Joint Working: Reality or Rhetoric in Housing the Mentally Vulnerable?
Nicola Glover – Thomas
Abstract: Effective joint working has become an essential component of public service delivery. The interface between the public, private and third sector is increasingly complicated as co-working and the pooling of resources is required to meet greater service demands.Within housing,joint working has emerged as a particularly thorny problem as a legislative gap within the Housing Act 1996 has required other organisations to step in and meet unmet housing needs. This article explores the nature and impetus for joint working withinthe case study of social housing for the mentally vulnerable drawing upon empirical data collected from an ESRC funded project called ‘Housing The Mentally Vulnerable: The Role Of Charites’ (Award Ref: RES-000-22-0286). It examines the benefits that can accrue from successful collaboration, the barriers to joint working that currently exist and the need to draw upon known mechanisms that could facilitate the joint working process.
Keywords: Joint Working, Housing, Mental Vulnerability, Service Delivery
Introduction
The concept of joint working to facilitate public service delivery hasbecome a central tenet within policy development (Home Office, 1998). The notion of joint working centres upon the relationship and the working interface between several organisations to meet agreed objectives. Effective joint working amounts to organisations achieving intended outcomes through active communication, co-working and the pooling of resources, both financial and non-fiscal. So far, the policy focus has largely been on an inter-organisational level; ignoring the importance of inter-professional working as a vital component (Hudson, 2002).
The genesis of this paper arose from an ESRC funded empirical research project,(Award Ref: RES-000-22-0286) entitled ‘Housing The Mentally Vulnerable: The Role Of Charites’ (Barr et al., 2005).The research sought to fill existing gaps in knowledge, particularly as to the exactnature and scope of charitable involvement in housing the mentally vulnerable. It also sought to identify any problems which might exist in such provision, and to suggest possible steps for these to be overcome through harnessing best practice, suggesting support provisions or identifying areas for legal reform. The empirical sample consisted of thirty-four organisations and individuals working within the fields of housing and mental vulnerability, including charitable housing providers, legal experts and housing support groups. A series of qualitative interviews were carried out over two phases. Based on an analysis of the empirical data the work categorised the nature and type of housing provision offered by considering the multifarious roles charities play, the client groups they deal with, the support and service provision offered, the type of housing given (physical and geographical nature, as well as the mode of accommodation), the duration of stay and the legal nature of occupation as well as gaps in provision. The work then explored problems with housing provision, joint working, staffing issues, rent arrears, influence of funders, charitable focus and funding, risk assessments, anti-social behaviour/dual diagnosis and legal difficulties.
The focus of this paper examines one particular difficulty which emerged from the empirical data, that of joint working and the effective implementation of worthwhile collaborative endeavours between organisations to provide social housing for the mentally vulnerable. For this paper, the term ‘mentally vulnerable’ comprises those suffering from clinically recognised mental disorders, such as schizophrenia; those with a form of organic brain malfunction, such as dementia or brain damage following injury; and those with a learning difficulty.Housing the mentally vulnerable provides an ideal context for considering the nature of joint working and its practical implementation especially following the Government’s Third Way policy initiatives which have, amongst other things, sought to open up public service provision to all sectors including the voluntary and charitable sectors thereby necessitating greater co-operation and joint working between organisations and individuals. The Third Wayhas been and currently remains an enthusiastically endorsed political logic and has been central within policy development since 1997. Evidence of this is highly visible within social housing both in mainstream provision as well as ‘special needs’ housing provision; a general policy trend towards the inclusion and use of the third sector to aid public service provision, traditionally a responsibility of the state, has emerged.As early as 1999, Dickson (Dickson, 1999) raised concerns about the viability of some aspects of the Third Wayideology, and notedthat although “partnership and joint working will [not necessarily] fail…there are signs already that in places [Third Way political] rhetoric may be moving ahead of reality and that with massive organisational change underway in health, local government and youth justice the danger is that operational demands suffer at the expense of structural reform”. Despite early concerns, cracks have and continue to appear within the system of public service provision, yet the Third Way trend to harness “all talents” (Dickson, 1999) from all sectors continues to be a major theme within service provision. Within housing, existing research shows that…[joint working]…is problematic because as different organisations and agencies have developed, their cultures have become more diverse (Goss et al., 1995). The research data found that all organisations within the sample recognised that it had particular aims and objectives which may not always work in unison with partner organisations. It was also acknowledged that public agencies are governed by altogether different targets which taken together can hinder effective joint working.‘[H]ousing associations find it difficult to fully co-operate with other agencies because they are concerned with their own agenda and performance targets set by the Housing Corporation’ (Barr et al., 2005, p 47).
