All of the different places are battling for the same cause.
But they do it separately so they're not as effective
whereas if they all teamed up together they'd make a lot more impact
and be able to help people a lot better.
Individuals often need to use a range of services
including health care, social care, housing, and the criminal justice system.
Historically, these services had limited experience of working together.
Well our welfare state is based on a very 1940s assumption
that you can distinguish between people who are sick who are the responsibility of
the health service and people who are somehow merely frail or disabled who we
describe as having social care needs that are the responsibility of local government.
And people are means tested and paid towards the cost of their care.
I'm not sure if that distinction ever made sense
but it feels increasingly unfit for purpose in the early 21st Century given current demography.
Increasingly organisations and practitioners are realising the benefits
of looking beyond their own service and practice
to meet the needs and wishes of people who use their services.
We obviously deal with medical conditions day in day out
however we can only take those patients so far dealing with their medical problems.
They often have social issues that we need to deal with
housing issues that need to be dealt with
and other issues that are blocking them from actually moving forward in their health.
When services are not joined up what are the consequences to service users and carers?
Time and time again the people that use social care services and health services
tell us how fed up they are with having to tell their story to a social worker one day
to a community nurse the next day.
Too often, service users and carers need to find information themselves,
and to push for the support they need.
It's recognised that when you work in a fragmented way that people fall through the gaps.
They receive a poor service or they don't get what they need
or they have to continually wade their way through bureaucratic systems that are not joined up or interlocked.
For some individuals a lack of joined-up services can have serious consequences
as Annabelle discovered when she made the transition from children's to adult's services.
A few months after my official discharge
I was admitted into psychiatric intensive care for attempting suicide.
You are stuck in an institution trying to find which way's up.
No one ever signposted me to an organisation that could have helped.
It was me sitting on the internet going, I need something more than this!
In July 2006 the body of Stephen Hoskin was discovered
at the bottom of a railway viaduct near his home in Cornwall.
He had been murdered.
Stephen had a learning disability.
Desperate for friendship he had accepted a group of people into his home.
Several of this group were later convicted for the brutal killing of Stephen.
The leader of the group was Darren Stewart.
He was already known to agencies because of his criminal activities and being a frequent user of services himself.
Investigations revealed that Stephen had made several calls and visits to a number of agencies
all of which should have alerted people to the danger of his situation and his vulnerability.
It seemed to me that every agency had a small piece of information or even quite a large piece of information
but they looked at that information as though it was disconnected from anything else.
One of the principle findings of the serious case review was that every agency had a piece of a jigsaw
but at no stage did they seek to discuss the information that they held
or the concerns that they had about Stephen's circumstances.
That's not to say that these agencies acted in a way that they knew of the danger that Stephen was in,
they did not see it coming.
So it had a very major impact on all services.
The agencies concerned have since made major changes to prevent this type of tragedy from happening again.
Integration is not just about joint working between agencies.
It also requires integration within each agency across all parts and between each level of the organisation.
Every services seems to have an us and them.
There seems to be a divide between psychiatrists and nurses,
psychiatrists and therapists, therapists and nurses.
And then there's the divide between NHS and charities.
And then there's the divide between the patient and professionals.
And when you've got so many divides information gets lost,
information doesn't get shared and the best advice isn't given.
But effective integrated working does happen - both within and between agencies
producing positive outcomes for service users and carers.
Professor John Carpenter was the co-author of a study
which compared integrated and non-integrated working of health and social care.
We did find differences,
that the service users in integrated teams were more satisfied with the quality of their care,
they were more likely to say that they had been involved and they were more likely to say things like
that they'd been fully informed about their medication and needs in those kinds of respects too.
There are many different models of integrated care,
including the approach taken by the Timberdine Nursing and Rehabilitation Unit in Worcester.
Here we are what I would consider truly integrated,
we've got everybody that we need within our service area, within easy reach.
Within our building we actually have social workers we have therapists,
obviously our nurses are based here and our care staff.
