Bairns' Hoose Pathfinder Phase – Research Report

6. Multi-agency working

This chapter summarises progress, challenges and facilitators related to multi-agency collaboration in order to provide a holistic, child-centred service. This draws on many sub-standards of Standard 5: Planning for children (e.g. processes around Interagency Referral Discussions); multi-agency planning meetings; the role of a Bairns’ Hoose coordinator; and information sharing. This also includes additional themes from the qualitative interviews, for example co-location and building a shared understanding and vision of Bairns’ Hoose.

Progress on multi-agency working

Overall, partnership working was seen as going well. Partners described multi-agency working as having been a “journey”, and where there had been some challenges, these had often been overcome with time. As relationships were built and strengthened, there was a sense that developing a shared vision and understanding of Bairns’ Hoose had been an area of progress. This was despite some operational and practical challenges or disagreements (see the next section on challenges for more detail).

“There is, to an extent, a shared vision when it comes to different disciplines and different areas. Sometimes, how to reach that vision isn't always the same.”

Where partnerships experienced particular challenges in working together, these often involved health partners or, in some cases, those involved in the court process.

Of the six partnerships with established sites, three had co-location offices on-site, two had co-location spaces outwith the Bairns’ Hoose site, and one was planning to construct a shared office space in the garden of their Bairns’ Hoose. For those partnerships taking a hub-and-spoke approach, some had co-location spaces at each site, while others had a single co-location space at the ‘hub’ site or at an external office.

The following areas of progress are drawn from StART2 submissions.

At StART2, some progress was noted regarding the Bairns’ Hoose coordinator role. This is a dedicated manager responsible for overseeing and coordinating CYP and their families’ journey and is a requirement of multiple Standards. Two partnerships reported having recruited this post in the time between StART1 and StART2.

The interagency referral discussion process was considered to be well-embedded across all Pathfinders at StART1. Further improvements noted included incorporating holistic support at the point of the interagency referral discussion, inviting SCIM interviewers to the discussions, and consideration of referral to Bairns’ Hoose being made part of interagency referral discussion protocol/templates. However, interagency referrals to Bairns’ Hoose were still being scoped in one partnership. In two partnerships, it was thought that further work was needed on referrals in cases where it was not considered necessary to interview the CYP but where they may still have benefited from the services available through a Bairns’ Hoose.

Some progress on data sharing processes was reported, although partnerships were still developing these. For example, two partnerships were still working on information sharing protocols either with a third sector organisation or between the organisation and the Scottish Children's Reporter Administration (SCRA). In one partnership, a data sharing agreement was still needed for outsourced services (such as those providing recovery services to CYP). In terms of information systems, scope for further integration or streamlining was identified. In one partnership, a dashboard was being developed to promote data sharing and they were exploring an electronic interagency referral discussion model. Another partnership planned to explore the use of Shared Electronic Mailboxes.

Ongoing challenges for multi-agency working

There was consensus that multi-agency working always brings challenges, due to different priorities, values and legislative requirements of different organisations. This could cause friction and mean extra time was needed to come to a shared view or find solutions to practical problems.

“In IRDs [interagency referral discussions] [the police] can be quite black and white with things because it's criminality or not criminality, you know, that's kind of how they're thinking. Whereas, as a health professional, I'm thinking more about the bigger picture of the young person, the child involved. What might they need, what support might they require, how might this have affected them, all that side of things.”

In fact, getting all partners to understand the purpose of Bairns’ Hoose was mentioned as a challenge in itself and something that takes time. For example, in one partnership, a lack of clarity among local councillors about Bairns’ Hoose was seen as delaying the identification of a site. It was suggested that a more thorough and supportive briefing may have mitigated this. Participants also highlighted the need to justify the approach and explain the risks of re-traumatisation of CYP to justice partners (discussed further in Chapter 9).

“It's taken us, I would say the best part of fourteen months [to get to a place where] now people are coming to us saying ‘Can we come and visit the Bairns’ [Hoose]? Can we hear about the work?’ So that's been a bit of a challenge, but it is starting to really pay dividends now.”

Agreeing roles and responsibilities had not always been easy, especially due to individual agencies having to take the lead on distributing funding, for instance when purchasing a new building for Bairns’ Hoose. When one agency had responsibility for the funding, this could make other agencies feel less involved and communication and transparency were seen as essential. At the same time, agencies taking the lead could feel overly burdened by the administrative work and responsibilities that came with this.

In one partnership, there had been disagreement about how money should be spent and who should be coordinating, which was thought to have led to a more fragmented approach to implementation and siloed working. There was a question around whether this may have been partly down to the broad guidance as part of the Bairns’ Hoose Standards, which could be interpreted in different ways. When responsibilities were unclear or there was a lack of accountability built into governance structures, this could lead to lack of ownership of tasks and delays to progress.

“You can have a multi-agency group that's all supportive and saying the right thing, but actually stepping up and undertaking the action doesn't always happen.”

