The partnership between health and social care services policies in UK
Introduction
For the past decade or so, the focus within health and social services has been on improving all-round services through partnership between different organisations. The aim of this has been to improve integration, efficiency and provide better care for all types of patients in the community. However, the policies involved in both health and social care services have not always allowed the partnerships to work as they should. Whilst there have been some successes and partnerships have improved integration and overall care, there have also been mistakes that in some cases have made things worse rather than better.[1]
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The aim of this essay is to track the development of the partnership between health and welfare services over the last ten years or so, and how effective this partnership has been. There will be a critical review of partnership policy, and a focused case study on the Sure Start partnership as an example of how partnerships between health and social services in the UK are fairing.
The development of a partnership between health and welfare service
The development of partnerships between health and welfare services has been a critical focus of New Labour policy over the last ten years. However, these terms are often not defined particularly well and are therefore fairly difficult to analyse. The problem is that collaboration and partnership between the organisations is difficult in light of different cultures and power relationships within the professions.[2] However, this has not stopped attempts by New Labour to create partnerships between health and social care through various initiatives and policies.
It was in 1999 that the government set out its radical NHS Plan that promised to transform the way in which health and social services interacted. The development of Care Trusts meant that health and social services would be dealt with by a singular organisation in certain areas for the first time. The main focus of the changes being on child services, service for the elderly and mental health services.[3]
The first problem of developing partnerships was to overcome the difficulties and issues between new staff committed to the partnership and older staff who had worked in the organisations as separate entities. The UK Centres of Excellence funded by the DfES were created in an effort to combine high quality services in one place. These then led to specific Children’s Centres. The idea was to combine disciplines of health and social care in one arena as a focus on a specific group of individuals – in this case families and children.[4]
The focus for many of the partnership policies and initiatives has been on children, families and the elderly in an effort to provide better integrated care for these groups.
One of the biggest developments within partnerships between health care and social care has been to empower those who use the services in an effort to smooth over integration. The idea is that with user participation these organisations will better understand how to work as a partnership to help the needs of the user. If the users can help to shape service standards, then differences between the organisations will be reduced and effective partnership will be increased.[5]
The idea behind this is also to manage internal diversity within the country as a society and the diversity within organisations so that these different parts can work together more easily.[6] The partnerships and their success are looked at in two ways. Firstly, how well the partners can work together to address mutual aims, and also how service delivery and effects on health and well-being of service users has been improved.[7]
The focus of policy has been on inter-organisational partnerships between health and social care, rather than focusing on individual professionals working together between organisations. The development should be seen as ‘NHS working with DfES/DCSF’ rather than ‘GP’s, doctors and nurses working with social workers’.[8]
The biggest shift has been the creation of the Primary Care Groups and Care Trusts which are responsible for the welfare of healthcare services in the community. These organisations are being encouraged to work with social services so that intermediate care can be provided, hospital waiting lists can be cut and the roots of issues can be sorted rather than merely the outcomes being treated. The formation of Care Trusts that try to combine health and social services in one organisation has been somewhat hit and miss in the UK.[9] The next section will critically examine these policies.
Critical review of partnership policy
One of the biggest problems with these policies is that many of the terms used are extremely vague and it is hard to evaluate their effectiveness. ‘Partnership’ is not accurately defined by most of the policies, and this leaves the concept open to interpretation.[10]
The concept of user participation and feedback within the policy is also rather poorly defined, and this means that the effectiveness of user participation to bring together health and social services tools is rarely monitored.[11] There needs to be more feedback for users on their participation within these organisations, and the participation of users needs to be tied directly into policy to improve partnerships.[12]
The term ‘culture’ is also given importance in the policies because it determines how the organisations work together in the partnership and work with users of the services. However, studies have shown this term has not been given a universal meaning and local organisations have given the term different meanings. This leads to inconsistent services and fluctuating success within a partnership.[13]
However, there have been some benefits of the increased user participation within health and social care partnerships. It has allowed users to gain more power within the relationship and in many ways help to self-manage their own needs more clearly. This is certainly the care within health and social care partnerships for the elderly community. Rather than being seen as a drain on resources, the older generation can now work with health and social services to maintain a higher quality of life and continually contribute to society. With health and social care working together in this way, the elderly community have better access to their needs as well as being more efficiently care for due to the organisational collaboration.[14]
The difference here is that whereas before an elderly person would be seen separately by the NHS and by private and government-based social services agencies, these organisations now work together to provide all primary care needs in one package. This makes it easier for all involved in the process.[15] It removes the boundaries that have been such an issue for many older people over the decades within the UK welfare system.[16]
The problem of course arises when the partnership as a whole is not serving the needs of individuals. Whereas before an individual may be failed by one organisation, now the failure will cover all the services they require. With the health and social services organisations also working with private entities such as insurers, if one area fails then the service package as a whole can fail.[17]
The problem is still that the two markets of health and social care are organisationally opposed. The culture within the organisations is geared towards competition rather than cooperation, and this has been extremely hard to overcome.[18] The disciplines have found it hard to build up levels of trust that allow for successful communication and partnership.[19]
Despite these problems with policy, there have been cases where policies have established partnerships between health and social services. One of these partnership initiatives is known as ‘Sure Start’. The next section will present a case study of this partnership to evaluate its strengths and weaknesses.
