Horizontal Teamwork in a Vertical World: Exploring interagency collaboration and people empowerment
By Peter Limbrick
Published by Interconnections, March 2012. Paperback, 124 pages.
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- Power in horizontality
- Where service user and horizontal structure meet
- The workforce in the horizontal landscape
- Planning the service user's journey
- High standards in interagency collaboration
- A rich horizontal landscape for people in need
From the back cover:
We have constant reminders of how hospitals, schools, care homes, GPs, social services, etc damage service users by failing to work together. People who run commercial organisations take collaboration in their stride and do it well, but many managers of public services wrongly assume it is impossible.
As UK public services are downgraded by the coalition government in favour of social enterprises and private bodies, a formula for joint working becomes ever more essential.
Peter Limbrick takes up the challenge, contrasting vertical organisations, characterised by top-down power, with the horizontal landscapes that must be cultivated between them. Here skilled leadership replaces hierarchical authority and space is created for the user's voice to be heard loud and clear.
Horizontal teamwork in a vertical world explores why agencies do not collaborate and offers a guide to managers for creating coherent support for the multitude of people who need help from two or more agencies at the same time.
Extracts from the Introduction:
Some people who need support from public services experience problems of fragmentation and disorganisation when they are helped by more than one agency at the same time or in the same period of time. The agreed antidote is interagency collaboration or, to use another term, multiagency co-ordination in which separate agencies find a way of working together to minimise or eradicate the problems often caused to the service user by a number of separate, concurrent or consecutive interventions.
Though interagency collaboration is easy to define, it has not proved easy to achieve and good examples are a rarity. While service providers, whether concerned with education, health, social care, law enforcement, the courts, housing, etc struggle against the odds to comply with government regulations and guidance, and while the media have a field day each time the persistent fragmentation results in a high-profile tragedy, we seem to have made no progress in learning how separate agencies can work together effectively in systems – systems that are allowed to grow beyond pilot projects and are sustainable against persistent pressures to revert to fragmentation.
In the UK we stumble forward, forever groping in the dark, always trying to make the best of a bad job without the benefit of accepted scientific or technological formulae about how to do it. Time and again we construct a more or less effective integrated system for this or that category of service users only to see it crumble in the face of stronger forces like a sandcastle before the incoming tide.
This essay is offered as an exploratory contribution to thinking about interagency collaboration and, seeking a fresh perspective in the hope that it will open up new solutions, will examine the issues in terms of verticality and horizontality.
Thus the subject matter of the essay comprises vertical organisations and the horizontal structures they must create between them in pursuit of interagency collaboration for particular service users or categories of service users. From this explorative viewpoint I intend to keep a close focus on the people who require simultaneous or consecutive support of some sort from two or more of their local agencies on the understanding that the effectiveness for them of interagency collaboration is the only criterion of success.
It might be helpful at this point to indicate the range of people who might, at some point in their lives because of some condition or situation, need integrated support from two or more agencies. My list of examples includes:
- children of any age with a multifaceted condition
- children with special needs at school who, and whose family, have some formal involvement with social workers
- teenagers leaving local authority care with no home, qualifications or employment
- men and women with a history of drug addiction being released from prison
- elderly people who need continued support on discharge from a geriatric hospital ward
It is impossible to treat the subject of improving service provision properly without also addressing empowerment of people who use public services. Everyone would agree now that the practitioner does not automatically know best, that the service user has views that must be heard and that the person being helped carries both rights and responsibilities to be an active participant. This enlightenment has not yet permeated through all of public service provision and many people complain of being a very junior partner or even of being subject to subtle processes of disempowerment at the hands of some agencies and the practitioners within them.
Good practice in the UK shows that service users can be competent, equal partners and even help design local service provision for the category of service users to which they belong. The argument that this empowerment requires a horizontal landscape is a large part of this essay and I will take it a stage further and suggest that horizontality provides a space in which people can be proactive in finding local solutions to their shared problems.
A quick tour through the essay
Following this introduction, Chapter 1 gives an explanation of horizontality using TAC as a successful example and contrasting it with the verticality of public services in the UK. The horizontal landscape stretched between and created by public services is offered as the essential arena for inter-agency collaboration. While I suggest that horizontality should become a core function of public services, I acknowledge that its development can be a very great challenge to practitioners and their managers.
Chapters 2, 3 and 4 give greater detail about horizontal structures in terms of implications for service users and workers. Chapter 2 discusses the issue of disempowering and empowering service users on the understanding that service development initiatives in the 21st century must address partnership working. In the flattened power structure of the horizontal landscape, the voice of service users can be more clearly heard although I argue that the service user can never have an equal voice in how support is delivered.
In Chapter 3, the multiagency keyworker and TAC are described as essential models for the interface between service users and the horizontal structures that have been designed for their joined-up support. Lessons from the TAC model and from its predecessor, One Hundred Hours, are used to explain in part why keyworking has not flourished in the UK. I suggest that both children's TACs and keyworking should be taken much more seriously and I offer suggestions for developing these roles.
Chapter 4 focuses on practitioners and managers, showing clear advantages for them in developing and working in new initiatives for interagency collaboration but highlighting the need to offer them practical reassurance and protection in the horizontal landscape. The development of local initiatives for interagency collaboration requires time, resources and effort but should offer staff members new patterns of work rather than increased workload.
Chapter 5 offers a structure for radical service redesign, the purpose of which is to create multiagency integrated pathways for those categories of service users who are shared between two or more agencies. Discussions to agree a shared vision and a list of values are described as the essential starting point. One of the tasks for managers is to agree high standards for user empowerment and effective support with formal regulatory systems. Another key task is to agree how integrated support will be funded.
Chapter 6 celebrates an example of very effective interagency collaboration in the commercial world and offers reflections on it. A key lesson from this example is the need for service contracts with enforceable criteria to prevent the horizontal landscape becoming an unregulated free-for-all. The provision of therapy for disabled infants is used to show how professional competence can be maintained in the face of very many new agencies providing interventions.
In Chapter 7, the final chapter, I argue for a radical shift of balance between the interdependent vertical organisations and horizontal structures that are needed to cater for the multitudes of people who require interagency collaboration. Three reports, all published early in 2012, are quoted to justify this argument. The experience of the new children's trusts in England is used to demonstrate that this sort of expanded vertical organisation is not a viable way forward. I offer six key components of service redesign to counter the problems that have hindered horizontal teamwork to date in the UK.
In the Appendix I acknowledge and applaud the brave efforts of the people in Argentina who, ten years ago, began a movement that became known as horizontalidad. I draw a distinction between their urgent efforts to provide essential schools, clinics, food, etc as a sub- or anti-political movement and the challenge of this essay to create horizontal landscapes between existing public services.