Health and Social Care

Director of Care and Learning’s Spotlight: Bill Alexander, Highland

September 24, 2015 by No Comments | Category Uncategorized

For the first two years, people kept asking me, ‘how’s it going?’ I used to say, ‘well; we’re doing it, and it seems OK’.

Now, it’s just the norm, it’s the day job. Apart from the governance meetings and the associated bureaucracy (much less than there used to be in the old world) you would no longer know we were doing ‘it’ at all.

For us in Highland, ‘it’ is not just integration – it is the lead agency model, and it has been in place since 2012. NHS Highland is funded by the Council to provide adult social care, as part of an integrated lead agency. And in Highland Council, we are funded to deliver child health, as part of integrated children’s services.

I have always believed that the lead agency model is the logical next step from the ‘joint services’ world that we previously inhabited. While joint services were far better than separate (or silo) service delivery, they were laborious and complex, and neither staff or service users understood why everything had to take so long.

Lead agency working is quicker, streamlined, and it makes sense. It is single governance, single management and a single budget – short of one public agency, it is about as integrated as you can get.

The new organisational arrangements in Highland have created a real platform to consider and take forward how we deliver truly integrated front line services to people and communities.

In the Council for example, we have created a new single Department across children’s health, education and social care. We have formed health and social care Family Teams around associated school groups, and filled them with Health Visitors, Early Years Practitioners, School Nurses, Social Workers and Children’s Services Workers – all supporting the same families and communities under one manager. We have aligned Primary Mental Health Workers with Additional Support for Learning staff and Allied Health Professionals. We have developed a truly integrated service plan, that is the service plan for all of our staff, to support all of Highland’s children and families.

As I walk along the corridor that runs past my room, I pass the Educational Psychologist who manages all Additional Support Need Services; I pass the Allied Health Professional (AHP), who is currently the professional lead across AHPs in both organisations; I pass the former Head Teacher, who line manages all care and learning services in the West Highlands. Critically, I pass lots of colleagues, in huddles in their rooms, around the water cooler, and on the phone – making integrated children’s services work across a region that forms one third of Scotland’s land mass.

Of course, we need to make sure that we have not created two new silos – one for children and one for adults. We have been focussed on this. We have a dedicated group made up of senior managers, third sector colleagues and parental representatives, and chaired by the two Chief Executives, where we are held to account for improving the transitions process – which was far from perfect under the old arrangements. We met yesterday, and I was hugely encouraged by the progress that is being made.

And we keep moving things forward. Currently, we are looking at enhancing locality planning; recommitting to boosting breastfeeding rates; supporting five schools to participate in the Schools Programme part of the Attainment Challenge; and reviewing the Highland Practice Model to get the full benefits of our integrated arrangements amongst so many other things.

I wouldn’t want to go back to the old world, and neither do I believe, would anyone else.

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