Within health and social care, there are many references to the need for health and social care agencies to ‘work together’ more effectively in ‘partnership’. Evidently, the health and social care sector provides a service for the wellbeing of vulnerable people which is achieved by considering a diagnosis of their health condition and also maintaining a report from health professionals. Working in partnership is a key element of practice within the health and social care sector and it is a very good way of achieving the aims and objectives that need to be met.
For example it is depicted as a tool that addresses the wider determinants of health such as poverty, employment, poor housing and poor educational attainment with primary care trusts and local authorities being the key partners, leading and driving change locally. ( The concept of partnership and collaboration Carnwell and Carson,2001) This paper will demonstrate an understanding of the philosophies of partnership in relation to health and social care, I will also attempt to analyse and identify the potential barriers to partnership working in the health and social care services.
Lastly, I will evaluate the outcomes of partnership working for users of services, professionals and organizations in health and social care services. The Philosophies of working in partnership in health care is concerned with the health and social care organisation joining together to produce effective service to support people’s needs and also to understand the importance of promoting autonomy with individuals. Health and social care services have been encouraged to allow consumers to become more involved and to have more of a say in the design and provision of services.
Part of the reason for this refocusing on service users as active consumers rather than passive recipients of services may simply be that health and social problems have become more complex and multi-dimensional and that the older more static models of welfare have outlived their usefulness. According to Carnwell and Carson, (2001) partnerships with service users enable individuals to make informed decisions for their treatment and embolden their independence. The health care sector needs a partnership philosophy for several reasons which are as follows; equity, efficiency, quality and ultimate goals. (City of London College, 2013)
The professional groups involved are social workers, health workers, educational and therapists. The users of service can be children, the elderly, young people in care homes, individuals with mental health and learning difficulties. There are six types of philosophies considered in working in partnership. One of the philosophies is empowerment, empowerment in health and social care is where by users of service claim for their rights, responsibilities and individuality.
Health and social care settings that involve empowerment are places such as Hospitals, Surgeries, Opticians, Dentist, Schools, Nurseries and Residential homes. (Ask Jeeves, 2013) Independence in health and social care is when users of service carry out their daily activities independently. For example a self-caring user of service doing their own shopping on a weekly basis or however many times they need to go shopping. Service provider has to comply with the philosophy of Autonomy according to the Health and Social care Act 2008 and Regulations 2010 from which the outcomes are derived.
For example, a patient is being discharged from hospital where he or she will take part in making their care plan by deciding what sort of help they need. Respect in health and social means the users of service has to be respected, furthermore “we suggest that the type of respect that physicians owe to patients is independent of patient personal characteristics, and therefore, ought to be accorded equally to all (Beach, Duggan, Cassel, Geller, 2007).
Power Sharing is networking between organisations when coming together as one body or team dealing with the service user’s case or issues to give quality of service on one objective, for example, social workers, district nurses, carers and doctors. Ethic is where by you have to respect people’s opinion, behaviour and attitude. Making informed choices involves letting the users of service know the policy and procedure of the treatment or service that they are going to receive.
For example users of service or cancer patient will be informed about the procedure of taking chemotherapy and on those grounds the users of service or patient can decide whether to have the treatment or not. There are three levels of partnership relationship within health and social care services which are as follows; service user’s level: the service user has the right to cancel any service that they do not want and they have to say what they want to be included in their care plan (person centre to be promoted).
The inter-professional level is between practitioners working together to provide an effective service for individuals for example; diabetic nurse, occupational therapist and opticians all have the wellbeing of their patient at heart. Finally the organisation and policy level where partnerships need to exist at each of the above level for long term benefits to be created. Implement working in partnership at work in residential home. The service user has to be the centre of their service to promote good health care.
There is a procedure to follow to move an elderly person to a residential home which is as follows: The service user’s social worker will send a referral to a particular home,to indicate the health problem, life history and type of support he/she might need. The assessment will be carried out by Head of Care or Senor Carer to get more information about the service user with congestion with the service user’s family. The assessment form will be taken to the Care Home Manager to decide if the service user has meet up with the criteria.
The funding will be looked into if the service user is private or if the local Authority has a client. The care home Manager will make a phone call to the service user’s social worker and the family about the outcome and also check if the resident will stay long term or short. Once all the necessary information is taken and completed, the resident will move into the home. The care plan will be done by one of the senior in the unit as there is 3 different units. Demential, nursing and residential unit.
Each units has a qualify and competent staff to give resident support according to their need, and also treat people with respect and dignity. Stakeholder that will be working for the resident will be the GP, Care Home Manager, Carer, Social Worker Head of Care, resident’s family, pharmacist, chiropodist, hairdresser and District Nurse will work together to give residents high quality of service to meet up with CQC care standard. Resident’s care plan will be reviewed monthly and will be updated to monitor resident daily activities and well being.