The empirical data suggests that housing the mentally vulnerable effectively is largely dependent upon the mechanism that facilitates the delivery process, namely joint working (Barr et al., 2005, p 47). While the mentally vulnerable often have particular service needs, service delivery has necessarily become more specialised to meet these needs. Both charitable and non-charitable housing providers are increasingly focused on particular areas of service delivery,whether it is general housing provision, bespoke long-term housing for the mentally impaired, specialist sheltered accommodation for the elderly or highly supported housing for those with mental disorders. The entire research sample acknowledged that improvements in joint working are needed if the service delivery process in this area is to be enhanced. Yet, the data suggests that joint working currently remains a rhetorical ideal and recognition of its importance has not been paralleled by any overwhelming practical implementation (Barr et al., 2005, p 48).The joint working model appears to be a largely abstract and illusory ideal. As such, this paper seeks to evaluate the effectiveness of contemporary joint working practices within social housing provision for the mentally vulnerable and using empirical data assesses those practices and considers methods to facilitate the process.
Briefly, the structure of this paper is as follows. The first section considers the nature of joint working, including the rationale and impetus for joint working within an ever-complicated landscape of public service provision, the policy trend towards joint working and the emergence of policy initiatives and legislation reflecting this trend. It further examines the delivery process used when housing the mentally vulnerable and considers the complexity involved; numerous organisations, including housing providers, housing managers, housing support organisations, funding bodies and mental health bodies and teams are all part of the service provision process. Effective joint working is frequently viewed by those working on the ground as an ideal and something that is rarely attainable. However, the benefits which can emanate from good joint working practices should be sufficient incentive; the data suggests that for some charities and individuals, it is enough to encourage the use of facilitation methods to improve joint working.
The next section examines the legal obligations, which currently exist to house those without accommodation under the Housing Act 1996. It considers the unique position of the mentally vulnerable within the housing system, recognising the real potential for many mentally vulnerable people to fall through the legislative net, thereby increasing the need for other housing bodies to step in, meeting unmet housing needs.
The final section considers the many hurdles thatprevent joint working, within the context of housing the mentally vulnerable, from being as effective as it could and discusses the need for facilitation methods to be embraced and the adoption of best practice as identified by the data whenever possible. It is clear that policy trends welcoming collaborative efforts are likely to continue; joint working is here to stay and as such, these mechanisms to aid partnerships and organisations working together are essential for the long-term health of the delivery process and the wellbeing of current and future service users.
Joint Workingandthe Delivery Process
At a general level, greater collaboration between disparate agencies has been a key policy priority within the health and social care field since the enactment of the National Health Service and Community Care Act 1990 (Carr, 2005, p 392). The Act introduced significant structural changes to the delivery of health and social care services, giving lead responsibility to local authorities to ‘identify and assess individuals’ needs[,]…design packages of care’ (Griffiths, 1988, p 1) and co-ordinate services between agencies. A clear shift away from primary care provision emerged; authorities became service enablers, commissioning services from both statutory and non-statutory sources. This shift has brought joint working to the fore, as service provision increasingly requires effective joint working between agencies that largely depends upon viable delivery processes, social networking and cooperation between agencies, active within service delivery and management (Secker et al., 2001). This dependency upon joint working is no less evident when examining the various avenues by which housing the mentally vulnerable can take, including the use of charities offering both housing and housing support.
