In the summer of 1970 at the tender age of 10 years old, I decided that I wanted to be a teacher. I can remember the conversation that set my future course quite clearly. I was asked by the class teacher to get together a small group of singers and players from the oldest class and lead them in performing the winning song from that year’s Eurovision Song Contest for the school and parents in a summer concert – ‘All Kinds of Everything’ sung by Dana. Being bossy and, I have since learned, a natural team player, I found the experience exhilarating and fulfilling – not so much the performance which I can’t actually remember, but the working together in practice and rehearsals to put it all together – peer collaboration.
I have spent my whole working life teaching in secondary schools, and between 1990 and 2016 I was fortunate to be in positions of whole school leadership. Having embarked on a career as a teacher of Music and Physical Education in South Yorkshire in Autumn 1982 (the date is significant), I then progressed to become the Music subject leader in a Roman Catholic school (again in Doncaster) before then becoming a senior leader in Birmingham (where, amongst my many roles I was what is now called the ‘Designated Safeguarding Lead’). In 1996, I was appointed to a deputy head post in Cornwall and then, from 2002 as headteacher in Bude.
The family move to Cornwall was deliberate yet at the same time accidental. We decided that with a young and growing family we wanted to move out of Birmingham (which we loved, and my job was tremendously rewarding) to ‘somewhere’ south of the M4 and west of the M3; both my wife’s parents and mine lived in Kent. After a number of unsuccessful interviews for deputy headship across the southern counties we moved to North Cornwall, thereby achieving our goal! Serendipity is a wonderful thing – previously long forgotten ancestors of mine are buried in the churchyard at St Endellion, my mother was bombed out of Plymouth during the war to a then unheard of village on the North Cornwall coast called Port Isaac and the job that I had been appointed to was at Wadebridge School, just fifteen minutes’ drive from both. Mother was (and remains) very envious – she used to shop and go to the cinema in Wadebridge as a child!
Why is this brief nostalgia important – although I did not know it, from that very first fledging appointment as a novice music teacher in Doncaster where within months I was immersed in a community supporting itself during a national miners strike, I have been committed to, and proactively engaged in developing the power of collaboration to support young people both in their schools and more widely within their communities. Only as a headteacher when embarking upon setting up an Integrated Health Centre in the most isolated town in Cornwall did I really begin to reflect upon the privileges that had been bestowed me upon throughout my career – and, indeed, as a 10 year old! It was only through leading and managing the IHC project that the tangled ways in which collaboration and collaborative school leadership both in Birmingham and Cornwall had shaped my principles, my beliefs and fundamentally my values as a school leader became clear.
Why an Integrated Health Centre?
In an online article in August 2018 for the media outlet ‘Cornwall Live’, a local Cornwall Councillor in Bude explained that “We are quite remote. We’re not on any main trunk road. You don’t pass through Bude on the way to somewhere else, you have to come here for a purpose. This sense of isolation has helped create a strong community spirit. We’re like an island community but on land. Don’t get us wrong, we love getting out to other places, but there is a very strong sense of community here, of belonging and of independence.” (La Broy, 2018)
Sense of belonging, independence, and isolation. All the while things are going well for a young person and their family, that sense of belonging is truly wonderful; I saw it on countless occasions both as a deputy and then headteacher in Cornwall, and have seen it as a father of three boys growing up in this very special part of the world. However, it doesn’t take much for that equilibrium to become unbalanced, and then the independence and isolation so epitomised by, but not unique to Bude, can quickly rise to the fore in a young person’s experience and life. How, then, can those of us in a position to support young people and those that love and care for them genuinely support and nurture them? Therein lay the catalyst for what was to become the Integrated Health Centre project at Budehaven Community School, and my commitment to Inter Professional Collaboration began.
