Implementing Telecare
Seek ways to support cross-agency working

Many pressures are challenging the familiar boundaries between health care, housing and social care, yet the practicalities of working between such different agencies represent a challenge to telecare projects which are becoming part of mainstream service delivery. At the same time another boundary – that between patients / service users and professionals - is also crumbling, as people gain direct access over the internet to information previously controlled by professionals. This too will have implications for those re-designing service delivery, with those receiving services being at the centre of the service delivery process.

For example, at the service user/ professional boundary, issues may arise over who provides, accesses, and has authority over, information relevant to the service user, and how does greater use of technology to facilitate this affect the processes of delivering care?

A second set of issues relates to the boundaries between those engaged in the care process – how do the structural divisions between health, housing and social care, geographical divisions within both, and established professional divisions affect the timely provision, access and use of patient information?

Diverse structures and cultures

Organisations working independently develop unique and distinct ways of working, which is expressed in their physical infrastructures and in the roles and responsibilities through which they provide services. It also shapes their cultures – what people value, and the way they work together. They develop different views about information –

• whether it belongs to individuals, or the organisation;
• is it a means of control, rationing, or a means to improve service;
• is it something you protect or something you share?

People with such distinct views may find joint-working difficult, at least initially. Some aspects of separate agencies can be changed fairly easily, but experience suggests that the deeper aspects, especially their cultural differences, are much harder to deal with.

Planning cross-agency change

If part of integration involves working with other agencies, this is likely to require particular care and considerable time if it is to work satisfactorily. Suggestions which others have made to deal with this include:

• Create small pilots that can be up and running quickly, to show what can be achieved, and to convince doubters;
• Create dedicated teams with members from each agency, and give them time and resources to get to know each others values and ways of working;
• Co-location has been shown to be effective;
• Develop a common language with clear definitions so that all stakeholders are clear about what telecare means;
• Recognise that all organisations will need to shift closer together, and that staff will need time to adjust to this;
• Organise joint awareness raising, training and service planning events.
• Undertake joint pathway planning around service redesign

The JIT intends to develop further guidance on mainstreaming during 2009/10, building on the lessons learned from the ongoing joint telecare review process.