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The Value of Partnership Working in Achieving A High-Quality Service Within Legislative Boundaries

The document discusses the value of partnership working between health and social care agencies to provide high-quality services within legislative boundaries. It outlines how in the UK, the welfare state separates "health" and "social care" services. More recently, there has been recognition of the need for greater coordination and integration of these services at regional and local levels. A number of policies have aimed to facilitate partnership working through mechanisms like pooled budgets, integrated providers, and care trusts. However, fully effective joint working remains elusive, so the paper seeks to summarize lessons learned from research on health and social care partnerships in England.

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Tamim Ruhul
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127 views2 pages

The Value of Partnership Working in Achieving A High-Quality Service Within Legislative Boundaries

The document discusses the value of partnership working between health and social care agencies to provide high-quality services within legislative boundaries. It outlines how in the UK, the welfare state separates "health" and "social care" services. More recently, there has been recognition of the need for greater coordination and integration of these services at regional and local levels. A number of policies have aimed to facilitate partnership working through mechanisms like pooled budgets, integrated providers, and care trusts. However, fully effective joint working remains elusive, so the paper seeks to summarize lessons learned from research on health and social care partnerships in England.

Uploaded by

Tamim Ruhul
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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The value of partnership working in achieving a high-quality service within legislative


boundaries
In a UK context, the post-war welfare state that was developed in the late 1940s is based on the
assumption that it is possible to distinguish between people who are sick (who have ‘health’ needs and
receive care free at the point of delivery) and those who are merely frail or disabled (who receive ‘social
care’ services that are often means-tested and subject to charges). In addition to this, many wider
services (for example, education, policing, social security etc.) have tended to be organized on
hierarchical lines, with resources and policy flowing from the center downwards. More recently, there
has been increasing recognition of the need to create links between these different central government
functions at a regional and, in particular, at a local level, with more effective inter-agency working for
people who have a range of needs. Thus, a disabled person who lives in local authority housing may
need adaptations make to their house, have particular transport needs, have particular health and social
care support needs, and be keen to access training opportunities in order to gain employment. Similarly,
a child at risk of abuse may be living in poor housing in a run-down inner-city area with few social
amenities, be in trouble at school, may be at risk of crime (either as a victim of crime or as a
perpetrator), and may self-harm or have substance misuse problems (or both). In both these
hypothetical scenarios, the person concerned will need a wide range of agencies to work together in a
coordinated way to meet their needs.

In response to this need to co-ordinate local services more effectively, there have been a number of key
policy initiatives. For example, in 1973 the NHS Reorganization Act placed a statutory duty on health and
local authorities to collaborate with each other through Joint Consultative Committees. Advisory rather
than executive, these bodies were soon seen to be inadequate for the task in hand [17], prompting calls
for further reform. In 1976, these arrangements were strengthened by the creation of joint care
planning teams of senior officers and by a joint finance programme to provide short-term funding for
social services projects deemed to be beneficial to the health services. Despite growing criticisms of
these mechanisms for joint working, formal arrangements for collaboration remained substantially
unchanged until the community care reforms of the 1990s [18]. Here, there was an attempt to create a
more market-based approach to the delivery of public services, with a purchaser-provider split in health
care and the stimulation of a much more mixed economy of provision in adult social care.

Since 1997, the emphasis has arguably been more on creating local networks or partnerships between
local agencies. Key policies include:

The Health Act 1999: here, three new legal powers (or ‘flexibilities’) enabled health and social care to
create pooled budgets, to develop lead commissioning arrangements or to create integrated providers
[19].
The creation of Care Trusts (NHS bodies with social care responsibilities delegated to them). With
around 10 such organizations in existence at any one time, this is the closest model to a full merger of
health and social care in England [20].

The creation of Children’s Trusts: more virtual in nature than adult Care Trusts, these typically bring
together a wider range of partners than just health and social care, and are local authority-based.
Alongside these new organizational arrangements, there is also an emphasis on a common assessment
framework for children, greater information sharing, a lead professional to co-ordinate care and greater
co-location of different professions working with children and young people [21].

Although it is very early days, one emerging option in English health and social care is the piloting of
personal health budgets (see [22] for a summary of this policy). Mirroring a system already underway in
adult social care, these pilots may allow some patients to receive the cash equivalent of directly
provided services, with greater scope for them to spend this money more creatively. If the pilots prove
successful, there may be more scope in future for people to integrate their own health and social care
bottom up, rather than relying on health and social care policy and organizations to integrate services
top down.

However, despite these changes, effective joint working between health and social care seems just as
elusive as ever—and the 10th anniversary of the International Journal of Integrated Care seems a good
opportunity to reflect on some of the underlying concepts and frameworks that might help to translate
policy aspirations into practice. As a result, this paper does not contribute new data or insights per se,
but rather seeks to summarize lessons learnt from policy and research into health and social care
partnership working in England. At times there is a risk that the frameworks proposed seem a little
abstract so we have also tried to reflect briefly on how they have and might be used in practice.

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