Keyworkers need co-ordination as much as disabled children and families do. They cannot create it on their own – especially while performing the rest of their duties in their main role
Peter Limbrick writes:
In the hope that there can be a national debate about these important resource issues before the government arrives at its view about keyworking, I am offering here my observations about one aspect of keyworking – the co-ordination of interventions and services for disabled children and their families.
In my view, keyworking is only one part of multi-agency joint working for these children and families. CCNUK (click here) have adopted the term care co-ordination while in my work I tend to use service co-ordination in the expectation that education and health service managers will feel more part of it. Much of what I say here is applicable also to lead professionals.
The crux of the discussion must be to what extent a keyworker who has no additional resources can be effective as a multi-agency care co-ordinator or a service co-ordinator.
Let us start at the beginning. We have known for a long time that children and families suffer when their many services and practitioners from health, education and social care services and from the independent sector, all work separately from each other. This disjointed, piecemeal approach (which is still the experience of very many children and families – perhaps the vast majority) can make families more fragile and vulnerable and can reduce the child's quality of life and opportunities for development. For decades, parents of disabled children have been crying out for someone, some single person who knows the child and family well, who can link it all together for them.
Enter the multi-agency keyworker.
But if it is confusing, disorganised and even chaotic for the child and family, how can an un-resourced keyworker (who, in the majority of cases, will have her main job to do at the same time), however hardworking and committed she is, avoid crumbling under the heavy weight of the same fragmentation and disjointedness? What power will she have to remove multiple waiting lists, multiple assessments, multiple meetings and multiple unconnected action plans? What will sustain her when she has to fight so many battles on so many fronts? How can she, as a lone operator, hope to influence all of the local agencies and services?
The answer must be for senior managers in statutory health, education and social care services to create a multi-agency, collective effort to remedy, as far as possible, the disjointedness and fragmentation. With proper multi-agency service co-ordination, there will be a smooth journey for the child and family along a well-organised, efficient, integrated pathway. At best and when it is working well, this will feel to the child and family like a single support system even though it is made up of many separate agencies, services and practitioners.
In this joined-up environment, the multi-agency keyworker can function as a champion for the child and family helping them understand all the processes, helping them articulate their situation and shape the interventions to meet their unique needs and aspirations, helping them anticipate and prepare for each next step and helping them to prepare for life ahead and the many challenges it will bring. This keyworker carries the unique authority vested in her by the integrated service, has good information about all aspects of local provision to pass to the family when needed, enjoys the support of a multi-agency management structure and has her own needs met for training, support and supervision.
If we do not find the additional resources to create a local multi-agency integrated pathway, if we do not find the resources to create the local information bank that keyworkers, parents and disabled young people need, if we do not find the additional resources to train, manage and support keyworkers properly then, instead of being effective service co-ordinators, they will become themselves the victims of the same fragmentation and disjointedness. Keyworkers need co-ordination as much as disabled children and families do. They cannot create it on their own – especially while performing the rest of their duties in their main role.
My expectation of this new government is that they will want to meet the challenge posed by the increasing numbers of babies, children and young people whose condition and situations are multifaceted, whose needs are long term and complicated, who require multiple interventions to be integrated, effective, well-organised and non-fragmented. It is for these children that the UK needs well-resourced keyworkers (designated and non-designated) functioning within a supportive, multi-agency, fully joined-up system.
If a national debate can be generated as the government in England comes to a point of view, there are many stakeholders whose voices need to be heard loud and clear and there is much good practice to learn from. The discussion must involve disabled children, young people and their families, the voluntary sector, academics and the national organisations for nurses, doctors, therapists, teachers and social workers – and the institutions that train these practitioners.
We must include managers and practitioners in the statutory services who are involved with keyworking, service co-ordination, TAC and lead professionals. These are the people whose job it is ultimately to provide most children and families with keyworkers. They can speak with authority as service providers about what works, what does not work and what resources are needed to ensure success and sustainability.