Whilst I was learning the ropes of being a headteacher, Dr Barbara Vann was an experienced head in another Cornish secondary school 55 miles down the road in Truro. In a chance encounter in Bude with a health professional, I became alerted to a project that Barbara was looking to develop with the support of the Duchy Health Charity. On a visit to New Zealand, Barbara and a group of Cornish headteachers had seen in action Integrated Health Centres located on school sites. The concept was simple – in a rural context, expecting families to travel to health, housing, care centres was unrealistic and for teenagers impossible. So, bring the services to the teenagers and work with the school to wrap care around them in a collaborative model. The Duchy Health Charity, I soon learnt, were looking to support the development of three such centres in Cornwall, one in the East, one in the West and Barbara’s school in the middle. I lobbied hard for the East pilot, and following confirmation of our successful bid the journey into Inter Professional Collaboration (IPC) to support young people truly began.
Inter Professional Collaboration in developing an Integrated Health Centre
The political landscape at the time of the IHC development was very supportive of our vision and ambitions and those of the Duchy Health Charity. The ‘Every Child Matters’ (ECM) agenda underpinned our exploratory work, a framework with which professionals in all walks of life working with children were familiar (UK Government, 2003). The political imperatives and policies of the early 2000s actively encouraged, indeed necessitated multi agency collaboration with education, social care, health and police talking to each other and working together in a manner epitomised by ‘Team Around the Child’ meetings (see later). The government department overseeing this work was the Department of Children, Schools and Families. There is much in a name. Whilst the department became the Department for Education under the newly elected Coalition government in May 2010, much of the ECM principles remained in the work of schools and other professionals working with children – and remain today. I have long been of the view that children should have ‘their own’ cross party governmental department – the Department for Children should not be prey to the inevitable short termism of our political electoral system with the turmoil that is brought by each new Secretary of State with their own ideas and agendas; only with settled, long term strategic plans carrying support and commitment across the political divide can the inequalities and the ‘gaps’
facing our children be properly addressed.
It is, then, within this context, and with this commitment that the IHC project was born and came to fruition in 2009 with the official opening of the ‘Haven’ at Bude, the Crayon at Hayle and Bwyva at Penair, Truro. How, though, was the Haven to actually realise its ambitions?
We were determined that the students at the school would be central to developing the models of delivery in The Haven and the Student Management Committee was the decision making board – a blend of adults and students, the students always comprised at least 51% of the committee. At the official opening, the North Cornwall MP, Dan Rogerson, spent an afternoon with student members of the committee before stating that “This new health centre is an excellent idea and the students I met today have put a lot of thought and time into getting the project off the ground. The Duchy Health Charity has given hundreds of thousands of pounds to build the centre, and the students have raised tens of thousands themselves to furnish it. Now the Government and the local PCT [Primary Care Trust] must ensure this scheme is a success. The NHS is so often out of reach for rural communities, it makes sense to bring its services to where young people are anyway — their schools — using professionals who are on site, and whom students trust. Along with the students we met today, I am convinced that this is the right way forward for the wellbeing of young people at secondary age. If the PCT gets this right, Bude’s Haven can be a model for the whole country.” (Bude & Stratton Post; 16th April 2009). The challenge ahead lay in the remark “..using professionals who are on site, and whom students trust” How was that to be achieved? “And whom students trust” are four key words in ensuring the success of The Haven; how were we to build and sustain trust of our students? How were professionals going to ‘trust us’ in an area where confidentiality, safeguarding and sensitivities prevail on a daily basis? Would parents trust us? Trust in leadership is a fascinating area, but that’s not for this paper!
In July 2010, the leaders of the three schools involved in the project attended an international BELMAS residential conference in Berkshire (British Educational Leadership, Management and Administration Society) where amidst the official seminars and key-note speeches I was introduced over dinner to Dr Twyla Salm, a Canadian academic working at the University of Regina, Saskatchewan. She introduced me to the concept of Inter Professional Collaboration and the research ongoing in Canada. On the face of her initial description, this model, it seemed to me, met our aspirations and needs perfectly, and I was particularly struck by the fact that if IPC could work across the vast swathes of remote territory in Saskatchewan and the Yukon, then making it work in Cornwall should be straightforward! The conference also introduced me to the International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy hosted in Australia. It was through these ‘introductions’ that I became set on adopting IPC as our modus operandi in Bude.
