Developing Integrated Services in
Gloucestershire
Introduction
The Children and Young People’s Strategic Partnership vision, as set out in
the Children and Young People’s Plan, is for every child to reach his or her full
potential. Integrating services is central to realising this vision and ensuring
better support for children, young people and their families. Every Child
Matters and the Children Act 2004, the National Service Framework for
Children, Young People and Maternity Services, Youth Matters and Choosing
Health all require agencies to develop more integrated front line services and
develop common processes (such as the Common Assessment) for
professionals to use.
Further background information & guidance can be found at
http://www.everychildmatters.gov.uk/
This paper explains the work undertaken to date in developing integrated
services in Gloucestershire, sets out the plan to take the work forward,
explores the potential models for integrating services, and poses some key
questions for discussion.
Please use this paper to promote debate in your service area/ team/
organisation, so that you can take part in a much wider debate at
countywide workshops taking place during late June and early July.
The workshops will largely focus on engaging practitioners in the
discussion about how we will take this work forward.
Understanding Integration
It is still the case that children and young people can face a sometimes
confusing array of professionals and organisations with overlapping functions
and inability to meet their needs. Our aim is to enable frontline professionals
to work closely together, focussed on the needs of children and young people
rather than the services they represent.
Much confusion arises from the various terms used to describe the many
different types of integrated working arrangements. In order to design or
improve inter professional working we need to be able to distinguish and
describe different types of arrangements, and consider which type is best
suited to the needs of a particular user group and the resources available.
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The best way to explain the concept of ‘degree of integration’ is to describe
two ends of a continuum. At one end is a loose-knit team called a ‘network’,
and at the other end is a closely integrated team with integrated management:
Network – membership can change and is voluntary. In these teams
practitioners are organised in professional services and managed by their
profession-manager. The network is made up of practitioners who serve the
same group of users either because of need or geographical location, the
network meeting is used to cross-refer or arrange co-working/parallel working.
Most networks provide the means to share information about individual
service users, and allocate tasks according to a plan based on a shared
assessment.
Integrated team - ‘one door entry’ to all of the services and one team
leader/manager, although practitioners often also have senior professional
advisors. There is an agreed set of objectives and priorities and an
operational policy with procedures governing all members of the team. In an
integrated team there is a collective responsibility where members are
accountable as a group for pooling and using their collective resources to
achieve a common goal. Members are not necessarily accountable for
clinical decisions, just for how they allocate and manage their collective
resources
See Appendix 1 for further useful definitions
For the purposes of developing a model for integrated working, services have
been grouped as follows (see also Appendix 2 – Services across the
spectrum):
Universal Provision
Core staff who deliver across the whole needs spectrum, meeting universal
needs, but also involved when needs become much more serious or complex.
(Often referred to as Tier 1 in the health service).
Supporting Universal Settings (Tier 1)
Mainly services potentially accessible to all who wish to use them, but likely to
be accessed by children and young people who need targeted universal and
community multi agency support. (Often referred to as lower end of Tier 2 in
the health service). E.g Children and young people who attend an educational
setting or youth group, who may require extra support to address a specific
educational need such as literacy support or to address a health need such as
an acute illness.
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Targeted Services (Tier 2)
Services that provide more specialist support to a targeted group of children
and young people who have been identified to have emerging needs, which
cannot be met by universal services. E.g. Children and young people who
may have difficulties in a number of areas of their lives such as managing
their behaviour or feelings, choosing a healthy lifestyle or may be at risk of
being excluded from school.
Specialist Services (Tier 3)
Services that provide a highly specialised input to children and young people
with complex needs. E.g. Children who are looked after or in need of
protection or who have a severe or enduring mental health difficulty or may be
involved with the criminal justice system.
It should be noted that these definitions have been developed locally, and
services have been grouped following consultation, in order to help us to think
through the development of integrated services.
You may want to discuss these definitions and concepts in your teams
to tease out the differences.
How will we know we have made a difference?
The aim of this work is to establish a coherent set of joint agency
networks and/or integrated teams by 2010.
The principles set out below are proposed success measures:

Information, advice and guidance is available to children, young people
and their families from a range of community based settings which are
readily accessible near to where families live.

Services are accessible before needs become complex and need high
level intervention (e.g. social work, CAMHS, YOS, YPSMS)

Common processes recognised across the agencies enable
identification of children with additional needs, use of the Common
Assessment to access needs, and access to a range of agencies who
will meet the need.

Lead Professional arrangements are established that co-ordinate
services across the agencies, based on the Common Assessment, to
reduce duplication and enable the timely delivery of the right services.