The Peter Connelly case, also known as the “Baby P” or “Baby Peter” case, was a prime example of the failing attempt of working in partnership. As a result it lead to the subsequent dismissal of Haringey Council’s director of children’s service. This caused a mental change for child protection in England. Referrals increased massively and social workers have been faced with a level of scrutiny and anger not encountered since the Victoria Climbie case. On 3 August 2007, baby p was found dead in his cot 48 hours after a doctor failed to spot the child’s severe injuries,especially his broken spine.
Conversely, Peter was on haringey council’s child protection register throughout the eight months of abuse which he suffered more than 50 injuries. Despite the fact that his family had been seen 60 times by agencies. This proves that the inspections of the agencies including social workers from the council and the Nhs weren’t effective enough. It’s is evident that the observation of the client was poor. The lack of working in partnership effectively caused the demonisation of social workers. Many workers were sacked.
Some had to go into hiding because of death threats. Sharon Shoesmith, who was the director of children’s services at the time of Baby P’s death, was sacked by a panel of councillors on 8 December 2008 over the case. Haringey’s safeguarding services was proven poor. In December 2008, An emergency inspection after the Baby P case came to wider attention during the court hearing. This was followed by a second review. The second review said Haringey had made “limited progress” since the 2008 joint area review.
Ofsted chief inspector Christine Gilbert said in a letter to Ed Balls that she believed the second inspection had happened too soon. The professionals of the cases should of examined the child more frequently and monitored and keep a track record of the damage being done to the child. For example when Peter returned home in January the GP and social workers should have carried out more inspections. Since they failed to do that on the first of April that year Ofsted took over the responsibility for inspecting children’s services from the CSCI.
The same month Peter was admitted to hospital with minor injuries. Bearing in mind that they were aware that the child was reunited with the mother and her boyfriend. The injuries to peters face and hands were missed by the social worker. By all means the doctor or another professional should have noticed it and pushed for further inspections and wrote reports. All that was done was a second arrest of the mother. On the 1st August Peter is examined at a child development dress clinic, where severe injuries, including a broken back, are missed.
Then two days later peter is found dead in his cot. Reviews proved the joint areas of safeguarding was poor as both professionals missed the injuries of the child. Furthermore the NHS is criticised by the Care Quality Commission for failing in Peter’s care. If legislation, organisational policy and professional attitudes change constantly this could have a negative impact on service user’s experience of service resulting in fragmentation, “Older people are being let down by a social care system in which they are “passed like a parcel” between services” (Jane Dreaper, 2012).
The government were looking for a way to out, so they aim to provide an extra 2 billion pounds a year for social care by the year 2014/2015. However, reports say that this amount is not sufficient to maintain the service quality and efficiency. In this case that means that elderly people are not getting the quality of care that they should be getting, there needs to be a more organised approach to this issue so that the next generation will have a good quality of life in their old age.
The current legislation, organisation practice and policies for partnership working in health and social care make provision for considering several models of working in partnership. The legislation on health and social care is an act which has established the Care Quality Commission which regulates all health as well as adult social care services. The act empowers the commission in various capacities and gives them different duties that they should fulfil. The regulations governing the commission and its supporting staff change very frequently” (AIC search and media, 2013).
There are various legislation acts within the health and social care setting such as UN convention of children’s right 1989, protection of children Act 1999, Education Act 1921- 2002, Special Educational Needs and disability Act 2001, Mental Health Act 1983, Carers (Equal opportunity Act 2004/ carers recognition and services Act 1995), Human Rights Act 1998, Race relations Act 2000, Equal pay Act 1970 and Data protection Act 1984. At this present time there are legislations and organisation practices and policies procedures affecting partnership working: Equality Act 2010, Care Standards Act 2000, Disability Discrimination Act 2005.
The Equality act 2010 was newly endorsed to prevent different types of discrimination (indirect and direct discrimination), victimisation and harassment (Oluponle, 2013). Barriers within working in partnership are structural procedural, financial and professional. One principle of strengthening strategic approaches to collaborative working is clarity of roles and responsibilities, in organising and agreeing what roles each person has and designing organisational arrangements indicating which roles and responsibilities are to be fulfilled (Glasby, Dickinson and Miller, 2011).
There are many advantages of working in partnership as it improves the lives of vulnerable people such as the elderly and also the objectives of joints partnerships are met simultaneously. For example families do not have to give the same information about person in care to different professionals, it improves the information shared between professionals, it improves the efficiency of the care system as a whole and it is also cost effective (Mithran Samuel, 2011).