Following up on my conversation with Twyla, the paper that really kick started my commitment to IPC at Budehaven was a discussion paper written for the Ontario College of Family Physicians with the unpromising title, for our circumstances, “Implementation Strategies: “Collaboration in Primary Care – Family Doctors & Nurse Practitioners Delivering Shared Care” (Way, Jones, & Busing, 2000). In it lay a definition that encapsulated everything we were striving to achieve:
“Collaborative Practice is an inter-professional process for communication and decision making that enables the separate and shared knowledge and skills of care providers to synergistically influence the client/patient care provided.”
The paper went on “…While collaboration is certainly about positive working relationships amongst professionals, it is much more. Collaboration is a way of working, organizing, and operating within a practice group or network in a manner that effectively utilizes the provider resources to deliver comprehensive primary healthcare in a cost-efficient manner to best meet the needs of the specific practice population.
These two statements drew together all my reflections from the past twenty years – isn’t this precisely what the communities in South Yorkshire were doing during 1983-4? Isn’t this what music education is all about – collaborating together in an organised way, sharing the knowledge and skills of different musical disciplines, singers and instrumentalists, understanding that you are playing but one part in an integrated whole and whilst your part is crucial, the whole can only be truly realised through collaboration – you have a responsibility to every other participant, they in turn each have a responsibility to you and you all have a responsibility to the outcome – and, as a consequence that outcome is so much more fulfilling?
So, how do we achieve Inter Professional Collaboration on the ground, as it were? And, how does IPC differ from ‘multi agency meetings’ with which we were familiar through the government policies of the 2000’s? I believe that the apparent semantics – Inter Professional Collaboration or Multi Agency (or, Multi Discipline) Meeting – are crucially important. Let us take the Team Around the Child meeting as an example. Under the Labour governments’ Every Child Matters policy framework, where a need for additional support for a child was identified, a Team Around the Child (TAC) meeting was arranged by the referring agency. Here, a multi-disciplinary team of practitioners established an Early Help plan to meet the needs of the child and regular meetings were scheduled for the team under the direction of a named ‘lead professional’. The aims are no different to those espoused by IPC. However, whilst TACs sometimes produced some outstanding outcomes, too often, in a rural setting particularly, frustrations quickly developed for all concerned, including the young person and their family. The referring professional too frequently became the ‘lead professional’, and they found that professionals from other agencies often couldn’t manage to attend the meeting and the team often diminished in size along with, therefore, the breadth of expertise. Furthermore, the very designation of a lead professional can abdicate others from responsibility – they are all themselves extraordinarily busy and may well be the lead professional for other cases. Don’t misunderstand me – some of the plans and outcomes delivered through the TAC model were of very high quality. However, at the other end of the effectiveness spectrum, Multi Agency Meetings can equate to a group of people from different agencies meeting together to….do what? This is where the semantics are important. The very term Inter Professional Collaboration demands more and acknowledges more of each participant before the meeting even begins:
Inter, there is an explicit connection between participants in a way that is not necessarily required in a multi-agency meeting;
Professional, every participant is present to bring their own professional, expert advice to the meeting irrespective of their positional or non-positional roles in their organisations and the community;
Collaboration, the best outcomes can only be achieved by everyone working collaboratively and, hence, together.
Most of the literature I encountered focussed on different aspects of health care provision working inter-collaboratively both in terms of their staff’s training and education and their practice. We, of course, were looking to be far broader and whilst focussing on schools and health working collaboratively were also looking to encompass every agency that supported young people and their families. D’Amour and Oandasan, cited in Interprofessional Education Collaborative Expert Panel (Interprofessional Education Collaborative Expert Panel, 2011) – an excellent guide and toolkit for IPC – reported on Health Canada’s work and asserted that “Inter-professionality requires a paradigm shift, since interprofessional practice has unique characteristics in terms of values, codes of conduct, and ways of working.” (D’Amour D & Oandasan I, 2005) The authors identify seven key elements of successful IPC in a rural environment, and these were later drawn together in a diagrammatic format (Gaudet A Kelley M Williams AM, 2014) that then lived on my office noticeboard (the ‘blue diagram’ as it became fondly known!) It has also been reproduced in a slightly different way together with a short commentary authored by myself in the Cornwall and Isles of Scilly children’s mental health plan 2017 (page 38) ‘Turning the Tide’ (NHS Kernow, 2017). These seven elements formed the basis for our IHC strategic planning and operational practices, and we endeavoured to ensure that the ‘right minded people’ were leading and managing the centre as we explored putting IPC into practice – we consciously planned how we were going to implement and facilitate activity across all seven elements as we moved forward.