Agencies and organisations are enabled to work together, to share
information and expertise, improve efficiency and cost effectiveness,
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reduce duplication, and more effectively improve outcomes for Children
and Young People.

Smooth transitions through services established, particularly if needs
become more complex or as children become adults with continuing
needs.
What have we done in Gloucestershire so far?
Integrated working practices have been in development for many years in
parts of the county and around some needs groups. There are already good
examples of integrated teams and multi agency practices from which we can
learn and develop. These include:
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Connexions ‘one stop shops’
Sure Start local programmes
Child Protection/ACPC/Safeguarding Board Development
Multi Agency Family Support Intervention Team
Child Action Multi Agency Groups, mainly based around schools
Early Years Centres/Children’s Centres
Youth Offending Service
YPSMS (Young People’s Substance Misuse service)
Teenage Pregnancy Partnership
GAP programme
Behaviour support teams
Good practice exists at the front line on a less formal basis, with excellent joint
agency work being undertaken across health, social care and the voluntary
and community sector. However, it is a mixed picture and lots of agencies
operate separately, meaning that for children and young people access to
good multi agency support is not consistent.
Since 2005 the Change for Children Programme has undertaken specific
project work to develop integrated services in Gloucestershire:
Improving access project – Integrated Service Delivery
This included researching models of integrated service delivery – both the
theory, and practice in other local authorities, and how these models might
inform the development of integrated working practices. A model was
developed which plotted agencies across the needs spectrum (see Appendix
2). This is provided to help you to think about all the services which we could
be talking about when we explore future models of integrated services.
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The development of Integrated Services is now a separate project in the
2006/7 Change programme. Through the CYPSP a multi agency group is
being established which will take this project forward.
Supporting Young People Project/Targeted Youth Support pathfinder
Phase one of this project focussed on joint planning and commissioning of
services for young people, building on the positive track record of partnership
work in this area.
Phase two will consider options for integrated management and leadership of
these services so that young people receive a fully joined-up service across
the agencies. The aim of this is to develop a workable local model for targeted
support services for children 5-19 in order to deliver improved, user-friendly
services for young people with additional needs.
Common Assessment and Child Action Model
Since 2003, the Child Action Project has been implementing the Common
Assessment framework in Gloucestershire and through the Child Action
Model, establishing simple processes across the agencies to identify, assess,
and meet the needs of children & young people with emerging needs through
joint agency networks. Over five hundred staff across one hundred settings,
including forty-five schools have now been trained to use the Common
Assessment, and over eight hundred and fifty Common Assessments have
already been completed. Three thirty multi agency groups, usually based in
schools but also based in community and health settings, have been
established across the six districts, and in settings where the Child Action
Model has been implemented. These groups consider or commission
common assessments in order to enable co-ordinated support for child and
young people who have additional needs, but would not reach the threshold
for high level services.
What are the common issues we need to consider when
developing our model of integrated working in
Gloucestershire?
As a result of all the work undertaken as described above, a number of key
issues have emerged which we need to consider when we are deciding how
we design our integrated services in Gloucestershire. These issues are:

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Ensuring consistent access to support for children, young people
and their families across the county
Better information about what services do
Design services around the needs of children, young people and
families – not organisational needs
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Shift focus in service delivery from service lead (needs identified
according to match the existing provision) to needs led
Ensuring universal services respond to additional needs
effectively
Be measurable in terms of impact and sustainable
Linkage between universal and specialist services needs to
improve
Be planned together so that they are individually - responsive,
joined-up and holistic
Involve young people in design, delivery and evaluation
Our challenge is to ensure that when we develop our model of integrated
services, we build on progress to date, but also tackle these key issues
commonly identified by children, young people and their families, strategic
managers and front line practitioners.
How are other local authorities developing integrated
services?
Local authorities across the country are grappling with the issue of how to
develop their integrated services. All have different starting points and are at
different stages of development. Some, like us are at the consultation stage,
others have made decisions about the direction they are taking, whilst others
are implementing their models and have integrated services in place. Some
examples are listed below:
Somerset – Somerset are setting up what we would describe as tier 1 / tier2
integrated teams in localities across the county starting with 4 pilot sites.
Locality managers have been employed to develop the teams in these pilot
areas. Staffing is likely to include family support workers, Connexions PAs,
youth workers, EWOs and community mental health workers.
Tier 3 services (such as social work & specialist CAHMS) will link with the
localities but will for the time being remain specialist teams.
Devon – Devon have had integrated Joint Agency Teams for children with
disabilities in place for some time. These teams meet the needs of children
with disabilities across the spectrum including those with very complex needs.
