Working Together Apart

In this paper we report upon the development and operation of a “street-level” response to the problems of interprofessional joint working in providing appropriate care for elderly people living in one Scottish city. The “exchange system”, as it was known in the locale, was a mechanism for co-ordinating the movement of elderly people between the geriatric, psychiatric, and residential services within the city in response to changes in the needs of the individual elderly person, and the needs of service providers. The importance of the scheme stemmed from the fact that it was not imposed on professionals' work, but rather that it developed out of that work. By focusing on the operation of interprofessional joint working at the street level we draw attention to those complexities involved in such work which are often overlooked in the broad policy statements on joint working which have emerged from government departments, and health and social services agencies. Policy makers and analysts alike have largely ignored the meaning and consequences of joint working at the level of professionals' actual work, and it is this lacuna in the literature that the paper seeks to address. The paper concludes with an appeal to researchers and practitioners to describe any such schemes of whatever nature operating in their own locales. In so doing a corpus of knowledge looking critically at the experience of interservice and interprofessional collaboration at the street level may emerge which would inform broad policy statements.