So, what are the seven elements?
1. Shared responsibility and accountability
5. Professional confidence and assertiveness
7. Mutual trust and respect
How we interpreted the seven elements of IPC
A regret of my leadership of the IHC development ten years ago at Bude was a reluctance on my part to use the term Inter Professional Collaboration on a daily basis – I was concerned that health professionals were far more familiar with such practices than I and did not want to risk our ‘credibility’ with those professionals we were looking to work more closely with; some school based colleagues were less than enthusiastic about the project, anxious that it may detract from our core purpose of education; that I would have to constantly explain what it meant, and that would get in the way of actually delivering the project. And, in the early days of opening The Haven we were wrestling with the new priorities, policies and language of a new government. So, whilst living absolutely by the principles and ethos of IPC, rarely did I use that term in the earliest years of the IHC project. That hesitation soon dissipated, and since leaving headship, as colleagues across the county will testify, a day has rarely passed in the last five years where I don’t use the term!
Shared Responsibility and Accountability
Within an IPC environment everyone is recognised as a professional in their field, whatever position they may hold in their own organisation, however much contact they may have had with the individual young person or their family, however much experience they may have relative to other participants. Each professional has an individual responsibility to acquaint themselves as fully as possible with the material facts and then has a shared responsibility and accountability for the processes of IPC and the outcomes determined. It is indeed like an orchestra with every participant thoroughly skilled and practised in their instrument of expertise, but unable to perform the whole symphony without fellow professionals around them.
This, it quickly became clear is not straightforward! Different fields within the health providers, for example, have different ways of working, different referral procedures, different IT platforms and different safeguarding protocols. Multiply those variables across all the different agencies and there was potential stagnation of activity before we even began. But, the shared responsibility and accountability underpinning our work alongside an unwavering focus on securing the best and most sustainable outcomes for the young person cut through all of the bureaucratic hurdles. And, we always had the student committee urging us on and they would brook no obfuscation! It quickly became apparent that an eighth element needed to form the bedrock upon which IPC could flourish – relationships. Whilst the seven element model implies high quality relationships we determined that it needed to be explicit and high profile – we took the line that it is incumbent upon all professionals to work hard at developing good, professional relationships with others both as an individual and as a representative of their organisation. This won’t happen without some oiling of the wheels and that takes time and energy. When we first opened the IHC, our Centre Coordinator was also a health practitioner. When he left us to take a promoted post within the NHS, we took the opportunity to appoint a Centre Manager, still with a health background but with a role description that placed the building and developing of relationships between adults and young people and between themselves as a premium. It was that appointment that allowed IPC to develop and the IHC to thrive.
The second bullet point on the Centre Managers role description! Professionals must have confidence that a journey to Bude is not going to be a wasted journey – indeed, as head I soon realised that everything we did in Bude had to be just that little bit more than might normally be deemed necessary – we needed people to actually look forward to coming to Bude and tell others the same. Typically, a trip to Bude for most working in the three larger towns of North Cornwall, Bodmin, Launceston and Wadebridge is a minimum of 40 minutes each way by car; some services are located in Liskeard , a journey of at least an hour. Many of the professionals serving Bude work for Devon based organisations – the North Devon hospital in Barnstaple serves Bude and the extreme north of Cornwall, again a trip of 40 minutes. Confidence that organisation, coordination, hospitality of all events was of high quality was paramount to IPC working; we needed trust. Yes, of course, efficient and effective organisation of the professional activity was important, but we needed to ensure people were in the room. This proved one of the most challenging aspects of pursuing IPC and it will be interesting post covid pandemic how the virtual solutions to some of the rural issues can be successfully blended with face to face contacts.
