged in this programme the answer is much simpler. It is about finding ways to encourage local commissioners to become passionate and dedicated supporters of their Communities of Practice, to engage in authentic dialogue and to build continuous relationships with them. Ultimately, to work towards more intelligent commissioning through the integration of the policy and practice worlds.
Dr Michelle Cornes
Research Fellow, Social Care Workforce Research Unit, King’s College London
Fellow, NIHR, School for Social Care Research.
References
Department for Communities and Local Government (2011) Making Every Contact Count: A joint approach to preventing homelessness. London: HM Government.
Scanlon, C & Adlam, J. (2012) Disorganised responses to refusal and spoiling in traumatised organisations in E. Hopper (ed.) Trauma In Organisations London: Karnac