Case study of sure start
The Sure Start program was created in the ‘early years’ of the New Labour government and looked to help children and families both before and after birth in a holistic and integrated way. This includes provided healthcare and social care for children, as well as providing in-need adults with social care that they can benefit from. The government put a large amount of money into the project from 1998 onwards, and has rolled the program out across the country.[20]
The program sees all health and social care service providers work together to benefit parents and children in a wide variety of ways, particularly for vulnerable children and those with learning difficulties. These issues can benefit from an integrated approach that combines different aspects of health and social care in one package.[21]
Reports from this program in local areas show that commitment to partnerships and cooperation has been high amongst the staff involved. Those involved in the partnership, whether health and social services staff or parent members, found the experience to be positive and allowed for a more integrated approach to family welfare. Work with families has improved somewhat, although there are still problems.
The biggest problem to the effectiveness of the partnership is differing organisational cultures. These cultures mean that health and social services cannot always work effectively together, and that there are also limits on parental involvement. Parents found that the bureaucratic cultures of the organisations meant they were reluctant to participate further in the partnership. Likewise, staff within the different organisations found it hard to work with certain other staff because of differences in organisational culture.[22]
In other studies, the results were even poorer. Rutter found that the objective of Sure Start to eliminate child poverty and social exclusion was not being met. The results of National Evaluations of the Sure Start Team were analysed and showed that after 3 years, there was no significant service improvement. In fact, in some areas the service had got worse and had made the situations of families worse.[23]
The problem here was that whilst the partnership was working successful in bringing together health and social services, this was not improving the actual services offered on both sides. With only one organisation to now use, the most disadvantaged families were being let down in all areas rather than just in a few areas. It seems that many of the weaknesses of both organisations were combined in the partnership rather than their strengths.
Other results show mixed results. One study showed that the partnership had been effective for teenage mothers in improving their parenting, but the actual children of such mothers were in some cases worse off. The problem seems to be not with the concept of the partnership itself, but the actual practical effectiveness of the local organisations involved in the particular partnership and the level of communication and cooperation between different staff.[24]
Overall, the project has certainly been a success in developing integrated support networks for children and families throughout the UK. However, the effectiveness of this support network has been hindered in many areas because of different organisational cultures and a lack of adequate management capacity across the disciplines. These cultural problems have also limited the effectives of service user participation in some areas, and this is something that needs to be addressed in the future if these partnerships are to be successful.[25]
Conclusion
The policies of the New Labour government have tried to overcome the previous problems of drawing together the health and social services into one partnership. These organisations have always been highly separate, and attempts in the 1980’s and early 1990’s to foster cooperation between them often failed because of the differences in the organisations.[26] The issue has been that trying to find a fast and effective solution to the boundaries between health and social care is difficult, although it is attainable in the long-term.[27]
The partnerships themselves have actually been quite successful in creating sustainable and integrated local support networks across the UK. However, the effectiveness of these partnerships has been damaged by a number of factors.
Firstly, there is still too much competition and a culture of ‘blaming the other organisation’ between health and social services. Both organisations would prefer to absolve themselves of responsibility and compete for success rather than work together to solve the problem together. Although when things go right the partnership can work, when things go wrong both parties look to blame the ‘other side’. This means many users are let down by the partnership with no-one taking responsibility for the failure.[28]
Also, there has been too much emphasis on inter-organisational cooperation rather than inter-professional cooperation. Whilst organisations as a whole are difficult to change because of imbedded cultures and management styles, individual professionals can quickly be shown how to work together to both achieve better results for their respective organisations. The government policies should be more focused on getting individuals within different organisations (e.g. doctors and social workers) than looking at combining whole organisations. This gives the user the integrated support they need whilst still allowing the different organisations to concentrate on what they do best.[29]
In conclusion, partnerships between the health and social services in the UK can work to improve support for those who need it. However, the focus needs to shift from inter-organisational cooperation to inter-professional cooperation if the partnerships that have been successfully set up are to be effective in the future.
Bibliography
Anning, A (2005) Investigating the impact of working in multi- agency service delivery setting in the UK on early years practitioners’ beliefs and practices. Journal of Early Childhood Research, 3(1), pp.19-50 Balloch, S and Taylor, M (2001) Partnership Working: Policy and Practice. Bristol: The Policy Press.
