Fragmented services are disempowering

What this means

When people have to repeat themselves, when they have to chase services, when information is missing – although it may not be intentional, it does express to people with care and support needs that their time is worth less than professional time. These aspects, and many more, are symptomatic of fragmented or siloed services. The group wanted to make the point clear that they experienced not one coherent system, but fragmented provision, with a mix of public sector and private interests often not acting to the same ends.

What is your experience of different services across the system?

In this clip, Ann Kearns shares her experiences of accessing different services:

There are particular points when services splinter – notably in transitions between services. Who decides when transitions happen, and whether they are ‘smooth’?

Resist the temptation to put everything into little boxes. Instead, embrace complexity.

What are some of the things to consider when making home adaptions?

In this clip, David Yeandle talks about some of the key things to consider:

The research 

There is more detail about service and system-level issues in More Resources, Better Used, but fragmented provision has been an issue for many years in the health and social care sectors (Mullard, 2016; Carey, 2015). Carey (2015) proposes that fragmentation has ‘…promoted inconsistent and unreliable services, the development of superficial relationships with users and carers, and the loss of belonging and fractured identities of social care employees‘ (p.2406).

When people have to repeat themselves – in effect, bridging the gap themselves between fragmented services - as well as being frustrating in itself, it can lead to bigger issues. Healthwatch (2015) found issues including having to repeat several times about the distressing death of a loved one; that people missed out information when asked questions again, because they became disorientated at repeating themselves so much; and that vital information about communication or personal needs had not been recorded, leading to inappropriate or distressing situations, with people having to explain themselves all over again. 

Thinking about particular stress points, one in particular is noted by the research, as between children and adult services. There are many different transitions, but one that everyone goes through is becoming an adult, and it is something that every young person will experience differently. It’s also something that’s different for parents, caregivers and families. For instance, Codd and Hewitt (2021) focused on transitions for young people with a learning disability to adulthood. They found that there was extra stress on families as a result of the transition from children’s to adult services (Codd & Hewitt, 2021).

Transitional safeguarding, too, is about taking into account the wide range of issues that affect a young person’s safety and wellbeing. Keeping young people safer as they approach adulthood is a systems change that requires coordinated input from all services that work with young people (Office of the Chief Social Worker for Adults et al., 2021). 

Systems leadership is a response to fragmented services and the challenges of integrated service provision. It has been described as ‘…leadership across organisational and geopolitical boundaries, beyond individual professional disciplines, within a range of organisational and stakeholder cultures, often without direct managerial control’ (Ghate et al., 2013). It’s about developing constructive relationships across professional boundaries – including with citizens – and using leadership that shares power with others and facilitates involvement, rather than closely directing a process (Miller, 2020). 

The research suggests that systems leadership may involve ‘sacrifice’ – recognising and accepting that acting to obtain shared or community-focused goals may not always be in the sole interest of the leader’s own organisation (Miller, 2020). This is a good example of how sharing power as equals is likely to involve cost to those who already have power, something that those individuals and organisations must be prepared to accept. 

What you can do 

If you are a senior leader: There is a self-assessment tool for leaders in social care in relation to systems leadership. As you reflect and note down actions you can take to improve systems leadership and increase integration, think explicitly about power in this context: 

• How can you distribute power to where it has the greatest benefit to citizens – including sharing power directly with them – to improve joined-up responses? 
• How can you listen to where people who have care and support needs find the cracks in the system – rather than only focusing on professional gaps and frustrations? 
• How can you be a positive influence on senior leaders in partner organisations, encouraging them to share power as equals too? 

If you are in direct practice: Take some time to understand how fragmented services can feel to the people with care and support needs you work with. Note down these emotions, and recall any specific examples in your practice where you have noticed poor collaboration or a lack of a joined-up response. What can you personally do to address this? 

• Are there any multi-agency relationships you could develop, so that increased joint working can help plug existing gaps? 
• Are there actions you can take on behalf of, or in partnership with, people, for example agreeing to chase up a particular professional they are having trouble contacting? 
• Are there ways to support people’s confidence in challenging professionals, encourage awareness of their rights, and to make it easy to provide feedback to services (including your own)? 

Further information 

Watch

Donna Hall and Phil Livingstone talk about the wraparound service that citizens should rightly expect from services, when thinking about integrated care boards. 

Read

The Research in Practice Strategic Briefing Systems leadership - enhancing the role of social care.

A short blog on moving beyond technical integration and towards thinking about relationships as fundamental to better integration.