Staffing in these teams includes occupational therapists, mental health
workers, social workers, community psychiatric nurses, and learning disability
nurses.
Devon are now planning to re-scope these teams in order that they meet the
needs of all children with complex needs including children with disabilities.
These will be Tier 3 integrated teams, with tier 1 & 2 organised in networks.
Cambridgeshire – Cambridgeshire have made the decision to take the fully
integrated approach, developing integrated teams across the county which
provide services to children of all ages, 0-19, and across all need groups. The
approach is a phased one. Currently the locality teams are mainly comprised
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of tier 1 & 2 services such as connexions, youth service, EWOs, and
education behaviour support, with early years services joining in September,
and a longer term plan to integrate social care into the localities. Health
services including school nurses and health visitors are aligned with the
locality teams.
How should we organise our services?
As described above services range from universal – accessible to all, to highly
specialist and accessible to very few that have very high needs.
Services are also organised intro teams which range from single agency, but
which support some co-ordination of services with other agencies, to fully
integrated teams, as described above.
Universal
Co-ordinated Teams
T
a
r
g
e
t
e
d
Co-located Teams
Integrated Teams
Specialist
Exercise
All services can be plotted on this graph according to the level of need the
services meet, and the levels of integration in the way the services are
currently organised. As a team exercise, plot where you think your
team/service is currently. Discuss whether this is where you think you should
be on this graph, and if not, where do you think you should be.
This will be discussed further at the Locality Workshops – please bring your
teams work with you.
If you are unable to have a discussion with your team, or have views you
would like to express, a feedback form is attached to this paper for you
to complete and return. These will be used in the analysis of
information gathered at the end of the road shows.
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What does this mean for the future shape of services?
Although the development of more integrated services delivery is complex
work, there is a finite range of options, which we could pursue.
The potential models fall into 4 broad categories:
Model 1
Status
Quo
Model 2
Network
Children
&
Young
People
Model 4
Fully
Integrated
Teams
Model 3
A
combination
of networks&
integrated
teams
Model 1
Status Quo +
This model implies no organisational change to current arrangements, but will
require increased use of common processes and use of the common
assessment across the agencies. Teams will remain the same, but be
enabled to increase levels of joint working by, for example, using the common
assessment as the referral into the service.
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Benefits
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No organisational disruption
Less anxiety provoking for staff
Current good practice and performance will continue in all sectors
Low cost in short term
Risks
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Will not meet the requirements of the 2004 Children Act for integration
of front line services
Unlikely that standards to be achieved under the National Service
Framework for Children, Young People and Maternity Services and
Youth Matters will not be met
Multiple entry points to services will remain
Multiple high level services will continue to be a feature for children &
young people
Inequitable access to services across the county will not be addressed.
Transitions between services are likely to remain problematic
Will not engender ‘cultural change’ and new ways working between
professionals
Potentially higher cost in long term as will not tackle need for early
intervention, prevention & reduction of duplication
Model 2
Networks
This model suggests no structural change in organisations, but that staff will
be organised into professional networks across the county, such as those
currently established through the Child Action Project. This model implies that
workers remain in their existing teams, but would all become part of a locality
multi agency network through which they would commission/deliver
assessments and services.
Benefits
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Low organisational/staff disruption
Less anxiety provoking for staff
Networks may be developed locally and based on local need.
No agency is excluded
Will build on existing good practice eg child protection, child action
model
Change takes place at a steady pace and is largely driven by front line
practice
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
Enables voluntary sector involvement in networks to continue
Risks
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Potential difficulties in managing networks across both high need and
lower needs groups
Potential local discretion – can exacerbate local difficulties
Lack of clarity in terms of expectations of professionals – no formal
working protocols for more complex cases
Networks are built on voluntary contributions – those who choose not
to engage will just not turn up
Potential to be dominated by more powerful professions /organisations/
personalities
Networks can be resource intensive, particularly for high level services
May lack clear strategic direction and lead to maintenance of status
quo
Model 3
A Combination of networks and integrated teams
This model suggests that some services are organised into local multi agency
networks, whilst others are restructured into integrated teams. There are
potentially two ways of doing this (see Appendix 1).
Services described above as Tier 1/2 are organised into networks, whilst
specialist Tier 3 services are restructured into integrated teams
Or
Services described above as Tier 1/2 are restructured into locality-integrated
teams, whilst specialist services are organised into networks.
