Occupational Therapy News OTnews October 2018 | Page 25

INTEGRATION FEATURE
I
am a band seven occupational therapist who qualified in 1997,
and have been working in the NHS for the past 20 years.
Since September 2014, I have been developing and managing
a fully integrated multidisciplinary team of health and social
care staff, and I would like to share some of my experiences,
challenges, rewards and light-bulb moments.
The service started out as a pilot scheme to prevent
unnecessary hospital admissions and to support people to remain
in their own homes wherever possible, and was operational 8am to
8pm, seven days a week, 365 days a year.
This was a multidisciplinary team consisting of occupational
therapists, physiotherapists, social workers, nurses, assistant
practitioners and technical instructors, and was known as the
community assertive in-reach (CAIR) team.
Having spent the previous eight years working in emergency
and acute medical units, trying to prevent patients from
being admitted further into the hospital and
to reduce their length of stay, I jumped
‘‘
information and break down barriers is a must to improving efficiency
and streamlining patient care.
Staying with the theme of integration, another challenge as a
manger was the different policies and terms and conditions that
affected the different staff groups, as social workers are still employed
by the council and health staff are still employed by the NHS.
This means different holiday entitlement, different full-time hours,
procedures for managing absences, professional requirements for
supervision, continuing professional development, accountability
and governance, to name but a few.
My personal challenge was to have a working knowledge of
each of these and to gain an understanding of my managerial
boundaries within each staff gr oup. To be completely integrated,
there needs to be one single all-encompassing organisation in the
future, which allows consistency of systems and policies
and provides clear guidance on accountability and
governance for all staff groups.
Having worked traditional therapy
at the chance to help to develop and
hours for many years, another
To be completely
manage this new service – with the
challenge was compiling a rota that
integrated, there needs to
extra staff and resources being made
covered 12 hour days, seven days
be one single all-encompassing
available – and applied for the post on
a week, with the correct staffing
organisation in the future, which
a secondment basis.
levels and skill mix between the
Following a very successful
professions and the correct ratio
allows consistency of systems
12-month pilot, the team received
of qualified to unqualified staff.
and policies and provides clear
substantive funding to become a
This was a whole new learning
guidance
on
accountability
permanent service and I was successful
experience for me in itself, before
and governance for
in applying for the role of team manager
considering the concept of fairness
on a permanent basis.
and trying to provide shifts that were
all staff groups.
Over the following year, the service
equal for everyone, but also allows
expanded and evolved to become more
personal circumstances and preferences
community based with the focus being to prevent
to be taken into account.
patients even going to the emergency department and
Another issue for myself and the shift pattern was
with the referral system and acute medical response being provided
working 12-hour shifts, which I had never contemplated before
initially by a private organisation.
and I found quite scary. I was not sure if I would still be productive
The team became known as the crisis response team (CRT) and
and be able to concentrate and make the right decisions at the
now, almost 18 months later, all interventions are provided by the
end of such a long day and I had prepared a supply of caffeine and
team itself and, additionally, includes support workers and senior
‘Borroca’.
support workers and consists of around 40 staff.
However, I quickly got used to it and found it very beneficial to
achieving a better work/life balance, but there are some negatives
The challenges of technology and policy
and one of these was identified by Wendy, one of the team social
One of the greatest challenges with integrating health and social
workers, who observed that ‘long shifts bring longer periods of
care staff into one team was the different IT systems and methods
absence from work, which leads to gaps in communication and
of documentation used by each and having the two organisations
interpretation of what is going on and it is difficult to keep up to
agreeing on access and data sharing.
date’.
Following lengthy discussions, training was agreed and a process
To be efficient, it makes sense that patients in a crisis should
developed that allows all staff to access the required information and
only need to be assessed initially by a single professional who is
systems. However, not all other teams within health and social care
able to identify the problem. However, this is a whole different field
have this access, therefore the team needs to document on multiple
of expertise when it comes to role blurring and understanding
systems to be able to transfer information about patient care and
professional boundaries and there is always the worry that ‘you
interventions.
don’t know what you don’t know’.
This creates much duplication and waste and is inefficient. Going
This has been quite a challenge for some staff, and there were
forward with the integration agenda, having systems that can share
some issues around staff feeling that someone else was doing their
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