Joint working has been on the health policy agenda for decades. Now, at last, it is being put into practice. Barbara Millar reports

When Dumfries and Galloway health board set out to find a new headquarters last year, it discovered that the local social services department was in the same predicament.

Seven months ago, both organisations moved their offices and senior staff into the same building - an arrangement dubbed 'co-location'. It was part of an effort to make joint working a reality.

And, as health board chief executive Neil Campbell and social services director Keith Makin told the inaugural conference of the Scottish Development Centre for Mental Health Services last week, there are already benefits.

'The emphasis from the start was on trying to understand better the opportunities and limitation each faced, to understand each other's pressures and cultures, ' explained Mr Makin.

Both had to move their headquarters.

But they also wanted to redress the history of poor communication that had dogged both agencies, so co-location was a natural step. And they wanted to deliver a joint planning system, to be more efficient, avoid duplication and provide a seamless service.

'The idea of moving into the same building seemed to hold no risks that were not manageable, ' said Mr Campbell.

'It offered us the opportunity to integrate our teams. Our offices are next door to each other, as are those of our senior staff, and we have a joint reception and telephone number. This is symbolic to the users of our services.'

But, Mr Campbell stressed, one organisation had not consumed the other, and 'we have not rocked the boat as far as our accountabilities are concerned'.

The two agencies now collaborate, plan and train together. They hold a joint management team meeting once a month and have produced joint community care and children's plans.

Delegates heard other examples of successful joint working. At Glasgow's Riverside Resource Centre, acute inpatient and community services had merged to form three clinical needs-led community mental health teams.

The impact of such a merger had been to reduce mis-referrals, enhance the opportunity for early intervention and target scarce resources at the areas of greatest need, said consultant psychiatrist Alistair Wilson.

It had also given all staff, particularly community psychiatric nurses, the opportunity to enhance clinical skills.

A very different model of community mental healthcare is improving services to users in another part of the city, said Fraser Mitchell, senior social worker with Glasgow council, based at the Shawpark Resource Centre.

Patients formerly assessed in the resource centre are now assessed in their own homes by a combination of two disciplines from psychiatry, clinical psychology, social work, occupational therapy and community psychiatric nursing.

There is then a team meeting to discuss the assessment before a decision is taken to refer the patient back to primary care, allocate them to the community mental health team or refer them on to the psychotherapy or addiction services.

'We are sharing skills and ideas between disciplines at assessment level in a much better way than we did before, ' said Mr Mitchell. 'We have improved our communication with GPs, so they know the kind of referrals we can deal with, and we are better able to target our resources.'

Joint working has been talked about for almost 25 years. It may have been described in various ways, but, apart from a brief interlude with the market, it has remained at the forefront of thinking about services delivery.

So can it be taken further forward under the Designed to Care white paper?

Professor David Hunter of Leeds University's Nuffield Institute for Health believes so.

'It is to do with the fact that people are beginning to think there is no other way left to go. We have got to make it work, ' he argued.

'It took the market experiment to make us realise the importance of working collaboratively.'

The new way of joint working would be different, he said.

'There is a much more ambitious agenda, away from disease to health.

This is not a new approach, but what is new is getting this focus into the health policy frameworks.'

But there are still 'massive voids' between health and local government.

'We are not very good at allowing people to be attached to different agencies to get experience of different cultures and organisational settings, ' Professor Hunter said.

'The consequences are familiar - duplication of responses, failure to take a holistic perspective and a poor level of mutual awareness of what each can offer.'

Other barriers included a tendency to 'tribalism', the under-development of management skills in negotiating, bargaining and team building and the 'tyranny of the four Ts - time, territory, tradition and trust'.

Successful alliances needed agreed goals and focused activity, senior management commitment and involvement, good project management, good communication, and inter-agency partnership and ownership, he suggested.