Barnes, M, Newman, J and Sullivan, H (2004) Power, participation and political renewal; theoretical and empirical perspectives on public participation under new Labour. Social Politics, 11(2), pp. 267-279. Belsky, J et al (2006) Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study. BMJ, 332, p. 1476.
Brown, L, Tucker, C, and Domokos, T (2003) Evaluating the impact of integrated health and social care teams on older people living in the community. Health and Social Care in the Community, 11(2), pp. 85-94.
Carnwell, R and Buchanan, J (2005) Effective Practice in Health and Social Care: A Partnership Approach. Maidenhead: Open University Press.
Carpenter, J, Griffin, M and Brown, S (2005) The Impact of Sure Start on Social Services. Durham Centre for Applied Social Research. Available at: http://www.dcsf.gov.uk/research/data/uploadfiles/SSU2005FR015.pdf
Carr, S (2004) Has service user participation made a difference to social care services? London: Social Care institute for Excellence. Available at: http://www.scie.org.uk/publications/positionpapers/pp03.asp
Clarke, J (2005) New Labour’s citizens: activated, empowered, responsibilized, abandoned? Critical Social Policy, 25, pp. 447-463.
Dowling, B, Powell, M, and Glendinning, C (2004) Conceptualising successful partnership. Health and Social Care in the Community, 12(4), pp. 309-317.
DCSF (2008) Sure Start Partnership Work. SureStart Website. Available at: http://www.surestart.gov.uk/stepintolearning/setup/feinvolvement/partnership/ (Accessed 27th December 2008).
Gilson, L (2003) Trust and the development of health care as a social institution. Social Science and Medicine, 56(7), pp. 1453-1468.
Glasby, J and Peck, E (2004) Care Trusts: Partnership Working in Action. Oxford: Radcliffe Publishing.
Glass, N (1999) Sure Start: the development of an early intervention programme for young children in the United Kingdom. Children and Society, 13(4), pp. 257-264.
Glendinning, C (2002) Partnerships between health and social services: developing a framework for evaluation. Policy and Politics, 30(1), pp. 115-127.
Glendinning, C, Powell, M A and Rummery, K (2002) Partnerships, New Labour and the Governance of Welfare. Bristol: The Policy Press.
Ham, C (1997) Health Care Reform: Learning from International Experience. Plenary Session I: Reframing Health Care Policies. Available at: http://www.ha.org.hk/archives/hacon97/contents/26.pdf
Hudson, B (1999) Joint commissioning across the primary health care–social care boundary: can it work? Health and Social Care in the Community, 7(5), pp. 358-366.
Hudson, B (2002) Interprofessionality in health and social care: the Achilles’ heel of partnership? Journal of Interprofessional Care, 16(1), pp. 7-17.
Leathard, A (1994) Going Inter-professional: Working Together for Health and Welfare. London: Routledge.
Leathard, A (2003) Interprofessional Collaboration: From Policy to Practice in Health and Social Care. New York: Routledge.
Lewis, J (2001) Older People and the Health–Social Care Boundary in the UK: Half a Century of Hidden Policy Conflict. Social Policy and Administration, 35(4), pp. 343-359.
Lymbery, M (2006) Untied we stand? Partnership working in health and social care and the role of social work in services for older people. British Journal of Social Work, 36, pp. 1119-1134.
Maddock, S and Morgan, G (1998) Barriers to transformation: Beyond bureaucracy and the market conditions for collaboration in health and social care. International Journal of Public Sector Management, 11(4), pp. 234-251.
Martin, V (2002) Managing Projects in Health and Social Care. New York: Routledge.
Myers, P, Barnes, J and Brodie, I (2003) Partnership Working in Sure Start Local Programmes Early findings from local programme evaluations. NESS Synthesis Report 1. Available at: http://www.ness.bbk.ac.uk/documents/synthesisReports/23.pdf
Newman, J et al (2004) Public participation and collaborative governance. Journal of Social Policy and Society, 33, pp. 203-223.
Peck, E, Towell, D and Gulliver, P (2001) The meanings of ‘culture’ in health and social care: a case study of the combined Trust in Somerset . Journal of Interprofessional Care, 15(4), pp. 319-327.
Rummery, K and Coleman, A (2003) Primary health and social care services in the UK: progress towards partnership? Social Science and Medicine, 56(8), pp. 1773-1782.
Rutter, M (2006) Is Sure Start an Effective Preventive Intervention? Child and Adolescent Mental Health, 11(3), pp. 135-141.
Stanley, N and Manthorpe, J (2004) The Age of Inquiry: Learning and Blaming in Health and Social Care. New York: Routledge.
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Footnotes
[1] Leathard, A (1994) Going Inter-professional: Working Together for Health and Welfare. London: Routledge, pp. 6-9
[2] Lymbery, M (2006) Untied we stand? Partnership working in health and social care and the role of social work in services for older people. British Journal of Social Work, 36, pp. 1128-1131.
