Interprofessional and inter-agency collaboration

The Social Care Institute for Excellence looks at how partnership working is being encouraged

Interprofessional and inter-agency collaboration (IPIAC) aims to bring together professionals, agencies, services users, carers and service providers.

Although the terms partnership and collaboration are often used interchangeably, it is more helpful in this context to view them as different but connected ideas. Collaboration is the more active version of partnership. Although two agencies may be in partnership – that is having formalised links – it is when they collaborate that they work together. Successful partnership is based on collaboration.

Legislation and policies promoting IPIAC have been part of the care agenda since the early 1960s with collaboration viewed as a way to improve standards and reduce costs.

Efficiency and effectiveness

The 1989 white paper, Caring for People, followed by the NHS and Community Care Act 1990, shaped the development of IPIAC in the last decade. More recently, the government has issued a large number of policy documents promoting collaboration to improve efficiency and effectiveness. This was most clearly voiced in the 1998 white paper, Modernising Social Services, which stated that “people do not fit into neat service categories, and if partner agencies are not working together it is the user who suffers” (DH, 1998 para 6.5).

It works in two ways.

Interprofessional: This refers to the working relationships between different groups of professionals, for example between social workers, teachers and police officers. Each professional group will bring its own perspective to the collaborative process. When considering this type of working it is important to think about how best the differing perspectives can be brought together and how the respective professional contributions can be harnessed to improve the standard of service and the experiences of service users and carers.

Inter-agency: Consideration must also be given to the collaboration between organisations rather than the professionals within them – for example, looking at the local authority adult and community service rather than the social worker. It should involve an awareness of the different cultures and working practices within organisations and investigate how the resourcing and priorities affect staff.

In care provision, service users and carers may have complex needs requiring different types of help provided by a range of agencies. Even when groups of agencies are organised to work together, such as in an intermediate care team, collaboration between professionals is essential to the successful provision of care.

Sometimes different types of professionals may all be sited in one larger organisation, such as a local authority. In these cases, collaboration depends on formal partnerships and active joint working by professionals.

Driving up standards

Interprofessional and inter-agency collaboration is an effective way to drive up the standard of care. Policy and legislation now place users and carers at the centre of services. As consumers, they expect the professionals they come into contact with to work together.

Additional factors contribute to the importance of IPIAC, including:

● Changes to the way that services are organised, including the development of new departments. Although this has meant greater integration there are still boundaries to be bridged and understanding and collaboration is essential.

● Government policy and legislative focus has increasingly specified the need for interprofessional and inter-agency working for effective service provision.

● Reports into and awareness of suffering caused by the failure of professionals and agencies to work together has flagged up the need for effective collaboration.

● The demographic shift as older people live longer means there is increasing demand for services. Collaboration can help to address this cost burden.

● Social work and social care has moved beyond social services departments and is now developed in a range of agencies.

● Increasing specialisation in practice means professionals must work together to provide integrated care.

● Regulatory and professional bodies urge collaboration between those in social care.

Although effective collaboration is a key part of successful service provision, interprofessional and inter-agency collaboration does have its limitations. These include:

● Confidentiality: There can be tension between the need to share information between professionals and agencies and the preservation of confidentiality.

● Service users: For service users and carers IPIAC can seem to take place without their involvement or at the expense of their time with the given professionals. Their views and wishes should feed into policy, learning and practice.

● Time and workload: IPIAC takes time and commitment with the development of collaborative partnerships being gradual.

● Boundaries: There is overlap between the dimensions found in IPIAC with increased service user participation and the fact that professionals can be care users and carers.

● Worthwhile dissent: Sometimes differences in points of view between professionals play an important role in the successful provision of care.

Practitioners’ messages

● IPIAC refers to the active collaboration between professionals and agencies.

● This type of collaboration has been promoted by policy and legislation since the 1960s but has been given particular prominence by the Labour administration.

● With IPIAC, separate professionals will work together, informing the process with their distinct perspectives, but working to provide the best standard of care for service users. Agencies establish links to facilitate this type of joint-working.

● When carried out successfully, this will improve the standard of care for service users.

● According to Whittington (2007), poorly carried out IPIAC can treat users and their needs as fragments, limit choices, restrict access to services increase risk and weaken protection of control.

● It also addresses the flexibility of social care and social work which now takes place in a range of agencies and helps to smooth out understanding between new organisations participating in social care.

● Limitations to IPIAC include time and workload, the tension between sharing information and the need for confidentiality and the increasingly blurred boundaries between all people involved in social care, including service users and carers.

Further information

➔ Scie e-learning resource: Interprofessional and inter-agency collaboration

➔ Integrated Care Network

➔ General Social Care Council

Research abstracts: partnership working

Author MEADS Geoffrey et al

Title The case for interprofessional collaboration in health and social care

Publisher Blackwell, 2005, 165p.

Abstract The book recognises and explores the premium that modern health systems place on closer working relationships. Each chapter adopts a consistent format and a clear framework for professional relationships, considering those with the same profession, other professions, new partners, the public and patients. Section one, “Policy into Practice”, considers a series of analytical models that provide a contemporary account of collaboration theory, including global developments. The second section, “Practice into Policy”, examines real-life drivers for behavioural change. The third section evaluates personal learning and learning together.

Author ODEGARD Atle

Title Exploring perceptions of interprofessional collaboration in child mental health care

Reference International Journal of Integrated Care, Vol 6, 2006

Abstract This paper proposes a tentative theoretical model (Pincom) and a measure of mental health and school professionals’ perception of interprofessional collaboration (IPC). The model is based on 12 constructs derived from a pilot study, organisational and social psychology. The model aims to capture central aspects of IPC.

Author WHITTINGTON Colin

Title Learning for collaborative practice with other professions and agencies: a study to inform development of the degree in social work; summary report

Publisher Department of Health, 2003,13p

Abstract Experience is growing of what is involved in learning for collaborative practice. This experience promises valuable information for social work degree providers and others developing learning opportunities but has not been systematically researched in UK social work programmes for 10 years. The aim was a “first stage” inquiry to gather and analyse information on experience and initiatives among DipSW providers in their development of learning for collaborative practice with other professions and agencies. The purpose was to generate findings to inform a second stage of dialogue and development to support the new degree.

Author DARLINGTON Yvonne, FEENEY Judith A, RIXON Kylie

Title Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.

Reference Child Abuse and Neglect, 28(10), October 2005, pp1085-1098

Abstract This paper aims to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns. The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Analysis revealed that workers were engaging in moderate interagency contact, but were unhappy with the support provided by their agency. Principal components analysis and multivariate analysis of variance on items assessing attitudes towards other workers identified four factors: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust. The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organisational level.

This article is published in the 6 August 2009 edition of Community Care under the headline “Interprofessional and inter-agency collaboration”