One measure of our early success was in the rapid increase in the number of professionals looking to use our IHC facilities. This success was down almost wholly to the Centre Manager, although it gave her a headache – we never wanted to turn any agency away, we wanted to constantly evolve an ever increasing diversity of provider to enrich our IPC and better serve our community, but we were in danger of reducing the positive experience due to lack of space. Out of this dilemma Kevren was born. The Local Authority was looking to develop pilot centres for colocated working of different providers, and we lobbied and secured a new build to complement the IHC and further attract colleagues in different agencies to Bude. One of the beauties of Kevren was the IT networking allowing different professionals to log on to their respective highly secure platforms whilst sitting next to colleagues on a different platform. It sounds simple, doesn’t it? Do not underestimate the challenges and tenacity of different IT platforms! This itself became a magnet, and a real buzz emanated from Kevren – again, different professionals working together who may have had phone conversations or emails for many years now working in the same space, sharing tea and coffee with the Centre Manager making cakes to recognise and celebrate birthdays – not on the role description, but an unexpected bonus! Inter Professional Collaboration in action.
Collaboration depends on high quality communication, be that that verbal or written. Each professional is responsible for sharing with other providers critical information regarding the young person. The ability to present information in a manner that is relevant, concise, and timely is critical to the development of IPC. The context of the relationships is crucial – any communication is received differently depending upon how the partners view one another. This is why the egalitarian relationships are so important. Clear articulation of the purpose for sharing information is critical.
Collaborative communication also requires respectful and collaborative listening; again, this requires conscious attention to communication of all participants – inter professional collaboration requires everyone to recognise the professional expertise of everyone else around the table with the ‘client’ absolutely at the heart and all contributing to the outcome. The aforementioned Team Around the Child meetings, and ‘multi-agency meetings’ can too often mean lots of people say lots of things and then the onus is on someone to do something! A somewhat tongue in cheek characterisation, but IPC helps move away from this.
I have suggested that ‘relationships’ needs to be an unequivocal element in facilitating IPC practices. There is another, distinct from communication but a subcategory within it – language. Terminology and accepted parlance within different disciplines initially led to some unrest and confusion amongst our school based staff, and an understanding of different professional languages is important. Specifically, ‘risk’ and ‘supervision’ needed some unravelling. The notion of ‘carrying risk’, for example, was not one familiar to school staff – it has never been a terminology used in schools, and when the term was being used in an almost casual manner by health colleagues for whom it was part and parcel of daily communication we needed to do some unpicking as school staff became anxious – dealing on a day to day basis with a highly dysregulated student (another uncommon term in school cultures) suddenly assumed a different, and maybe alarming dimension.
Once again, underlining the imperative of acknowledging and respecting other disciplines’ professional opinions and viewpoints while being willing to examine and alter your own professional views and perspectives is fundamental to IPC. However, cooperating with each other can be passive and done through gritted teeth – we need positive, proactive cooperation and not risk engendering a negative ‘if I must’ attitude.
Professional Confidence and Assertiveness
How can passive cooperation be minimised? Professional confidence and assertiveness goes some way to achieve this. The partners’ respect for one another’s professionalism includes the ability to present opinions and viewpoints in a manner that supports a unique or synergetic solution being reached. A useful and thought provoking equation was presented in the Ontario paper summing up how the whole is greater than the individual parts:
Collection of individual approaches = addition 1 + 1 = 2
Integration of individual approaches = synergism 1 + 1 = 3
It is the role of everybody to enable each person to feel confident and be ‘allowed’ to speak freely and confidently – only then can the views and potential pathways forward be integrated into a coherent strategy. The co-operation and assertiveness of each partner means that decisions are made based on consensus facilitated by the full participation of the partners using a balance of co-operation and assertiveness.
This is the element around which we did the least work beyond recognising that within our desire to work collaboratively each individual professional and each organisation must retain their autonomy.