[3] Glasby, J and Peck, E (2004) Care Trusts: Partnership Working in Action. Oxford: Radcliffe Publishing, pp. 1-2
[4] Anning, A (2005) Investigating the impact of working in multi- agency service delivery setting in the Uk on early years practitioners’ beliefs and practices. Journal of Early Childhood Research, 3(1), pp.19-21
[5] Barnes, M, Newman, J and Sullivan, H (2004) Power, participation and political renewal; theoretical and empirical perspectives on public participation under new Labour. Social Politics, 11(2), pp. 267-270.
[6] Clarke, J (2005) New Labour’s citizens: activated, empowered, responsibilized, abandoned? Critical Social Policy, 25, pp. 449-453
[7] Dowling, B, Powell, M, and Glendinning, C (2004) Conceptualising successful partnership. Health and Social Care in the Community, 12(4), pp. 309-312.
[8] Hudson, B (2002) Interprofessionality in health and social care: the Achilles’ heel of partnership? Journal of Interprofessional Care, 16(1), pp. 10-14.
[9] Rummery, K and Coleman, A (2003) Primary health and social care services in the UK: progress towards partnership? Social Science and Medicine, 56(8), pp. 1777-1780.
[10] Glendinning, C (2002) Partnerships between health and social services: developing a framework for evaluation. Policy and Politics, 30(1), pp. 115-117.
[11] Carr, S (2004) Has service user participation made a difference to social care services? London: Social Care institute for Excellence. Available at: http://www.scie.org.uk/publications/positionpapers/pp03.asp
[12] Newman, J et al (2004) Public participation and collaborative governance. Journal of Social Policy and Society, 33, pp. 217-220.
[13] Peck, E, Towell, D and Gulliver, P (2001) The meanings of ‘culture’ in health and social care: a case study of the combined Trust in Somerset . Journal of Interprofessional Care, 15(4), pp. 323-325.
[14] Balloch, S and Taylor, M (2001) Partnership Working: Policy and Practice. Bristol: The Policy Press, pp. 143-145.
[15] Leathard, A (2003) Interprofessional Collaboration: From Policy to Practice in Health and Social Care. New York: Routledge, pp. 102-103
[16] Lewis, J (2001) Older People and the Health–Social Care Boundary in the UK: Half a Century of Hidden Policy Conflict. Social Policy and Administration, 35(4), pp. 343-344.
[17] Ham, C (1997) Health Care Reform: Learning from International Experience. Plenary Session I: Reframing Health Care Policies. Available at: http://www.ha.org.hk/archives/hacon97/contents/26.pdf, p. 25
[18] Maddock, S and Morgan, G (1998) Barriers to transformation: Beyond bureaucracy and the market conditions for collaboration in health and social care. International Journal of Public Sector Management, 11(4), pp. 234-235.
[19] Gilson, L (2003) Trust and the development of health care as a social institution. Social Science and Medicine, 56(7), pp. 1463-1466.
[20] Glass, N (1999) Sure Start: the development of an early intervention programme for young children in the United Kingdom. Children and Society, 13(4), pp. 257-259.
[21] DCSF (2008) Sure Start Partnership Work. SureStart Website. Available at: http://www.surestart.gov.uk/stepintolearning/setup/feinvolvement/partnership/ (Accessed 27th December 2008).
[22] Myers, P, Barnes, J and Brodie, I (2003) Partnership Working in Sure Start Local Programmes Early findings from local programme evaluations. NESS Synthesis Report 1. Available at: http://www.ness.bbk.ac.uk/documents/synthesisReports/23.pdf
[23] Rutter, M (2006) Is Sure Start an Effective Preventive Intervention? Child and Adolescent Mental Health, 11(3), pp. 137-140.
[24] Belsky, J et al (2006) Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study. BMJ, 332, p. 1476.
[25] Carpenter, J, Griffin, M and Brown, S (2005) The Impact of Sure Start on Social Services. Durham Centre for Applied Social Research. Available at: http://www.dcsf.gov.uk/research/data/uploadfiles/SSU2005FR015.pdf, pp. 44-48
[26] Glendinning, C, Powell, M A and Rummery, K (2002) Partnerships, New Labour and the Governance of Welfare. Bristol: The Policy Press, pp. 34-36
[27] Hudson, B (1999) Joint commissioning across the primary health care–social care boundary: can it work? Health and Social Care in the Community, 7(5), pp. 363-365.
[28] Stanley, N and Manthorpe, J (2004) The Age of Inquiry: Learning and Blaming in Health and Social Care. New York: Routledge, pp. 1-5
[29] Martin, V (2002) Managing Projects in Health and Social Care. New York: Routledge, pp. 180-190
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