A combustible mixture

Partnership is the buzzword in health and social care, promoted by
the government as the basis of user-centred services. But many are
asking how far the word has been accompanied by action. What
exactly does partnership mean in practice? A look at the Department
of Health website reveals 236 partnerships formed under the Health
Act 1999, compared with 20 three years ago. And there are many more
health and social care partnerships which have been set up without
using the so-called “flexibilities” under the act. So, on the
surface at least, much progress has been made.

But those figures may disguise a grimmer reality. Information
technology systems may be incompatible, a common language in which
practitioners on either side of the fence can talk about clients or
patients may be non-existent, and cultural differences between
health and social care are as likely to produce interprofessional
rivalry as they are harmony. The single assessment process (SAP),
in which care agencies supposedly co-ordinate the assessment of an
older person’s needs, is a case in point. A central plank of the
National Service Framework for Older People, the SAP is running
into trouble even before it has been set up in many parts of the
country.

Where it has already been kick-started, the SAP is fuelling
resentment in some areas about the implications of joint working
arrangements for professional practice. A report from the Royal
College of Nursing found community nurses in Scotland angry because
they felt social care responsibilities had been foisted on them by
hard-pressed social work departments. They claimed that joint
teams, far from being oases of cooperative endeavour, were places
of strife where practitioners competed over territory and
recognition. The two cultures had blended to create an explosive
mixture.

Managers will have to confront two challenges if partnership is to
replace conflict. First, joint approaches such as the SAP have to
be underwritten by proper investment in IT and in buildings for
multidisciplinary teams. And, second, there must be much more
emphasis on joint training of health and social care staff because
without shared ideas, shared values and shared purposes,
partnership does not have a ghost of a chance.

If partnership is to be more than a buzzword, it must be seen as a
process in its own right, not as something that results when the
gates between health and social care are opened. For service users,
the alternative is bleak.