Fragmentation and integration: a chronic dilemma in the interplay of cultural and task differences in the organizational effectiveness of care systems

Systems of care are categorized in different ways between health and social care, and then between formal systems and informal systems. I want to put forward a couple of hypotheses about what may be the psychological meaning that underpins these distinctions, and the resulting fragmentation of care. I will draw on previous research and more recent experience, in exploring these hypotheses further, as I attempt some integration of my own professional and personal experience and interest in the care of vulnerable people in society. In making an argument about the cultural dynamics of human service organizations, I start from an observation about relationships - that we each at first have to separate ourselves from the other in order then to make connections and engage with the world, and that this process of fragmentation and integration continues through our lives, and may be observed very readily in our working relations. I want then to take a particular kind of relationship, which may be readily observed in human service organisations, that is the relation of care meeting the dependency needs of one from another - and see how these dynamics of fragmentation and integration are worked out in systems of care of different kinds. In this I will draw on action research studies and consultancy with health and social care systems. I will then focus more specifically and from a personal standpoint on the particular challenge of looking after the needs of someone with dementia - and how the pressures that arise in this example of non-reciprocal care raise important questions about the nature of relationships. I explore the potential for an autobiographical narrative approach, as one way of gaining some psychological depth to our understanding of relationships of care. Finally I will comment on the interplay between cultural and task differences in understanding the dynamics of fragmentation and integration in care systems.'