In the first in a series of articles on partnership working, Jon Glasby and Helen Dickinson look at the value of interagency co-operation in the health and social care field to produce better outcomes
Open almost any newspaper and issues of partnership working (or lack of it) leap out at you. In extreme cases, it will be rare, high-profile, front-page stories about a child death, a mental health homicide, the abuse of a person with learning difficulties or an older person dying at home alone (see Case study). Here, partnership working is quite literally a matter of life and death, and a failure to collaborate can have the most serious consequences for all involved.
However, most newspaper stories focusing on social issues or public services will inevitably include reference to partnership issues either to the need for joint working or to a social problem that is so multifaceted that an inter-agency response is required. Whether it be gun crime, substance misuse, prostitution, social exclusion, regeneration, third-world debt, teenage pregnancy or public health, the issues at stake are often so complex that no one agency working by itself could ever hope to provide a definitive solution.
In social care and health, inter-agency issues are even more prevalent. For practitioners, most of the issues you face will involve working with other professions if you are to make a positive and practical difference to service users. For public service managers, partnership working is likely to occupy an increasing amount of your time and your budget, and arguably requires different skills and approaches to those prioritised in traditional single-agency training and development courses. Put simply, people do not live their lives according to the categories we create in our welfare services (and in subsequent professional training and organisational structures). Real-life problems are nearly always messier, more complex, harder to define and more difficult to resolve.
In response, policy has increasingly called for enhanced and more effective partnership working. Although such calls can be inconsistent, grudgingly made and/or overly aspirational, the fact remains that collaboration between different professions and organisations is increasingly seen as the norm, rather than an exception. With most new funding and most new policy initiatives, there is usually a requirement for local agencies to work together to bid for resources or to deliver the required service, and various acts of parliament place statutory duties of partnership on a range of public bodies.
Against this background, there is a real risk that frontline practitioners and managers are set up to fail – asked to work in partnership, but not given the training, development or support they need to respond proactively to this agenda. Despite some notable exceptions, many current educational opportunities are uni-professional, as are existing trade magazines, journals and textbooks – and the people who write in them. As a result, practitioners and managers are often exhorted to work in partnership, but trained and developed in ways that encourage a single-agency approach.
Yet despite the substantial and growing literature on partnership working, most books are broad edited collections, theoretical books inaccessible to students and practitioners, or texts focusing on partnership working for specific user groups.
Where more practical, accessible and general texts exist, these typically lack any real depth or evidence base – in many ways, little more than partnership “cook books” that give you apparently simple instructions intended to lead to the perfect and desired outcome. But in practice, anyone who has studied or worked in health and social care knows partnership working can be frustrating and messy. Even if you follow the so-called rules, the end result is often hard to predict, ambiguous and likely to provoke different reactions from different agencies and professions.
What should be central to most discussions concerning partnerships is the importance of being clear – with each other, with staff and with service users – what outcomes our partnerships are designed to achieve. But in practice, issues of outcomes and partnerships are often far from clear. In particular, there is a series of critiques about partnerships, including:
● Research literature that focuses on issues of process (how well are we working together?) rather than on outcomes (does it make any difference for people who use services?).
● A tendency to assume that partnership working is a “good thing” (that leads to better services and hence to better outcomes).
● A tendency to focus on potentially positive outcomes without necessarily considering the negatives of partnership working.
● The privileging of traditional notions of evidence-based practice, which have often been too narrow and too focused on particular types of research methodology to help us fully understand the relationship between partnerships and outcomes.
● A tendency to see partnership working as an end in itself, not as a means to an end.
● A potential lack of clarity about exactly which forms of partnership may be most appropriate to deliver desired outcomes.
The key aspect of all these critiques seems to be that by focusing on outcomes, we may better ensure the partnerships we create are fit for purpose and genuinely deliver more for service users than would be possible via a single-agency approach. Depending on the outcomes, local partners may decide they do need some form of partnership, but this is not automatically assumed, and the form of partnership required depends very much on where local services start and what they want to achieve.
This process is not always simple and straightforward and many policymakers, managers and practitioners tend to find it easier to think in terms of structures and processes, rather than outcomes. By employing such an approach, potential partners may retain a focus on partnership working as a means to an end, rather than an end in itself.
Ultimately, the current emphasis on partnership working means that everything about public services – their organisation and culture, professional education and training, inspection and quality assurance – will have to change. But partnerships can ultimately offer so much potential that this agenda is worth spending time and energy pursuing.
● Helen Dickinson and Jon Glasby, Health Services Management Centre, University of Birmingham, are the editors of the new Better Partnership Working series launched at Community Care Live.
More examples of partnership working visit our good practice database
This article appeared in the 15 May issue under the headline “Strength through unity”