Mutual Trust and Respect
In my view, this is the binding element without which IPC cannot thrive. Each provider must be able to depend upon the integrity of the others as the foundation for their professional collaborative working. Without trust and respect, the other elements cannot exist successfully; “…assertiveness becomes threatening, responsibility is avoided, communication is hampered, autonomy
is suppressed and co-operation is haphazard” (Norsen L. Opladen J. & Quinn J, 1995). And so, in our early experience and flirtation with Inter Professional Collaboration in the Rural Environment of North Cornwall and Devon we come full circle back to responsibility, accountability and cooperation.
There is no point at which the cycle should ‘start’ – each element is integral to the whole. The last twelve months through the covid pandemic and multiple lockdowns has been fascinating as face to face contacts have been replaced by virtual interaction. I have found it interesting as I have written this paper to reflect and consider the pros and cons of this enforced shift upon each of the seven elements. Can mutual trust and respect, for example, be fully grown, nurtured and embedded within a fully virtual environment?
When I retired from headship in 2016 I was frequently asked what is your proudest legacy or achievement? In truth, I never viewed any of my work in that way but I do understand the reason behind the question. Despite many achievements (including, as a specialist sports college the building of a large white tennis centre that can be seen for miles around!) my answer was the development of the Integrated Health Centre and Kevren and, more importantly, the opportunities that it has provided more widely for continued inter professional collaboration both in the school and across the Upper Tamar Valley area in Cornwall and Devon. The first three years of the Integrated Health Centre project was subject to a rigorous, external evaluation, commissioned by Duchy Health Charity – this was led by New Zealand researcher and evaluator, Reynold MacPherson who visited each of the three centres at the end of each of the first three years. His final report includes “During 2011-2012, Year 3, Budehaven added a ‘co-location’ building, Kevren, with hot desks and small meeting rooms to extend the reach of the IHC in order to pioneer a community health support service. The health, welfare and educational professionals hosted have exhibited early forms of interprofessional collaboration (IPC). About 37 professionals are now located in or visit The Haven and Kevren weekly, each either funded by the school, the NHS, charities or Cornwall Council. Student footfall doubled to about 4,000 in the second year of operations, and increased by another 25% in the third year due to additional users from the community. The wide range of general, mental and sexual health services, which focus on prevention and students making informed choices, were found to be highly valued by the students. A solely positive association was found between visits made to The Haven, academic progress, attendance and exclusions and a sharp fall in students’ engagement with the Youth Offending Service (YOS)…Budehaven plans to move towards a more evidence-based approach to improving professional practices and integrating health services with in-school interventions, curriculum development and community outreach.” (Macpherson, 2013) There is much packed into that summative paragraph of which I am proud.
What I did not fully appreciate in the summer of 2016 were the opportunities that I would discover on a broader, county wide basis to support and facilitate IPC across the county and beyond in my new, post-headship ventures. The majority of my work ‘beyond headship’ is supporting secondary school heads and their subject leaders; this includes representing headteachers in Cornwall on local and national boards the vast majority of which are multi agency reaching in many cases beyond the Cornish border. It has brought me into far closer working relationships with health providers and commissioners, and the opportunities for IPC to transform childrens’ lives across Cornwall and more widely are immense. It is the case that based on my experience in the last four years, IPC as a concept has had less traction with educationalists and school leaders in Cornwall than health professionals; school leaders are by nature and experience far less peripatetic in their working practices and cultures than health, and does this need to be a consideration in future planning?
The power and potential of genuine collaboration and of collaborative leadership continues to excite me, and in the book ‘Collaborative School Leadership: a critical guide’ (Woods P & Roberts A, 2018) there is much to reflect upon in terms of further developing and nuancing IPC. Just two examples must suffice; “One of the conclusions [of the project] was that the active and ongoing processes of ‘stimulating connections’ – through which existing networks and communities are broken down, new ones created and staff encouraged ‘to think beyond their normal circles of influence’ – are vital ingredients of a schools’ capacity for learning” (pg 89) – what does that look like in terms of the wider, multi-agency context in which IPC resides? My current work is constantly that of ‘stimulating connections’, but just seeing that phrase written down and that aspect couched in those terms has redefined some of my work – it has reminded me that stimulating connections for their own sake is nice but potentially of little impactful consequence – what is the purpose of that connection? And, what impact might it have? As Professor Sir Al Aynsley Green put it when addressing Cornwall’s secondary headteachers in the Autumn of 2018, HDWKWDAG – ‘How do we know we’re doing any good?’ Then, just a few pages later we read “The point about newcomers experiencing difficulty in breaking into existing groups highlights an important issue…such communities are capable of having hard boundaries and identities amongst participants that lead them to be focused inwardly on their own community …[and] may lessen the connectivity across a school.” (pg 100) This is a key point for all of us engaged in system wide inter professional collaborative work. Are we as open and welcoming, genuinely open to all professionals views and input as we like to think? Or, are we inadvertently living within an IPC bubble that is actually keeping some outside of our ‘boundaries’? Might we actually use an exclusive language that runs counter to the very things that we wish to promote?