Benefits
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Flexible approach, which allows us to fully explore where full
integration is needed
Potential in Model a) to build on current progress
Supports cultural change and transfer of knowledge and skills between
professionals
For Tier1/2 services this model would provide a formal structure for
integrated working
Voluntary sector organisations would be able to participate in locality
and specialist teams as appropriate
Will offer balance to the process of integrated working with a variety of
dedicated approaches
Should allow for a single pathway to be established and understood by
all including service users
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Time between assessment and service provision could potentially be
reduced
Potential for specialist assessments to compliment each other over
time, promote understanding and potential to address the need for
single agencies to commission costly external assessments
Would enable early compliance with expectation from DFES Review of
Care Proceedings to move to one multi-disciplinary assessment of
families
Risks
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Restructuring high level services may lead to risks in short term.
Staff perception that integrated teams will lead to diluting of skills
Lack of clarity about professional role and contribution to integrated
team
Significant time needed to build team culture and explore
tensions/cultural differences/perceptions and governance.
Disruption to existing good practice
Pattern of services may be confusing for families and universal
providers such as schools
Model 4
Fully Integrated Teams
This model implies that staff in main statutory agencies will be organised in
integrated teams across the county offering the full range of preventative high
level services to children and young people 0 – 19. Some voluntary
organisations may also contribute to teams
Benefits
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Tackles duplication
Potentially easier access to a range of providers via one access point
Breaks down organisational barriers to integrated working
Empowers professionals to focus on holistic needs of child or young
person
May facilitate more flexible working arrangements and make best use
of buildings
Will tackle the pattern of ‘referring on’
Potential for specialist assessments to compliment each other over
time, promote understanding and potential to address the need for
single agencies to commission costly external assessments.
Would enable early compliance with expectation from DFES Review of
Care Proceedings to move to one multi-disciplinary assessment of
families
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Risks
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May not tackle easier access as teams may be over loaded.
May be difficult to maintain focus on prevention
Cultural and organisational and professional barriers may obstruct
progress. A great deal of time will need to be spent on organisational
development activities across the board
Highly disruptive organisationally
May not meet user expectations e.g. young people clear they want
‘young people friendly’ services and influence over design and delivery
Such a broad remit may be able to engage with diversity within
communities
Not all agencies can be part of integrated teams eg school staff,
resulting in potential gaps in provision and under use of the lead
professional role
Focus may be on statutory agencies, voluntary sector not able to
respond flexibly
What’s next?
Six locality road shows will be held, one in each district. Dates and venues
are listed below. The information gathered from these workshops together
with the feedback forms will be used to decide the next steps, particularly in
terms of pilot activities. The information will then be widely distributed.
Decisions will be made through the CYPSP, and further locality events will be
held to progress the piloting arrangements.
Timeline for Integrated Services Development
May
Discussion
Document
June/July
Locality
workshops
August/September
Develop
proposals
September/October Oct onwards
Agree
Develop
pilots
pilot sites
Thank you for taking the time to consider the issues in this discussion paper,
and I hope you will join in with the big debate we will be having on developing
our integrated services in Gloucestershire.
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All events start with registration at 9am and will finish at 1pm.
District
Cotswolds
Date
Friday 23 June
Venue
Westwood Centre, Northleach
Tewkesbury
Tuesday 27 June
George
Watson
Tewkesbury
Forest
of Friday 30 June
Dean
Cheltenham
Monday 10 July
Gloucester
Tuesday 11 July
Stroud
Thursday 13 July
Memorial
Hall,
Westbury-on-Severn
Parish
Hall,
Westbury-on-Severn
Civil Service Club, Tewkesbury Road,
Cheltenham
St Lawrence Church Hall, Barnwood
Road, Gloucester
The Ballroom, Subscription Rooms
Stroud
You can download further information on these events from 2 nd June at
www.gloucestershire.gov.uk/changeforchildren, alternatively you can
contact Suzanne Caine on 01452 427103 or email
suzanne.caine@gloucestershire.gov.uk.
Kathy O’ Mahony
Head of Development, Children & Young People’s Directorate
Page 13
Appendix 1 Definitions
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Inter-Agency working – also described as a network team above separate organisations working together with a common purpose. Coordination provided by one of the partner agencies. (e.g. child action
model, youth inclusion support panels, child protection)
Co-located team – different agencies with separate management
structures working from single premises in order to provide a coherent
service. (e.g. one–stop shops, advice/drop-in centres)
Multi agency team – team members from different agencies, some on
a secondment basis, working at operational level within a single
management structure (e.g. youth offending service)
Multi disciplinary team – team members from different professional
backgrounds working at operational level within a single agency who
share common objectives but who make a different but complementary
contribution (e.g. CAMHS, Connexions). NB The term ‘disciplinary’
usually refers to the knowledge and skills underlying professional roles.
