Total Communication in Multi-Agency Working: Getting Consistent Practice Across Teams and Settings
Total Communication is not a specialist technique; it is a practical approach that uses multiple methods (speech, gesture, objects, visuals, symbols, writing, technology) so people can understand and be understood. The risk is that Total Communication works in one setting and collapses at boundaries: hospital discharge, GP reviews, safeguarding interviews, or a new provider taking over. This article sits within Communication, Accessible Information & Total Communication and reinforces Core Principles & Values by focusing on consistency across people, teams and partners.
Why multi-agency contexts create communication risk
Multi-agency working introduces predictable failure points:
- different professionals use different terms, pacing and assumptions
- information is shared in formats the person cannot access
- handover documents describe needs but not “how to communicate”
- new staff or new settings revert to speech-only under time pressure
When communication collapses, the person’s ability to participate in decisions reduces, and risk decisions become less lawful and less defensible.
Building a shared communication approach across boundaries
A robust Total Communication approach can be treated like a shared clinical safety control. Practically, this means:
- agreeing a small set of core communication methods that must travel with the person
- defining “must use” moments: discharge, consent, refusals, incidents, safeguarding, best-interests decisions
- ensuring those methods are visible in the documents partners actually read
Operational Example 1: Safe discharge handover that includes “how to communicate”
Context: An older person with delirium episodes and hearing impairment moved between hospital and step-down. Each transition triggered confusion, refusals of care and heightened distress because staff used fast verbal explanations and different terminology.
Support approach: The provider co-designed a discharge handover insert focused solely on communication and understanding checks, then required it for every transfer.
Day-to-day delivery detail:
- The insert used a “Do / Avoid” format (e.g. speak slowly, face-to-face; avoid multi-step instructions).
- A single, consistent phrase set was agreed for personal care and medication prompts.
- The handover required staff to record the person’s best understanding check (e.g. repeating back the plan, pointing to the correct option card).
- Receiving staff had to confirm they had read it during the first handover and record any adaptations needed within 24 hours.
How effectiveness/change is evidenced: The service tracked distress-related incidents within 48 hours of transfer and saw a reduction. Records showed consistent use of understanding checks and fewer “refused due to confusion” entries.
Operational Example 2: Safeguarding enquiries that remain accessible and fair
Context: A safeguarding concern required speaking with a person who communicated through a combination of signs, pictures and short phrases. Initial attempts relied on verbal questioning, resulting in inconsistent accounts and high anxiety.
Support approach: The provider worked with safeguarding partners to plan an accessible process that protected evidence quality and reduced distress.
Day-to-day delivery detail:
- A pre-meeting established how the person best answers questions (closed choice, pictures, short prompts) and what triggers distress.
- Questions were converted into structured options with visual supports and time for processing.
- The person was offered breaks and a clear “stop” signal; staff monitored escalation indicators and paused appropriately.
- Staff recorded the communication method used for each key answer so the process remained transparent and defensible.
How effectiveness/change is evidenced: The enquiry produced clearer, more consistent information with fewer re-interviews. The person reported feeling safer, and the provider could evidence a fair process aligned to communication needs.
Operational Example 3: Consistent Total Communication across a new staff team
Context: A supported living service onboarded several new staff and used agency cover. A person who relied on objects of reference and a small symbol set began to show distress, and staff reported “communication is difficult” despite existing plans.
Support approach: The service created a “Total Communication starter pack” and embedded it into induction, supervision and spot checks.
Day-to-day delivery detail:
- The starter pack contained the symbol set, objects list, and three everyday scripts (morning routine, meals, community access).
- Induction required staff to demonstrate use in practice (not just read the plan).
- Supervision included a short reflective review: what worked, what didn’t, and what needed updating in the person’s communication guidance.
- Daily records included a prompt to capture communication learning (“what helped today?”) to prevent drift and build consistency.
How effectiveness/change is evidenced: Distress incidents reduced, staff confidence improved, and spot checks found higher consistency in symbol/object use across shifts. The provider could evidence how capability was maintained despite workforce change.
Commissioner expectation: continuity across pathways and providers
Commissioner expectation: Commissioners typically expect communication needs to be managed as part of continuity and pathway safety. They look for evidence that communication methods travel with the person across transitions, that providers can work with system partners, and that poor communication is treated as a service risk with clear mitigation and review.
Regulator / Inspector expectation (CQC): staff awareness and consistent delivery
Regulator / Inspector expectation (CQC): Inspectors will test whether communication methods are understood by staff and applied consistently, including when pressure is high (handover, incidents, safeguarding, discharge). Strong services can show training, supervision, and records that demonstrate Total Communication is used in real decisions, not only described in plans.
Governance: how to stop Total Communication collapsing at boundaries
Embed communication into handover and escalation
Handover templates should include a short “how to communicate” line and a required understanding check for any significant change.
Make communication a standing item in incident and restriction reviews
Every incident review should ask: what communication method was used, what was the person signalling, and what adjustment would reduce recurrence?
Use audit questions that reveal reality
Instead of auditing whether a plan exists, audit whether staff can describe the person’s key signals and demonstrate the agreed method in a real scenario.