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Complexity and integration?

Wednesday 17 June

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This won't be news to you but, everyone on the planet is unique. We’ve our own opinions, fears, strengths, preferences and aspirations. And it's not just people that vary, we live in diverse social, cultural, economic and physical environments. What's more we all have a personal history and different events happen to us at difference stages during our lives.

The organisations that provide us with services need to find effective and efficient ways to deliver services whist taking account of each unique individual. No mean feat! Providers vary in the way their services are targeted, with some addressing a narrow set of issues and others responding to a broad range of different needs. No organisation can be all things to all people and there will be times when a service user will have needs that their provider can't respond to. This is not ideal and it could be that if we miss out on one form of help, then the support we get in different areas is less effective – an example would be an inability to fully access an educational opportunity because of an unaddressed health concern. One way to tackle these dilemmas is for a network of service providers to come together and work in an integrated way.

The idea of service integration is simple and very attractive; different providers share information and resources, coordinating their support and delivering seamless services, reducing duplication and working harmoniously together. In practice there's always a number of questions to be answered and challenges to be overcome. For example:

  • What services should be integrated and what should stay separate?
  • What parts and levels of the organisations should be involved?
  • How closely will the services work together?
  • What helps service integration, eg co-location, joint budgets, shared IT systems, joint meetings, shared planning?
  • How can different professions work together without treading on each other's toes?
  • What happens when there are differences of opinion about needs or how best to meet them?

Everyone has agreed for years that integrated working is desirable, no one seems to have all of the answers. The recent Public Bodies (Joint Working) (Scotland) Act 2014 requires integration of adult health and social care services. The legislation has a degree of flexibility allowing local areas to decide between various models of integration. It also allows local areas to decide whether or not they will also integrate child and family services.

Although the main focus of the legislation and much of the current debate is around adult services, including those for older people, it’s clear that significant changes in the way public services work will directly and indirectly impact on children and families. These impacts will be profound for some individuals; for example, care leavers, disabled children, young carers and vulnerable children. That’s why I believe it is absolutely critical for those tasked with planning and implementing service integration to carefully assess their impact.

CELCIS and Children in Scotland were recently commissioned by Social Work Scotland to conduct research to examine the impact for children’s service. We produced two reports. Report One examined the evidence base in terms of relevant literature and policy and Report Two reported findings from the research.



Topic: Research
Author: Vicki Welch

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