Inter Professional Collaboration in Cornwall – 2021
In terms of IPC across Cornwall, I would like to close by highlighting six key initiatives currently ongoing with health and education working collaboratively to support young people. Each follows the principles of IPC as outlined above, albeit maybe not explicitly. Overarching all activity is the Cornwall ‘One Vision’ plan (Cornwall Council, 2017) Professor Sir Al Ainsley Green makes reference to this visionary plan in his 2019 book ‘The British Betrayal of Childhood’ when he states that “People in Cornwall have produced their exemplary ‘One Vision’ document that sets out with real clarity how the principles of Every Child Matters can be resurrected into a coherent ‘joined-up’ policy plan for children in the county.” (Aynsley-Green, 2019).
Firstly, Cornwall’s inclusion in the Big Lottery funded ‘Headstart’ programme (Cornwall Council Headstart Kernow) with its focus on ‘building resilience and mental wellbeing for children and young people’ is coming towards the end of its transformative work, but its legacy will live on in a whole host of ways. The joined up inter professional collaboration between the Council, secondary schools, health providers, Trauma Informed School specialists and countless others has seen significant developments to the benefit of our young people. The challenge facing us all is to ensure sustainability and continued impact as we move out of the funded phase.
Secondly, and flowing out of Headstart Kernow is the BLOOM initiative which is an epitome of IPC in action. With a core purpose of “helping young people to thrive” the consultation centred model brings professionals together, including from the voluntary sector, to offer a holistic and inter professional approach to supporting children and young people’s emotional, social and mental wellbeing. In common with CAMHS and other health provision across the county, its work is conducted within the Tavistock i-Thrive framework (Wolpert M. Harris R. Hodge S., 2019) In each Bloom Professionals Consultation meeting, always led by a Clinical Psychologist with a Primary Mental Health Worker and always with a professional in attendance nominated by the young person’s parent/carer, everyone works collaboratively to determine the most appropriate formulation for an individual young person moving forward. It is a powerful model that in addition to its declared aim of helping young people is also extremely affirming for the professionals involved – a school TA, for example, finds it extremely reassuring when a Clinical Psychologist assures them that they are doing a wonderful job, they’re doing everything ’right’ and here are some additional things you might try and other professionals will work alongside you and the child and family. I firmly believe that creating networks of this nature are far stronger and sustainable than training a school member of staff to be the ‘lead mental health’ person. This is an inward looking, balkanised model, and in any case people are transitory as they move from one post to another taking their expertise with them. IPC also makes financial sense – why spend significant amounts of money on training school based staff to develop expertise in fields of work that take them away from their core purpose when there are fully trained professionals already working in our communities – we need to collaboratively, and professionally, join them up! Moreover, and this is so important, the ‘professional feel good factor’ for that TA cannot be replicated without that cross discipline, interprofessional conversation. Fundamental to the success of BLOOM, however, is the fact that each meeting is facilitated by a central administration team – not by one of the professionals. This additional capacity enables greater participation and contribution to formulations and plans by each participant – this learning, identified early on in the management of the Haven IHC with the appointment of the Centre Manager needs to be remembered as we develop IPC more widely in the future.
Thirdly, following the School Nursing Service being taken into Public Health and Cornwall Council, there has been a significant investment and commitment to expanding the team in order that every secondary school and its ‘catchment’ primary schools have a named ‘team around the school’ of School Nursing professionals and others from the Public Health team. Early days yet, and hampered by twelve months of lockdowns and covid security in schools, the opportunities for IPC to further improve the outcomes for our young people are clear.
