Joining forces

“Multi-agency working is not about IT”, some people say. “It’s about culture change and new ways of working." Maybe. But one of the most valuable objectives of policies like SAP and ISA is to achieve ‘joined-up working’ across the many agencies who deal with the vulnerable in society – and that requires new forms of supporting IT.

At present, there are many central and local government initiatives in multi-agency working; SAP (SIngle Assessment Process) for older people; around children in ISA (Information Sharing and Assessment) and ICS (Integrated Children’s System); and others around mental health services.

Just taking SAP as an example, the complex care needs of older people mean that there is often a range of professionals involved in their care. Without new forms of IT these professionals will struggle to work with the knowledge of one another’s actions, meaning they will be less informed, they will duplicate work and they will ask the older person questions that they have already answered. Furthermore, they will not co-ordinate with other agencies to establish a common perception of the clients needs and risks, and they will not produce one integrated care plan.

The same goes for initiatives around children. For example, a social worker in a child protection team needs to know – in real time – if a teacher has recorded serious concerns about the child, if the GP has treated the child for suspicious bruises or if they have appeared in A&E. They can then use a shared system to request information from all of these participants and also put together a co-ordinated response that is monitored to ensure that nothing falls in the cracks between organisations. We all know of the recent tragedies in this sector due to professionals did not having an overall view, and worse still, thinking someone else was dealing with the case.

To take another example, a youth offending worker would have a clearer picture if they could see that a child had been excluded from school and that social services gave respite care to the parents. They could use this knowledge to get the three agencies working more effectively together on what is ultimately a common goal around the well-being of the child concerned.

Another common notion is that the technology is the easy bit; it is the culture and process change that is difficult. This is all true, but it is worth qualifying. The technology certainly exists to provide effective multi agency solutions, and its implementation is perfectly possible, but achieving such an implementation is not always easy. If it this were the case, more areas would have done it. So why haven’t they?

Firstly, this is new territory. IT departments have generally focused on providing solutions for their own organisation. So a social services IT manager looks after the social services system, and the PCT IT manager does the same, as do the police, etc. This is understandably seen as the first priority, especially when government mandated statistical returns hang off these systems.

These systems on their own cannot handle the multi-agency agenda, as they were only designed for one organisation. There is little point in doing a multi-agency assessment in one system if other agencies cannot see it. So whilst these existing systems do an important job and will remain necessary they also have their limitations.

Furthermore, this can only give shared data; it does not deliver shared workflow and process management. It is no wonder that this has not been implemented anywhere, but with all the potential service costs and ongoing maintenance involved it is also no wonder that some companies encourage this approach.

A more practical strategy for multi-agency IT is to have one shared system in which the multi agency functionality lies. This system is able to define which agency can see or do what. It can also interface with existing systems, but it massively reduces the amount of integration required as the bulk of the data and functionality can remain in the shared system with just key pieces of data going back to the existing core systems in order to eliminate double entry and keep any statistical returns complete. ‘Hot Key’ linking can allow a user to navigate easily between client records in their core system straight to a client record in the multi agency system. This is an approach that has been specified and implemented with a number of social services and health sites and is working very well.

So back to the initial point. What is the difficulty with achieving such multi agency implementations? It moves away from the model where IT departments manage only their own system, to one where they also participate in the management of a shared system. It needs an unprecedented degree of co-operation and inter-agency working and aligning of budgets and aspirations. In short, it is a new business model that requires a system that is shared across agencies, that they have joint ownership and responsibility for, which they must procure together.

To make things harder, the government initiatives driving this agenda do not wield the carrot and stick equally to all the participating agencies. If we take ISA as an example, social services and education are taking it very seriously, partly because they anticipate inspectors auditing their progress; but in many areas it has proved difficult to get genuine engagement from other agencies such as health, or the police, or youth offending, and yet the participation of such partners is vital if the policy is to work as intended. So if a joined-up service is required it would help if there were joined up priorities and incentives.

But despite these challenges there is a technical approach that works and is affordable. Multi-agency IT is the lynchpin to multi agency working and it can be done, providing there is the will to do so.

David Grigsby
Business Development, Liquidlogic
www.liquidlogic.co.uk