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The TAC System: Horizontal teamwork for children, young people, adults and frail elderly people


The TAC System was designed for babies and pre-school children with complex disabilities but can be applied to any service user who needs help from two or more agencies at the same time. The following extract from Horizontal teamwork in a vertical world* suggests TAC is appropriate for elderly people moving between the geriatric ward and their own home or care home:


I want to explore the potential benefits of horizontality for elderly people whose last years include some mix of social services provision and one or more stays on hospital geriatric wards. We have repeated press and media reports (and again at the time of writing) about patients on geriatric wards lying in their own urine and faeces and being left unattended with drinks and meals they can neither reach nor feed to themselves. Public services, no matter what official reasons are given out when the situation is exposed, can hardly be much worse than this.


Taking the vertical-horizontal perspective, these patients, who might or might not have been under the care of local social services – but who certainly have a GP – and who probably had some links to their local community, when they go into hospital are entering a typically vertical and relatively enclosed domain which, at worst, can hold them disempowered and voiceless at the base of its highly structured power pyramid.


"While having only limited experience of this category of service users, I do feel that some modified version of the TAC model could offer a bridge between the two relatively unconnected environments the elderly person switches between – at home with more or less community support and in hospital under the NHS. The TAC model demonstrates the value of key people from both worlds linking together in some way in the horizontal landscape in pursuit of less fragmented regimes for treatment and care. Whatever form the linkage takes, its effects, following TAC principles, would be to:


·     bring a shared view of each elderly person's situation,  aspirations, strengths and needs

·     gather direct information from and indirect information about the elderly person to ascertain their under-standing of their situation, preferences and wishes

·     share knowledge, wisdom and concern in making a plan of action for the place where they are now and the transition to what might come next

·     maintain a close watching brief over the treatment and care that is provided in any setting

·     assume continuing responsibility for the elderly person's autonomy, health, comfort and wellbeing


"I am sure that some elderly people, with or without the benefit of family involvement, have received such compassionate and joined-up care. My plea is that it should not be left to chance – because we can see what can happen when it is. Such a strategy as I have described above must be the product of discussions in the horizontal landscape between hospital, social care, voluntary & community and private agencies and community members. It is the antidote to the 'pass the parcel' approach under which elderly people can so easily disappear from view."


Information for managers here.


* Horizontal teamwork in a vertical world: Exploring interagency collaboration and people empowerment, by Peter Limbrick.