Skills for a new era

New Labour has repeatedly emphasised its desire to bring down the
“Berlin Wall” between health and social care. After a steady stream
of policies, the pace of change increased rapidly after the
publication of the NHS Plan in 2000,(1) with the advent of care
trusts, children’s trusts, intermediate care, health scrutiny,
reimbursement and other initiatives. And according to
Delivering the NHS Plan these changes are not yet over:
“Older people and other service users have the right to expect that
local services are working as one care system not two. We will
monitor how far the NHS Plan and these further reforms we are
proposing take us towards that goal. If more radical change is
needed we will introduce it.”(2)

Increasingly, social care staff are finding themselves working with
colleagues from other organisations and professional backgrounds.
In adult care services, this is often in NHS-led settings such as
care trusts or mental health partnership trusts; for children’s
workers it is increasingly going to be in education-led children’s
services.

As a result, social care practitioners are having to ask themselves
a series of questions as they reappraise their traditional role.
What makes their contribution distinctive? How do they work with
others while still maintaining their professional identity and
value base? What can they learn from other professions?

For managers, the challenges are just as significant: how do they
bring different staff groups together to form new
multi-disciplinary teams? What kinds of training and organisational
development interventions might work best? What organisational
structures might best be suited to local needs? How can they work
with other agencies without losing local democratic control of
services and without an NHS or education takeover of social
care?

Unfortunately, those seeking answers to these questions from
existing training and education providers are likely to be
disappointed. Although there are many examples of good practice,
joined-up education provision tends to be relatively small-scale
and is very much the exception rather than the rule. Far too often,
medical schools train medics, nursing departments train nurses,
social work schools train social workers, education departments
train teachers, and business schools train managers – often with
little or no cross-fertilisation.

In Birmingham, this is changing. In 2002, the Health Services
Management Centre (HSMC) introduced a new course to help managers
and senior practitioners from health and social care work together
more effectively. After an initial pilot, this has developed into a
fully fledged MSc/graduate diploma in managing partnerships, taught
jointly by HSMC and its sister department, the Institute of Local
Government Studies (Inlogov).

Usually taken part-time over two years by people coming out of
their work situations to learn more about multi-agency
collaboration, the course includes compulsory modules on
partnership working in health and social care, organisational
development, managing for service effectiveness, and a choice of
managing resources or managing HR. Students can also take two
options chosen to reflect their partnership needs – these could
include topics such as housing, public health, primary care or user
involvement.

Laura Brodrick is strategic manager for older people in Sandwell,
and the programme is a new academic experience that she says is
benefiting her work. An experienced manager and qualified
occupational therapist, she finds a key feature of the course is
working alongside people from different organisational and
professional backgrounds, learning not just from university staff
but also from other people on the course. “The highs have been
working with fellow students with their wealth of expertise, as
well as the grounded nature of the programme.”

David Robinson is assistant director of adult care services in
Hertfordshire and is finishing his first year of the MSc. For him,
the value of the programme lies in gathering evidence-based skills
and referencing techniques to support the changes in culture he is
trying to achieve for both his service users and the management
team he is developing. This is particularly relevant for his chosen
dissertation topic, based on his contribution to the national
innovation forum – which, through partnership working, is
attempting to reduce the number of emergency bed days in acute
hospitals. The partnership group that he has established in
Hertfordshire includes five primary care trusts, three acute
trusts, district councils and the county council all working
together.

Designing a new course in interagency working was no mean feat.
Although HSMC and Inlogov are two departments at the same
university, they have traditionally been two separate bodies with
different ways of working. Exactly like the front-line services
that the government is trying to join up, the two departments had
different entry requirements, assessment mechanisms, cultures and
financial regimes. Turning the course into a joined-up experience
for students, therefore, needed exactly the same partnership skills
as workers and managers in health and social care require.

As Martin Willis, one of the programme co-directors, says: “Setting
up the programme mirrored the partnership agenda in front-line
services, bringing together two different departments and centres
of expertise to make the whole greater than the sum of its parts.”

Like partnership working in the field, this process takes time, a
shared vision and senior commitment to creating a seamless
approach.

Unfortunately, a new course like this that tries to cross agency
boundaries doesn’t always get it right. However, when the
experience isn’t as seamless as it could be, it gives a good
insight into the experiences of users and carers, and the
frustrations they must face on a daily basis trying to make sense
of separate health and social care systems. As Willis recalls:
“When we started planning the course we found that each department
had different requirements for essay writing and asked people to
submit a different number of copies on different paperwork.

“To sort this out we’ve had to create a single assessment process
for students exactly like the joined-up assessments currently being
developed for older people and for children. Imagine you’re a
student facing this inexplicable difference in focus: you would
feel pulled from pillar to post for no good reason.

“Now imagine you’re a service user, desperate for support and stuck
between two large public bodies that should be working together to
help you – surely we owe it to everyone we serve to try everything
we can to work together more effectively. And we believe this
course offers one of the ways forward.”

• For further information about the MSc/graduate diploma in
  managing partnerships in health and social care, visit the health
  and social care partnerships section at www.bham.ac.uk/hsmc or
  contact Sarah Stewart (S.E.Stewart@bham.ac.uk;
  0121 414 8395).

  Jon Glasby is head of health and social care partnerships and a
  senior lecturer at the Health Services Management Centre,
  University of Birmingham.

  Training and learning
  The author has provided questions about this article to
  guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl
  and individuals’ learning from the discussion can be registered on
  a free, password-protected training log held on the site. This is a
  service from Community Care for all GSCC-registered
  professionals.

  Abstract
  This article considers the importance of interagency education and
  training in supporting health and local government to work together
  more effectively. At present, too much education is just as divided
  as the front-line services that the government is trying to join
  up. But a new course in Birmingham is helping workers in children’s
  and adults’ services to work across agency boundaries.

  References
  (1) Department of Health, The NHS Plan: A Plan for
  Investment, A Plan for Reform, Stationery Office, 2000
  (2) Department of Health, Delivering the NHS Plan: Next Steps on
  Investment, Next Steps on Reform, DH, 2002

  Contact the author
  By e-mail at: J.Glasby@bham.ac.uk