The Government has embraced the multi-agency approach to public service provisionsince 1997. A raft of legislation, guidance and funding for various initiatives have since followed: joint working has been a central tenet in all of these. The White Paper, The New NHS (Department of Health, 1997(a)), recognised the need to harness different agencies to meet common goals, the new NHS was to be based on a system of integrated care, “[using]…partnership between NHS bodies and other local agencies” (Department of Health, 1997(b)). The partnership arrangements under section 31 of the Health Act 1999 (Department of Health, 1998) confirms this changing care landscape. Health bodies, including Strategic Health Authorities and Primary Care Trusts, together with other health-related local authority services, such as, social services and housing, can pool funds for designated services; partner agencies can choose one organisation to act as lead service commissioner; and, organisations can join staff, resources and management structures together (Davies, 2000). The NHS Plan (Department of Health, 2000) adds financial substance to this policy shift by offering financial incentives to departments and organisations demonstrating collaborative practices. For example, for social services, £100 million per annum is available to reward improved social services’ joint working arrangements. Within mental health, the National Service Framework for Mental Health also promotes joint working. It is acknowledged that there needs to be “working partnerships with agencies…[that]…address the needs of some people with enduring mental health needs” (Department of Health, 1999, p 7). Within social housing, the empirical data identifies the mentally vulnerable as a particular group with challenging needs that receive accommodation through several routes and often need additional support (Barr et al., 2005). The research illustrates convincingly that many charities offer these housing and housing support services to the mentally vulnerable. Indeed, analysis of the data suggests that most charities are involved in a mixed economy of provision, including: housing management, housing support, housing project ownership and/or floating support services. The need for several different organisations and agencies to be involved in the housing of the mentally vulnerable necessarily requires co-operative working relations between them. Without this, the overall objective of providing appropriate services to an individual in need becomes difficult to achieve. Worryingly, while the research identified that charities were well aware of the need for good joint working, few felt that it was ever truly accomplished. For many charities in the research sample, problems with communication and issues of confidentiality and information sharing interfered with the primary housing objectives. It was recognised that failure here had a significant impact on all concerned, and might impact upon the mentally vulnerable in particular as joined-up support was often not available(Barr et al., 2005, p 53). To add to the complexity of service provision in this area, many housing services are contracted out to specialist providers, some offering extra services including floating support services as an adjunct to housing.
The rationale behind joint working stems from the recognition that complex service provision by a single agency or organisation is rarely achieved (Homelessness Task Force, 2001). The Audit Commission notes that the policy impetus for partnership working has arisen from: “the perceived failure of separately defined and run services to meet adequately the expectations of users and…the public;…the need to base planning and provision on holistic themes affecting whole communities;…[and]…the desire to enhance community engagement and civic renewal…” (Audit Commission, 2005). More specifically, joint working is often initiated to achieve particular aims, including, the delivery of more co-ordinated packages of care; responding to new Government trends; addressing gaps in service provision; offering a more comprehensive service; reducing organisational fragmentation; bidding for new funding; and, because many organisations regard joint working as a model of best practice (Atkinson et al., 2002). Furthermore, the research data suggests (Barr et al., 2005, p 54) that of much greater practical value at ground level, joint working is regarded as a crucial tool that can improve provision,as collaboration requires knowledge, skills and experience transfer that increases trust levels among participating individuals and organisations (Mitchell et al., 2005, p 22). Many of the research sample indicated that the most successful housing projects often resulted from individuals establishing close relations with others who were also contributing to the work in some way. Where levels of communication are high, where there is a willingness to share information and where the objective is agreed by all and remains the primary focus, the housing project, whether itis the provision of housing and/or support, tends to be more successful overall (Barr et al., 2005, p 55).
However, the research data also suggests that working relations with co-agencies are often informal, commonly relying on staff to make and maintain contact with different organisations. This informal method of joint working can be ad hoc, inconsistent and dependent upon limited staff turnover and the ability of staff to establish good, personal working relations. The data indicates that relations across organisations are not always so easy to establish and frequent miscommunication can lead to serious problems (Barr et al., 2005, p 73). Likewise, if an organisation is to create or maintain effective social networks that enhance working relations, it is a trite proposition that it requires a stable workforce to do so. However, clear evidence emerged from the data that staff turnover is an ongoing problem for many charities as the charity’s ability to compete in the employment market is limited by its funding and career structure (Barr et al., 2005, p 45).Within the research sample, one individual noted that charitable housing bodies often experience difficulty when trying to compete within the employment market,“recruitment is difficult – we pay the best for our sector but not compared with other professions” (Barr et al., 2005, p 46). Dullahide et al. (Dullahide, Ellarby & Smith, 2000) found that staff turnover in voluntary organisations was at 20% per annum, more than for all other employment sectors. As a result of this, the opportunities to establish such close working ties are rare, stability and continuity are lost and interpersonal relationships within and without the charity sector are jeopardised.