Partnership Working in Health and Social Care

What is Integrated Care and How Can We Deliver It?

Glasby, Jon, Dickinson, Helen, Jon Glasby, Helen Dickinson

• Publisher: Policy Press
• Year: 2014
• Print ISBN: 9781847420169
• eBook ISBN: 9781447312826
• Edition: 2
• Topic: Medicine
• Subtopic: Health Policy

UK health and social care are increasingly being asked to work together across traditional agency boundaries. Although this sounds easy in theory, doing it in practice is complicated and difficult. In many cases, moreover, current training programmes, research and textbooks are even more divided than front-line services, and practitioners and managers are often being given the task of making partnerships work without the necessary support.

Against this background, the second edition of this bestselling book provides a concise 'warts and all' introduction to partnership and integration, summarising updated references to current policy and research, setting out useful frameworks and approaches, and helping policy makers and practitioners to work more effectively together, with greater emphasis on 'integrated care'. Written by the leading authors in the field and fully updated since the Health and Social Care Act 2012, the book is also fully evidence- and research-based, while still being accessible and applicable to everyday practice. Aimed at students, practitioners, managers and policy makers in health and social care, and including new reflective exercises and boxed examples, this is still the one book that everyone in the field should read.

1

What is partnership working and why does it matter?

In almost every walk of life, there is a balance to be struck between the expertise of the single practitioner and the need for cooperation, collaboration and coordination. This is evident in many of life’s most stressful events – when you move house, for example, you want both the solicitor and the surveyor to be experts in their respective fields, but you also want all those involved to communicate and to cooperate so that the overall process goes smoothly. Equally, when you fit a new kitchen, you want a qualified gas fitter to install the boiler and an experienced electrician to handle the electrics – if the wrong person tries to do these things then the consequences could be fatal. However, you also want someone in overall control of the project so that there are no unnecessary delays and so that the person tiling the floor comes after the person who has to dig up the floor to lay some pipes. With both these examples – moving house and fitting a kitchen – there is scope for some of the key players to blur the boundary of their role and to sometimes take on broader tasks, but there are also elements of the process that are only appropriate for a qualified expert.

If all this is true of everyday life, it is even more the case in health and social care, where the consequences of getting it wrong can be equally as fatal as the potential for faulty wiring or gas leaks in the examples above. When you move house or fit a kitchen, it can be incredibly frustrating when things go wrong – you can often feel completely powerless to do anything constructive and simply have to wait until problems resolve themselves. If delays leave you without temporary accommodation or without water and power for some time, you incur extra costs, significant disruption to your daily routine and a substantial impact on your quality of life. While the same is true in health and social care, the key difference is the potentially life and death nature of people’s contact with formal services. When you are seriously ill and need surgical intervention, waiting or negotiating with busy professionals is often not an option – if you need treatment now, then you really need it. Even in the community, people frequently approach services only reluctantly when they have exhausted every other avenue, and are often tired, scared and in desperate need of someone to help them understand what is happening to them, to think through possible solutions and to support them to get what they need. When you are ill, in pain or facing potentially life-changing events, then being passed from pillar to post by the very services that are meant to be supporting you can be a soul-destroying experience.

Against this background, this chapter explores the growing literature on partnership working and on integrated care in order to produce a practical (albeit tentative) definition of key terms and to help readers think through the different types of relationship they may need with different types of profession and organisation in order to deliver particular outcomes for service users and patients. In the process, this discussion links to some of the frameworks set out later in the book, and includes some practical case studies of health and social care communities that have developed close working relationships, including both positive and negative examples. The chapter concludes by summarising the current policy context, highlighting the problematic nature of the health and social care divide and ways in which this boundary has shifted over time. In the process, this chapter draws out some of the negative implications of the divide for users, practitioners and organisations.

Key terms

Part of the problem with ‘partnership working’ and ‘integration’ is that such terms can mean all things to all people. As Leathard (1994, p 5) has vividly observed, this area is a ‘terminological quagmire’ (demonstrated by the 52 separate terms that Leathard then lists to illustrate her point), a classic example of the ‘definitional chaos’ described by Ling (2000, p 83). In many ways this is because the issues at stake are complex (and often mean that we have to depart from traditional ways of doing things). However, this confusion is also made worse by the rhetoric in national policy documents (which tend to talk about collaboration in various unspecified ways as being a ‘good thing’ that leads to all kinds of different and better outcomes for people who use services). While the issue of outcomes is discussed in more detail below and in the final book in the current series, Evaluating outcomes in health and social care by Helen Dickinson, there is little doubt that ‘collaboration’ and ‘partnership’ became key buzzwords under New Labour, and that ‘integrated care’ is doing the same under the Coalition government. Other examples from the 1990s include concepts such as ‘community’, ‘empowerment’ and ‘involvement’. The classic example here is the notion of public–private partnerships (PPPs), which are not necessarily partnerships at all (see below), but which sound much more palatable and much less alien to the public sector because of the use of the word ‘partnership’ in the title.