“The procurement processes have been complex and again, possibly made more complex by the fact that the money from Scottish Government has gone into the [council] but then actually it's an NHS-funded building. [Landscaping] needs to be overseen by NHS Lothian [but it requires council] procedures and accountants so it wasn't so easy for us to just commission a service and sort the building.”

There was also a sense in some areas that communication could have been improved so that professionals all had a more comprehensive understanding of which services CYP and their families were accessing through different providers within and outwith Bairns’ Hoose.

While some progress had been made on data sharing, there were still various ongoing challenges. This was a problem between agencies, such as between social work and police, but was also a problem across local authority borders. In one partnership, participants described having to sit with partners at the same computer, effectively ‘double working’ and causing delays to information sharing.

“We've got five social workers right now from four local authorities accessing four different local authorities’ systems and they can't access each other’s.”

There was a suggestion that since interagency referral discussions are a similar multi-agency process across Scotland, a national approach to data-sharing would be more effective than spending time developing these processes locally.

“[We need] a national way to share information between multi-agencies. […] it would have resulted in less resource needed, it would have streamlined information sharing across different borders, it would have supported a lot of different challenges and barriers that we've encountered. […] It's really complex because our vetting procedures for example are not the same as the police's. So they kind of call the shots. But actually, what that means is we can't progress until we've got a really, really fully robust system in place.”

As mentioned previously, partnerships which were based in largely rural or remote areas tended to have smaller teams and staff pools to draw on. While this could be a benefit for relationship-building, it was also highlighted as a risk due to an over-reliance on certain individuals. When staff were absent or moved post, this could significantly limit multi-agency working and prohibit progress. There was a view that, in these areas, it was important to be pragmatic and hold meetings even if not everyone was available.

Facilitators to multi-agency working

Co-location

A strong theme in the qualitative discussions was the benefits of co-location for multi-agency working. It was thought to improve efficiency as well as strengthen relationships and the sharing of learning and experience. Even in areas where staff were not permanently co-located, it was thought that having a shared office space that Bairns’ Hoose staff could use supported this.

“Our team, one hundred per cent, would say they wouldn't be where they are in delivering what they're delivering without being co-located.”

In line with this, where staff could not be co-located, this was seen as making multi-agency working more difficult. However, for more geographically spread partnerships, the extent to which staff could be co-located was limited.

“We're not co-located, we're all spread. I think that makes communication much more difficult and it makes having a shared plan and a shared vision much more difficult. That does kind of widen that gap between strategic leaders and, you know, operational staff on the ground.”

However, the use of technologies like MS Teams was credited with helping to break down barriers and enable closer partnership working in geographically spread partnerships. Moreover, participants working in rural areas highlighted that many professionals had already built close working relationships prior to Bairns’ Hoose, possibly more so compared to other places, due to the smaller pool of staff. This was seen as an advantage for implementing Bairns’ Hoose.

Governance structures

Another key consideration for successful multi-agency working was establishing sound governance structures which facilitated this. As discussed in more detail in Chapter 5, this was seen as underpinning the extent to which partners could collaborate or ended up working in silos. Participants also reflected on the impact of different agencies taking the lead on Bairns’ Hoose. Since all agencies were required to work jointly regardless, it was not felt to make a great deal of difference which one took the lead. However, there was a suggestion that, in one partnership, where health partners were leading on Bairns’ Hoose, this may have supported the integration of health compared to other areas where this had been identified as more of a challenge.

Bairns’ Hoose coordinator

When discussed, the role of a Bairns’ Hoose coordinator was typically seen as a facilitator to multi-agency planning and working.

“The Bairns’ Hoose coordinator […] has been intrinsic to the smooth running of the Hoose itself, coordinating interviews, partners and overseeing ongoing support.” (From a Thematic Fund Report)

In one partnership, where the coordinator sat within a third sector organisation, this was thought to be beneficial by bringing a “firm focus on children’s rights-based practice, trauma-informed practice and neutrality as third sector.” However, it is worth noting that an alternative view was shared by one participant who felt that their current system of direct partnership working between professionals was a better use of funds than employing a coordinator:

“I sometimes worry that we're paying somebody to coordinate and therefore we're not actually using that money to deliver a service to a child.”

Building and maintaining professional relationships

One partnership explained that having a consistent core team had helped maintain relationships and momentum. However, it was generally acknowledged across partnerships that there could be a lot of staff changeover and that multi-agency working required ongoing, repeated conversations as well as regular opportunities for professionals to come together (for example at steering group meetings, or at the Scottish Government knowledge sharing events).

Linked to this, there was a sense that building relationships and creating buy-in among partners took time and this was something that should be factored in from the outset. As well as time, having senior-level support and Scottish Government backing for Bairns’ Hoose was thought to help create buy-in more generally.

“It's been a journey, an evolution. You need to let people have time to see the evidence of where things are working well and they will hopefully come around. Taking it one step at a time and not pushing people too hard.”

Finally, it was mentioned that third sector service providers who were already well established in local areas made it possible to partner with them within short timescales. One participant explained that third sector partnership would have been very difficult if they'd had to hire and train new employees in the time available.