Editorial

Citation

White, S., Miller, R. and Glasby, J. (2015), "Editorial", Journal of Integrated Care, Vol. 23 No. 5. https://doi.org/10.1108/JICA-09-2015-0036

Editorial

Article Type: Editorial From: Journal of Integrated Care, Volume 23, Issue 5.

Change and stasis in integrated working: getting the system sorted

Integrated working and integrated care appear to have intrinsic moral worth. They are generally desirable goals for public service and carry considerable policy impetus. These aspirations coexist, however, within a variety of contending discourses in organisations and in the political domain. In turn, each of these is supported by their own moral tales. Organisational story-telling can be inspirational, but culturally shared notions of practice may also be a powerful forces of stasis. They can be used as a filter in the interpretation of “evidence” and “facts”. The concept of culture itself is often taken for granted and its capacity to shape what can be thought, said, or done underplayed. In policy, culture is often presented as a medium relatively easily changed, change does not always feel rational to those required to do it. Organisations develop locally rational ways of operating which do not fit easily alongside those which have developed elsewhere, for equally rational reasons, to deal with quite different problems or needs. These are some significant reasons why integrated care can seem so elusive and barriers to its success so vexing.

The papers in this edition, in their various ways, attend to these matters. Catherine Needham and Jon Glasby go to the heart of the debates about personalisation. They provide a concise summary of the arguments, which are articulated at greater length in a recent edited collection. They describe how personalisation is a contested concept historically, personally and professionally. Ostensibly neutral “evidence” is interpreted and reinterpreted, presented and represented in different domains to support moral arguments in favour of, or against, the current settlement. The paper concludes by drawing attention to an emerging consensus that we need “a more genuine and longer lasting revolution” focused on building communities and supporting social justice.

Emilie Morwenna Whitaker summarises findings from her ethnographic case study exploring the implementation of self-directed support for children and families. It explores the profound tensions between the notions of ordinary help, autonomy and choice and the child protection functions of the State. Discourses of child centredness and risk dominant in children’s social care, do not always align well with a whole family approach which is arguably made possible through self-directed support. She concludes that we must ask questions “about the ability of professionals to share resources across organisational boundaries”. Indeed, this is a really wicked issue for integrated working.

Michael Clarke, Michelle Cornes, Jill Manthorpe, Catherine Hennessy and Sarah Anderson interrogate the concept of communities of practice in tackling multiple exclusion homelessness. They explore what communities of practice are and what makes them such. The paper shows the potential that exists for these to support “little miracles” in service delivery, and how their operation is often transgressive and subversive. These local acts of resistance to managerialism and the juggernaut that is payment by results can lead to real change for service users and more sustainable locally based solutions.

Jane Lewis, Jane Greenstock, Kim Caldwell and Beth Anderson explore the interface between hospitals and children’s social care. It is here that many serious case reviews have identified significant system failings. The paper examines the impact of various organisational configurations including co-location of social work teams. In common with the other papers in this edition it identifies everyday collaborative working as a key critical success factor in promoting effective knowledge sharing.

Taken together these papers suggest a pressing need for further attention to be paid to the impact of everyday professional practice, organisational story-telling, multiple rationalities and sources of stasis and change in seeking to promote effective integrated care. All aspects of practice, including normative organisational cultures themselves need to be open to revision in the face of the contingencies and real ethical dilemmas. Cultures have the capacity to sustain forms of professional reasoning which function as situated forms of common-sense. These have the tendency to shut down debate. We hope that the papers in this edition can help to provide practitioners and managers with concepts and methods to examine what they and their organisations take for granted, so that they can identify and let go of their own habits if they so wish. In this way we can create the conditions for compassionate and creative action.

Sue White, Robin Miller and Jon Glasby