But we have consultants coming in on a planned rota,
we have GPs coming in to see us every day on a planned rota,
we can easily access mental health advice.
We have ophthalmology coming in to see us, we have stroke services coming in to see us.
Stuart Townsend had experienced a lack of joined up care in the past,
but what are his experiences at Timberdine?
Oh, it's just totally flipside and everything I have to say is positive.
I can't think of one negative.
You know, it was, even from going home it didn't end once I left here.
It was chairs that were give to me and aids that were given.
Anything that they could do here for me here they've done for me.
I think it enables us to do things in a more timely fashion for people.
It means were not waiting for things for service users.
If, for example, they need a financial assessment done to enable them to get a care package
we can get that done quickly and easily.
If they need a hospital appointment our consultant can quite often make that happen more easily
or get the referral through the right person quite quickly.
Matron's got a lot of links with different people so she can makes things happen
so it means people have all the facets of their care taken care of more quickly and easily
and get them to where they need to be.
In Wandsworth, South London, integrated teams aim to reduce the number of hospital readmissions
of people with multiple co-morbidities and significant health needs.
These teams known as 'community wards'
care for people in their homes using telehealth technology and face-to-face care.
A neighbour just phoned to inform she's not feeling very well and should you like to speak to her at all?
Each team comprises a GP, social worker, advanced nurse practitioner, pharmacist and community matron.
The medical staff are able to call on the community ward social worker to carry out assessments,
organise care packages and ensure people get suitable support.
At home you actually do get to see them, give them more time.
You can see the environment they live in so some people can look after themselves, they have family.
Other people are completely alone
so when you come into a home you can actually assess a lot more than just a medical condition.
Shirley Ellis is a social worker on one of the integrated teams.
I must have known.
Good morning Mr Clark. How are you?
How have you actually found the benefits of actually being on the community ward?
Completely and utterly brilliant because it's stopped me being in hospital.
Prior to that I was going 6 weeks, maybe 8 weeks and then I was in hospital for 10 days.
Given the existence of different models for integrated working, the Social Care Institute for Excellence
conducted a systematic review of factors that promote and hinder joint working.
The factors can be grouped under three broad issues:
organisational
cultural and professional
and contextual.
Under the organisational theme it was things like are we clear about our aims and objectives?
Are we clear about what we're trying to achieve here?
And when people got that right then services flourished.
But when people weren't clear and people who were maybe outside of that particular joint working initiative
ie. people who might be referring into that service weren't clear about the aims of that service
then that's when things began to fall down.
For example, when different professionals are working together
they've got to agree and accept assessments other groups provide.
So, for example, when working with older people, an assessment might be carried out by a social worker
but the community nurses have to be confident in that assessment
and trust that assessment in order to action it.
Contextual issues refer to the background in which integration takes place.
So it can relate to the political climate, discussions that are going on.
So at the moment discussions about the numbers of older people affect how services are responding
may raise new issues for organisations that they have to deal with.
It affects how the senior managers are planning and negotiating and commissioning services
and what happens at that strategic level filters down to the operational level.
So if there are anxieties about cost shunting at the strategic level those get played out at the organisational level.
Just as open and constructive discussions between agencies are essential to plan effective joint working,
so is genuine dialogue with service users and carers.
They might all sit down and say 'oh we need to change this, we need to change this'
but if they get someone from the perspective of the patient then they can see what they think needs to be improved
rather than what the professional think need to be improved.
Successful integrated working depends on service users, carers and families
being empowered to make decisions about their individual care.
It also depends on their close involvement in the planning of such care.
We will also have to plan more around how we will treat and care and respond to individuals
with complex care packages and they will require multi-disciplinary teams and mulit-disciplinary responses
and therefore I think integrated working will become the norm as we go forward rather than the exception.
As budgets get tight and as structures change joint working is even more important now than it ever was.
And if ever there was a time for frontline professions and practitioners to stand up and to be counted
to make relationships work at a local level,
to see the world in broader ways and to develop new ways of working
alongside other agencies and other professionals, that time's now.