Whole Systems Working

So what if you were a parent with a disabled child. One day you are chasing education for that special educational needs assessment and the resources available inside and outside your catchment area. Then you are chasing your local PCT health provider for medical and therapy services available in your area.  Then finally you are chasing the local authority for the sort of help and benefits available to a parent as well as transport available. It can be confusing chasing three distinct agencies.

Whole systems working refers to the process of involving all stakeholders in the example above, all agencies in discussion about service changes.  The agencies think about the way the whole service delivery systems works for our parent, rather than focusing only upon their own service.

This example was chosen as the Director of Strategic HR Solutions was the HR Director leading on the creation a Children with Disabilities Trust in London which also involved co-located PCT, local authority and the education staff into a single management structure. 

It is important to emphasise that a whole system working does not involve yet another management fad claiming to reveal the secret of imposing order and rationality on a complex and turbulent world.  The reality is that this is not possible. Rather at Strategic HR Solutions for whole system working we can provide some ways of understanding disorder and apparent irrationality, while still managing to make some progress in addressing complex social problems.  Whole system working is not therefore a quick fix; more a guide to the complexity and uncertainty that characterises client policy formulation and implementation in the joining up of the health and social care.

There is a growing enthusiasm within the public sector for whole system working which comes from recognition that many of the problems that public services now deal with are too complex to be addressed by one agency acting in isolation.  Cross-cutting problems like health inequalities and social exclusion are frequently cited examples, but issues like reducing unplanned hospital admissions and delayed hospital discharges would also be included.

The idea that service delivery must be underpinned by a whole system approach is now widespread in public services discourse, and especially across health and local government.  In the case of services for older people, a study by the Audit Commission (2002) exhorted the use of whole systems working, suggesting that this requires three key elements:

- a shared vision rooted in the views of older people
• - a comprehensive range of services delivered by flexible, multi professional teams:
• - a way of guiding older people through the system to make sure they receive what they need, when they need it.
  
  

• As cited by experts, the Whole System is not simply a collection of organisations which need to work together, but a mix of different people, professions, services and buildings which have patients and users as their unifying concern, and deliver a range of services in a variety of settings to provide the right care, in the right place at the right time.

  The solution – a whole system approach –has been pictorially depicted by the ‘onion’ diagram that underpins the Every Child Matters reforms (Department of Education and Skills, 2004) shown below.

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  Whole system working is also being exhorted to address unplanned hospital admissions.  In Transforming Emergency Care (Department of Health, 2004) it is said that ‘ many lessons have been learned…..improvements must not be limited to the A&E department but made across the whole hospital and whole health and social care community’(p20).  Subsequent policy pledges reiterate this whole system aspiration.  In the recent Community Services White Paper ‘Our Health, Our Care, Our Say,’ for example, the Government talks of the need to encourage:

  ‘all health partners to work together in a system-wide approach to developing urgent care services including better care for patients with long-term conditions, shifting care from acute hospitals to the community, promoting better public health, integration with social care and improving access to GPs in-hours.’ (Department of Health, 2006, p90.)

  Strategic HR Solutions is an organisational transformation and HR interim and consultancy.  We believe strongly in developing the organisational proposition of your employees being engaged with your organisational purpose so that they give of their best