Working together: a model of integration.

By Sally Lee – Post Doctoral Research Fellow

Reflecting on last week’s ESRC Festival of Social Science event Safeguarding People at Risk research1of Financial Abuse (Bournemouth University, 9th November), I was struck again how readily passion, enthusiasm and energy can be found amongst front line workers from diverse agencies. It seems easy for people to co-operate where there is a common purpose and shared focus on the job at hand. Yet the integration of services, a drive which underpins recent social policy (particularly The Care Act 2014) is so difficult to achieve.

people-talkingClearly the scale of organisational integration is vastly different from small groups of professionals working together. The layers of complexity created by social change such as the marketisation of public services, increasing demand  and new technologies which offer opportunities and challenges make integration a bold goal. One that can be made increasingly difficult in a time of austerity where new policies are introduced requiring ‘more for less’, often influenced by political ideology (governments wanting to mould the public institutions which shape our society such as education, health and welfare, according to their own belief systems).

However, human services, at their most basic level are all about human relationships (Glasby et al., 2015), so perhaps organisational integration needs to be inspired by, and modelled on micro-level interactions where positive relationships are being forged (and always have been, working together is nothing new – during my career as a social worker in adult services I always worked collaboratively, and usually good humouredly, with health, housing, police and other colleagues).

sally-blogTheory about ‘bureapathology’ or ‘red tape syndrome’ (Oxford Dictionary online) offers insights into the difficulties bureaucratic organisations underpinned by a philosophy of rationality, have in embracing change. This ‘syndrome’ can take effect on an organisation and the individuals within it as they ascend the ranks, becoming absorbed into a culture, overwhelmed by often irreconcilable demands such as targets and budgets. It is characterised by resistance to change and an obsessive reliance on rules.

It seems to me that ‘middle managers’ are the ones most in danger of ‘bureapathology’. iStock_000001017387LargeThey do not enjoy the challenge and pleasure of front-line work, where contact with ‘lived experience’ keeps passion alive, nor do they benefit from the remoteness from front line work of senior management, which perhaps enables the making of difficult decisions. Middle managers are caught between pressures from above and those from below where the reliance on rules offers a firm ground on which to stand. Yet it is this level of an organisation which fundamentally influences the service, creating the ethos of a team – opening or shutting doors to collaboration.

Integrating health and social care seems like a monumental task and one which can only be achieved if commitment to a meaningful (ie realistic, honest and human) vision is inspired at every level.

Tapping into the power of effective front-line relationships, so evident at the event last week, might be a good place to start.


 Glasby, J., Miller, R. and Needham, C., 2015. Adult Social Care.

Weber, M. (1978). Economy and society. Berkeley, CA: University of California Press.(Original work published 1922)