Fourthly, the development of the Clinical Associate Psychologist programme which sees every secondary school with a named CAP working out of the school. Although being colocated in secondary schools, the CAPs are employees of the specialist CAMHS team. As new ways of working are explored, and new relationships and professional understandings are stimulated, uncertainty and risks are involved on all sides as the existing safety ‘barriers’ are broken down – this is true for the CAP themselves, for CAMHS and for schools. This is a truly ground-breaking scheme; developed under the leadership of Cornwall Foundation Trust the programme sees specialist CAMHS leaders working closely with academic staff at the University of Exeter and the Cornwall Association of Secondary Headteachers.
Fifthly, the county has determined that the NHS funded Education Mental Health Practitioner programme (EMHP) will be focussed in primary schools where the opportunities to work with children and their families holistically is at its most likely to have lasting impact. So far, four teams have been trained (two are still in training, delays caused by the pandemic holding up some of the planned implementation) and are operating in three localities of the county, Kerrier, Restormel and two teams in North Cornwall reflecting the greater rurality of that locality (the Upper Tamar team and the Camel team).
Finally, over the last four years Cornwall’s Clinical Commissioning Group commissioners have worked hard at developing and facilitating inter professional training. This is really difficult as the times of day that best suit different professionals are themselves very different. Commissioners have piloted a model whereby the training is hosted in the so called ‘twilight’ after school period between 4.00 and 6.00pm (again, beware the language and assumptions – for many health professionals, training activity in the late afternoon would certainly not be viewed as ‘twilight’! ). A clinical psychologist having been commissioned to write and develop a self-harm toolkit for schools has then delivered twilight training to each secondary school. The school is required to invite primary school colleagues from with their catchment area, health professionals with whom they closely work, including GPs, police, and other agencies to that training. To date, this way of working is in its infancy; similar rollout of anxiety and well-being frameworks are planned for the near future. School feedback has been very positive, and whilst in some cases attendance of other professionals has been limited the very act of inviting them is an important element of early IPC development. Allied to the five other initiatives described above, there are reasons to be optimistic.
Concluding thoughts – looking forward
The covid-19 pandemic has seen work practices completely transformed as the world has moved into a virtual environment of Zoom and Teams. How will Inter Professional Collaboration fare as we move beyond the pandemic?
As touched on earlier in this paper, how we choose to blend face to face and virtual realities in the future will be interesting and crucial. Woods and Roberts (op cit) can help us here, I think: “In our view, then, a fundamental purpose of an educational system, and of collaborative leadership is to foster the capabilities and practice that nurture relational freedom amongst those in non-positional and positional roles” (pg 126). By embracing IPC in terms of relational freedom – ‘freedom with others’ as opposed to ‘freedom from others’ – the whole inter professional agenda becomes attainable to everyone; how I wish I had this concept in my mind ten years ago! This simply encapsulates everything that Inter Professional Collaboration, and Cornwall’s implementation of One Vision should be. And, in the last twelve months we have seen it absolutely in action across Cornwall as colleagues from across a whole array of disciplines, in a wide range of positional and non-positional roles have simply got on collaboratively, driven by a strong sense of moral imperative and ethical purpose to ‘do what needs to be done’ to support young people and their families through three lockdowns and the personal challenges that the pandemic has brought to so many.
Intentionality, that absolute determination to make a difference – Cllr La Broy’s remark that ‘you have to come here with a purpose’ – underpins the rationale underlying inter professional collaboration. So, let us recall the closing words of Sir Al Ainsley Green in his book; stirred by the work of Thomas Coram in the eighteenth century and subtitled ‘Challenging uncomfortable truths and bringing about change’, Sir Al writes “The 350th anniversary of [Coram’s] birth occurs in 2018. Let’s celebrate it by re-energising his attributes of courage, compassion and commitment for children. Let’s end on a positive note that with effort, collaborations and partnerships we really can change the face of childhood today.”
David Barton March, 2021
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