Multi agency synchronisation. Partnership working. Working together. Just three phrases that sit as the foundations for just about every aspirational policy position, project and service design throughout my career in the public sector. Now we’re talking about integrated services. Riffs on a theme – that theme being ‘everybody row in the same direction’. That’s row as in boats, not row as in what we do when we’re not rowing in the same direction.
I’m a long time into working in the health and social care field, and the fact that the ‘working together’ agenda keeps being altered and tweaked can make it feel like collectively we are playing the role of Sisyphus, but that instead of a boulder we’re pushing blancmange. Every time we make progress the problem of communication systems between agencies, the problem morphs into a different shape. Sort out the I.T systems, it’ll then be information sharing problems. Sort out the info sharing problems and it’ll be thresholds for services being different, and so on. But, and it’s a big but, should we get jaded? Partnership working should be seen as a constantly evolving, iterative learning experience where there aren’t ‘failures’ but genuine opportunities to improve. Or as a learning blancmange…or something.
Isaac’s healthcare transcends 5 trusts, a CCG and around 14 professionals, minimum. Each of these 5 trusts will have a nuanced idea of what ‘perfect communication’ looks like within it’s trust. Ideally the directorates, teams, and services in each trust are like a well oiled machine ; clinical and non-clinical services chugging along in perfect synchronicity. Ideally. And I’m sure it happens like that….how could it not…?!
Right, so 5 trusts with perfect internal comms that means, for example, that when Isaac goes to the acute trust (trust 1) outpatients department for orthopaedics review on his hips then the Ortho knows exactly what his blood results were from when he was in A+E the week before. That’s if there’s good comms in one of the 5. Achievable? Occasionally in our experience.
Lets go from one to two trusts…or a trust and the GP…then when Isaac attends Ortho outpatients at the acute trust they’ll know not just the blood results but also what antibiotics the GP has given him for the chest infection that is affecting him to the extent he’s breathless and giving you dirty looks when you’re examining him. Achievable? Seems to depend on timescales but not something out of the realm of possibilities.
Once we get to three trusts and beyond we’re approaching a level of integration and comms that is beyond imagination. For Isaac to go to the acute trust for his orthopaedic outpatient appointment, them know about his chest infection, know about his antibiotics, know about the orthotic splints that he wears several hours a day but we’ve taken off him for the ortho appointment (orthotics trust number 2), know about the problems with balancing the dosages of trihexaphenadyl and baclofen that affect his muscle tone (neurology, trust number 3) , know about the positional problems that OT, Physio and wheelchair services are helping with (trusts 2 and 4) and know how his positioning affects his breathing (ENT, trust 5) is just ridiculously ambitious. So that’s what Isaac is up against. Five trusts, each knowing 20% of his healthcare needs, maybe 30% if we as parents fill gaps in info during consultations and pass on what’s happened elsewhere.
So for Isaac full service integration and partnership sounds really grand but lets just sort the small stuff first. Hopefully the Vanguard sites will highlight this sort of problem and create clearer communication systems, but first, I hope they get an understanding of what it is really like for Isaac. Some empathy about the unnecessary appointment clashes because of lack of alignment of appointment bookings, hours spent in a car seat going to visit different clinics all across the North West, weeks of delays when trust 1,2,3, 4 or 5 need to refer something to each other and then agree who is doing what. It’s a mess. Why get the empathy in place first? Because when designing systems it would help to see it through the person’s eyes who you’re doing it for (NB not doing it ‘to’).
That all said, there are several professionals involved in Isaac’s care who know, realise and empathise with the mess it can be in and they act as the gel and glue between the disjointed pieces. Phone calls, emails, exchanges of info all done by people who know what they can improve for Isaac rather than systemic responses. Isaac’s physio at trust 2 who contacts trust 3 and speaks with the physio at trust 3 about Isaac’s muscle tone and relays info before we take him for clinic appointment – because if all you examined was Isaac’s muscle tone after sitting in a car for an hour you’d be totally misled, and so on. The outreach nurses at trust 4 who have spoken to trust 3 neuro nurses and contact Isaac’s GP by phone to explain medication regime changes rather than waiting for the letter to go from trust 3 to GP. I know it won’t come as news to anyone that people make communication systems, systems don’t make people communicate.
So, in the end, working together for Isaac takes an individual AND collective commitment. Let’s continue to strive for systems that make people communicate – it’s the long fight, but in the interim lets make it people led, at every level.