Integrated team – as above - team members from different agencies
and/or professions working together at an operational level to provide a
coherent service under single management. May be multi-agency and
multi-disciplinary.
Integrated service – service framework under one management
structure with a common set of objectives and priorities characterised
by integrated planning commissioning and delivery of services across
agencies and sectors (e.g. statutory, voluntary and community).
Co-operation – services working together toward consistent goals and
complementary services, while maintaining their independence. This is
usually at operational level.
Collaboration – services plan together and address issues of overlap,
duplication and gaps in service provision towards common outcomes.
Co-ordination – services work together in a planned and systematic
way towards shared and agreed goals. This is usually at a more
strategic level and more organised than co-operative efforts. It
involves setting formal rules and joint goals and activities between
separate organisations e.g. development of C&YPP.
Joined-Up – services streamlined and co-ordinated and that gaps and
overlaps are addressed and eradicated.
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Appendix 2 – Services across the spectrum
ity
un
mm t
o
d c ppor
an
al y su
s
r
c
ive en
un i ag
Lead professional coordinates plan from CAF
ted mult
e
arg ed
g t inat
Further
n
i
ir
rd
concerns
qu -o
R e co
ntion
Univ
er
Prov sal
ision
terve
ing G
Ps
Early Schools
Y ear
s Ce
ntres
Midw
Conn ives
Scho exions
ol Nu
r se s
gal in
taff d
e
the s livering a
p
c r os
ec
Healt
s
h Vis trum
it
e
ory/L
Page 15
Specialist assessment
t
statu
Needs met
Child Young
person Family/
Carers
ialist
spec
Ta
r
Se gete
d
rvi
ce
s
Further
concern
s
g
uirin
Core
s
sup
po
rt
for visors
r
urse
ed N rse supe ools
Nam
nu
ch
/
S
ction
ialist
prote tial spec l Units ers
child
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id
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Re s
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Pup ction Fie n worke s
e
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in
ffend AMHS ts
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/GA r su holog
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Ho enta n wo ices ecto
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g
Appendix 3
Developing integrated services in Gloucestershire
Feedback Form
Closing date for feedback forms is Thursday 13 July
1a. Which Children & Young People do you support?
(please refer to Appendix 2)
0–5
years
5 – 11
years
11 –14
years
14 – 19
years
Universal service
Supporting universal settings
Targeted service
Specialist service
1b. Professional Background ………………………………………………………
2a. Where on the diagram below do you see your team currently? (please mark
with an X)
Universal
Co-ordinated Teams
T
a
r
g
e
t
e
d
Co-located Teams
Integrated Teams
Specialist
2b. If this is not where you think the team should be, where do you think it
should? (please Mark with a )
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3a. What do you think are the main barriers to integrated working? Please
rank in order from 1 – 6 of importance with 1 being the greatest barrier.
Professional Practices
Resources
Sharing
Process
Strategy/Leadership
Other – please state
3b. Within these barriers please tick all that apply.
Professional Practices
Unclear roles of professionals
Worry about losing their professional identity.
Lack of mutual respect between services.
Elitism
Other – please state
Resources
Equity in funding/budgets
Realistic resources, time and staffing
Other - please state
Sharing Information
Young people's fears about how info will be used
Lack of shared database.
Common approach and agreement on sharing information
Other - please state
Process
Greater flexibility across age ranges
Too much duplication of services
Clear pathways of referral and services/support care
Transition arrangements
Other - please state
Strategy/Leadership
Area structures and accountability
Relationship between statutory and non-stat. orgs
Buy-in by all agencies to the vision
Other - please state
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3c. Please give an example of what you think can be done to address these
barriers.
4a. Please tick which model you think will best meet the needs of Children and
Young People in Gloucestershire (see page 8)
Model 1 - Status Quo
Model 2 – Network
Model 3 - A combination of networks& integrated teams
Model 4 - Fully Integrated Teams
4b. Please explain briefly why you have chosen this option.
You do not have to provide this information and can remain anonymous if you
choose to.
Name …………………………………………………………………………………………
Job title……………………………………………………………………………………….
Area …………………………………………………………………………………………..
Thank you very much for completing the form.
Please return to: Suzanne Caine, Senior Administrator
Closing date for response forms is Thursday 13 July
By Post :
Children Centre Development Team, Children & Young People’s Directorate, 1st
Floor, Quayside House, Shire Hall, Westgate Street, Gloucester, GL1 2TP
By email :
suzanne.caine@gloucestershire.gov.uk
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