In many ways, however, the examples of community, empowerment and involvement above offer some useful insights. While these terms are over-used, used imprecisely and often misused, they all refer to some sort of underlying concept that seems important and worth striving for. We may not know exactly what the term ‘empowerment’ means, but it feels crucial and we often know it when we see it. In fact, the ambiguity of such terms is arguably a strength as it allows them to mean all things to all people. Similarly, the terms ‘partnership working’ or ‘integrated care’ refer to something highly significant and something worth trying to define and understand. Thus, even those commentators who have criticised the lack of precision in current policy still end up having to use some kind of similar term. A good example here is The King’s Fund’s discussion paper, Partnerships under pressure, which quite rightly identifies a number of problems with the term ‘partnership’ (Banks, 2002, p 5):

The term “partnerships” is increasingly losing credibility, as it has become a catch-all for a wide range of concepts and a panacea for a multitude of ills. Partnerships can cover a wide spectrum of relationships and can operate at different levels, from informally taking account of other players, to having a constructive dialogue, working together on a project or service, joint commissioning and strategic alliances.

Despite this, the remainder of the paper provides further definitional clarity, but continues to use the term ‘partnership’ throughout the rest of the document. In short, terms such as ‘partnership working’ or ‘integration’ may not always be very helpful, but they are often the best terms we have, and if they did not exist we would probably have to invent them.

Part of the difficulty in being more precise about key terms is that most writers criticise current approaches, then produce their own definition. While this is understandable, it means that there are a large number of definitions available, and that few commentators mean exactly the same thing by the same terms. For students and for frontline workers this seems unhelpful at best, and runs the risk of complicating further an already complex issue. Rather than repeat the same mistake, this book sets out some examples of basic definitions that we have found helpful (see Box 1.1), and tries to summarise some of the key features that we (and most writers) have in mind when talking about these issues. More important than the actual definition employed, however, is the way in which we distinguish ‘partnerships’ from other ways of organising public services (discussed in more detail below). For people using this book to study or in practice, the key issue is to check out that, whatever definition is being used, all key partners mean and understand the same thing (and this is a central feature of the subsequent discussion).

Box 1.1: Helpful definitions

In a key introductory textbook, Sullivan and Skelcher (2002) suggest that key features of partnerships are that they:

• involve negotiation between people from different agencies committed to working together over more than the short term;
• aim to secure the delivery of benefits or added value that could not have been provided by any single agency acting alone or through the employment of others (that is, shared goals);
• include a formal articulation of a purpose and a plan to bind partners together.

For Glendinning et al (2002a, p 3), a minimal definition of partnership working requires the involvement of ‘at least two agents or agencies with at least some sort of common interests or interdependencies; and would probably also require a relationship between them that involves a degree of trust, equality or reciprocity.’

For the NHS Future Forum (2012), the focus should be on ‘integration’ or ‘integrated care’, the true test of which is whether services feel integrated around the patient: ‘integration is not about structures, organisations or pathways – it is about better outcomes for patients. The entire health and social care system should embrace a definition of integration that truly puts people at the centre’ (p 6).

However, some commentators offer less positive definitions:

• For Alex Scott-Samuel, partnership working is often better described as ‘putting mutual loathing aside in order to get your hands on the money’ (quoted in Powell and Dowling, 2006, p 308).
• For Powell and Dowling (2006, p 305), partnership working involves ‘the indefinable in pursuit of the unachievable’.
• For Thomson and Perry (1998, p 409), ‘collaboration is like cottage cheese. It occasionally smells bad and separates easily’.

While we use phrases such as partnership working, joint working, collaboration and integrated care interchangeably, these various definitions highlight a number of key issues and principles that are worth stressing (and that readers should bear in mind as they read the rest of this book):

• Behind most definitions is a sense of added value, an ability to achieve something together that could not be achieved separately (perhaps encapsulated in the notion of ‘the whole being greater than the sum of its parts’).
• Also significant is a sense of reciprocity (that is, for the relationship to be mutually beneficial, and for some sort of sharing of potential risks or drawbacks).
• Several definitions emphasise some sort of formal and ongoing relationship – for some in Box 1.1, collaboration and partnership are clearly...

Table of contents

• Cover
• Title
• About the authors
• Copyright
• Contents
• List of tables, figures and boxes
• List of abbreviations
• Acknowledgements
• Preface
• 1 What is partnership working and why does it matter?
• 2 What does research tell us?
• 3 Hot topics and emerging issues
• 4 Useful frameworks and concepts
• 5 Recommendations for policy and practice
• References