Why joint commissioning isn’t the be all and end all of service management

In our continuing series on the challenges facing social care management, Martin Willis looks at the realities of partnership working and confronting professionals’ mixed feelings towards it

Martin Willis.
JOB: Deputy director of Inlogov, School of Public Policy, University of Birmingham; co-director of MSc in managing partnerships in health and social care.
QUALIFICATIONS: BA economics; master of social work; MSc public management; CQSW.
LAST JOB: Director of social work qualifying programme.
FIRST JOB: Clerk for Dartmoor Small Farms

Why are staff still so ambivalent about joint working? Are schools really not interested in the educational achievements of looked after children? Do health staff insist on a medical as opposed to a social model to the detriment of service users’ quality of life? Or are these urban – and rural – myths, perpetuated by people resistant to change, wishing to protect their empires?

Surely joint working puts the views of users rather than professionals at the forefront of decision-making and ensures integrated strategy, avoiding resource duplication and users having to tell their story repeatedly to every person who knocks on their door?

Community Care has illustrated some of the realities of this ambivalence. On the positive side are examples of three pairs of health and social care practitioners saying that, by working together, “it’s easier to improve the quality of life for our clients” and news of collaborative opportunities “tackling child neglect before maltreatment takes hold” in Staffordshire.

On the other, the continued fallout in Wiltshire of the decision by two PCTs to withdraw £3m from several care schemes and a carer bemoaning multiple assessments and the time it has taken to obtain suitable medication and basic household equipment tell a different, frustrating story.

After years of exhortation, pump priming, legislation and pilot initiatives, both the positive and negative sides of joint working are still true. So what can managers do about it?

First, replace the naïve optimism that joint working is the panacea to all social care problems with a more realistic and considered judgement as to whether it is likely to prove worthwhile. The Audit Commission’s report, Governing Partnerships, includes some welcome notes of caution that joint working can generate confusion and weaken accountability and that partnerships “may not be the best solution in every case”. Above all, staff need to be clear about how partnership working is going to help them achieve better outcomes for service users. People will enter into joint working wholeheartedly only if they feel it is likely to result in some positive gains which will outweigh the inevitable headaches.

Second, involve the right people at the right time rather than the usual suspects. Joint working with neighbours, faith groups and local supermarket managers may be more important to ensuring older people are supported at home than work with
colleagues from health. Similarly, research on Children’s Fund projects has shown that, in some circumstances, working with
after-school clubs run by voluntary organisations and informal parent support groups may be the best way of enabling a child to develop the confidence to go to school.

Third, do not waste time by trying to involve everyone at once unless this is necessary to ensure good communication and decision-making. Too many people at a protection conference will restrict individuals’ airtime to address their priority concerns and can intimidate service users. Likewise, staff and community representatives will rightly complain of going  to endless partnership meetings which are expensive in terms of time and goodwill if much of the discussion appears irrelevant.

Next, do not assume that everyone knows what everyone else does or that they understand what each other is talking about. Do ask someone to explain what their job entails or what they mean by a set of initials or a technical label. Even commonly used terms such as “commissioning” and “assessment” mean different things to different professionals. Communication is not just one-way talking but two-way understanding; so check out whether people you are working with have a clear and shared basis for moving forward.

Finally, do not leave discussion of money or other resource commitments to last. Money is simply a method of communicating with each other which puts a value on our transactions. Like any relationship, we need to work out what is to be managed in separate bank accounts and what jointly, with the latter being subject to agreed protocols. Trust takes time and investment to develop but it can be shattered overnight if jointly pooled resources are withdrawn or used for purposes which have not been agreed.

● Make sure you value the time, money and goodwill put into joint working.
● Focus on benefits in terms of user and community outcomes.
● Communication is about shared understanding.

● Joint working will solve every management and practice problem.
● Invite everybody to everything.
● Joint working only concerns involvement of professional staff.

This article appeared on Page 38 of the magazine (issue dated 28/9 – 4/10) under the headline Creaking Joints

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