Partnership and collaboration have been watchwords of the New Labour programme. The seemingly endless round of meetings, boards, mission statements, strategies, policies, “thinking out of the box” workshops and consultation exercises can dampen the enthusiasm of even the most ardent manager for joint working.
So why work in partnerships? The first answer is because of the “must dos” of government policy. From children’s and young people’s partnerships to the section 31 partnership flexibilities, government has repeatedly stressed the message that joined-up thinking and practice is a plank of its modernising agenda.
However, the second reason for working in partnership probably has a much greater appeal to social care practitioners. Users care little about whether they receive a service from health, housing, education or social services. Research has repeatedly stressed their annoyance at having to repeat their story to each person who calls or being bounced from department to department in seeking to find out who can make a decision. Every inquiry report highlights failures in both communicating vital information and co-ordinating services. For users, partnership working should mean more effective care.
So what makes a successful partnership? Much of the initial policy guidance and research focused on the mechanics of establishing partnership arrangements with emphasis on shared vision, structures, roles and responsibilities, incentives and rewards, and accountabilities. Co-operation and collaboration in the context of shared aims might make it seem so obvious as to not merit further attention. However, to work together, even with complementary values, demands sharing power and this will require compromise and therefore will inevitably bring tensions to the fore.
More recently, it has been increasingly recognised that developing and sustaining effective partnerships means understanding the different cultures in partner agencies. Alison O’Sullivan has written about her experience of the frustrations that partner agencies can feel at the formal and lengthy process of local authority decision making compared with the fragmented and oral culture in health.1
Two organisations exploring their culture commented on the contrast between the local authority practice of thrashing out issues before a paper is formally presented to a board or committee while the other expected argument and discussion to take place at the meeting. The result was that neither party understood why the other was behaving in what was perceived to be an odd manner, causing confusion and suspicion about motives. Partners need to spend time exploring and finding the potential benefits to be gained from differing ways of working. Shared aims are a must and shared values desirable.
Without shared understanding, partnerships, like any relationship, will falter and fail. And there are plenty of potential rocks on which they can run aground. Much has been made of the conflicting drivers particularly performance indicators and star ratings. Schools are driven by test and examination results. Primary care trust indicators are short on child care targets despite the national service framework.
Financial imperatives have undermined sincere plans to integrate learning difficulties and older people’s services. A fundamental focus is required on how the partnership will benefit service users, carers or the community.
A lack of an agreed focus on the outcomes will almost inevitably allow partners to drift apart. So too will a lack of mutual confidence and a lack of understanding of what your partners can contribute.
Partnerships often fail. The reasons for failing include a lack of purpose or communication. But there are also practical stumbling blocks such as crucial personnel moving on, a lack of a clear agreement about the partnership, failure to sort out resources (and not just who pays for what), and different accountabilities pulling partners in different direction.
Above all, partnerships will fail if they do not engage the commitment of front-line staff. One study found a reduction in job satisfaction, morale and role clarity during the first year of a mental health partnership with some staff members.2
Ultimately, the effectiveness of a partnership has to be evaluated by improvements in outcomes for users and this, in turn, depends on changing service delivery practice.
1 A O’Sullivan, “Crossing the cultural divide”, Community Care, 8 November 2001
2 E Peck, P Gulliver and D Towell, Modernising Partnerships: An Evaluation of Somerset’s Innovations in the Commissioning and Organisation of Mental Health Services Institute of Applied Health and Social Policy, Kings College, 2002
Martin Willis is programme director, Inlogov, Birmingham University; Des Kelly is consultant director in social care, Bupa Care Homes and Andrew McCulloch is chief executive, Mental Health Foundation.
“When I was…
“…chairing the steering committee for the London Homeless Mentally Ill Initiative, the agenda was massive, the difficulties myriad. Those involved included the then Tory government, a number of Labour local authorities, several health authorities, a number of homelessness charities and the Housing Corporation. There was mutual concern that the initiative wouldn’t work. In the end the partnership worked just about as well as could be expected, leading to some cutting edge services such as assertive outreach teams (as well as to some honourable failures from which lessons were learned) and to a reduction in the number of homeless mentally ill people sleeping rough in London. This came about because of the willingness of then junior ministers Tim Yeo and subsequently John Bowis to make it work. Patience, the mutually shared goal of getting vulnerable people off the street, resources – £25m was available, and mutual understanding over time all played key roles.” (AM)
- Involve service users right at the start of partnership working.
- Co-locating staff helps relationship building.
- Not all partners come from the same field. Sometimes difference is a strength.
- Have an agreed partnership agreement defining who does what.
- A good partnership is demonstrated by regular, well-attended meetings.
- Partnerships will go the way of all government fads and fashions.
- Working in partnership involves sharing everything on a 50/50 basis.
- Go for as many partners as you can get.