Social exclusion tackled more effectively through multi-disciplinary action. Therefore if the service user is mistreated it will be dealt with. The existence of lesser dilution of activates by agencies is effective as the service user will receive a better standard of living through the participation of muscle strengthening activities, listening to music, aerobics , educational games, amongst others. The establishment of partnership will also provide a less chance of agencies producing services that are counterproductive.
Conversely, there are also disadvantages of working in partnership as it can affect collaborative working, an elderly person not being able to leave the hospital because of the unavailability of health services or merely due to administrative matters within the hospital is a disadvantage. Due to the dispute between NHS and social care professionals, the NHS are no longer fully funding care packages which means the quality of service has declined.
Former partnerships have been broken because of this dispute making it more difficult for users of service to get what they need out of the service (Mithran Samuel, 2011). The threat to confidentiality can be seen as a disadvantage within partnership. For example the service user can urgently need the ambulance and the carer whilst making the phone call provides limited information about the service user. Consequently, the level of care will be affected due to the lack of information shared. Organisational difference is another disadvantage.
At a strategic level, competing ‘organisational visions’ about the joined-up agenda and a lack of agreement about which organisation should lead which ventures appeared to undermine the success of initiatives aimed at joining up services in a systems-wide approach, as did the absence of a pooled or shared budget. ( Regen, E. et al. (2008) ‘Challenges, bene? ts and weaknesses of intermediate care) Differences in resource and spending criteria between local authorities and NHS partners were thought to undermine the aims of joint working. The barriers within partnership are evident.
By all means new strategies need to be considered in order to reduce the negatives. The ways to improve partnership through some efficient strategies can be related to the following circumstances and references: Effective communication was reported to enhance joint working in a number of studies. (Brown, L. , Domokos, T. and Tucker, C,2003) For example, informal and open communication within a multi-disciplinary group was held to be valuable in assisting a newly-established scheme, and enhanced communication associated with integrating services was perceived to lead to improved outcomes for people using services.
Identify bespoke solutions. “Not all partnerships are of equal stature, and there isn’t one type of partnership that fits all situations – bespoke solutions with bespoke partners will best meet local needs”. ( Professor Sir Michael Marmot 2010) For example, Merseyside Fire and Rescue Service has more than 200 partnerships, some formal and others informal. Structure matters less than purpose. If there’s a lesson from successive NHS or social reorganisations, it’s the process of the attainment of the right structure which always appears as a futile quest.
As an alternative, more appropriate models are urgently needed, such as free partnerships and networks that shift and change according to the issues and tasks. So it’s very important that the level of communication is clear in order to deliver the best service for the people within care. Focus on outcomes. One way to make partnerships more successful is to become more outcome focused and define the purpose or added value of partnerships from the outset. Partnerships may be desirable for some issues and tasks, but may not always be necessary.
They aren’t simply a badge of collaborative working or a way of meeting people – their true value lies in what they can add to a project through shared objectives, aims and outcomes. A good way to focus on the outcomes is to negotiate with the structure of care as long as the person in care receives a good standard of living. Information sharing. Effective mechanisms to share information, including shared documentation and shared or compatible information technology systems were factors identi? ed as improving joint working, leading to speedier and timelier assessments of need.
Effective communication was also reported to lead to cases being prioritised more ef? ciently. Merging budgets where appropriate. Merging budgets could be part of the answer, and already happens, but their potential is often not fully exploited (as shown in a recent report by the Audit Commission). Governance and accountability are most important in delivering productive partnerships. Clarify responsibilities. In most partnerships it’s uncertain who’s responsible or accountable for what does and doesn’t happen.
This needs to change – an individual or organisation must be made accountable for providing outcomes. For example, who ‘owns’ or is responsible for delivering Local Area Agreements, Local Strategic Partnerships or Joint Strategic Needs Assessments (JSNA). In some areas these are effective documents and activities that change local lives, however, in others they are less effective and are often just paper or ‘tick box’ exercises, particularly the JSNA. Possibly, it’s because no one ‘owns’ these policies or is tasked with making them effective agents for change.
We need to make them matter so that partnerships are seen to ‘own’ targets and share responsibilities. Models of empowerment. Central government needs to practice what it preaches. The Health Select Committee spotted that partnership working has been greatly promoted by the Labour government under the title ‘joined-up government’, but examples of top practice at national level are difficult to find. The Cabinet Office Capability Reviews of the Department of Health (2007 and 2009) are critical of the absence of effective joined-up working.
It would be helpful if central government demonstrated how effective partnership working can be, thereby setting a good example for those working locally. Most of all, there needs to be clarity about what partnerships are trying to achieve. Consequently, we will be likely to have partnerships that truly make a difference to health inequalities. This essay has explored and analysed the concepts of partnership and its effectiveness for health and social care. Partnerships and collaborations can be seen as innovative solutions to new problems.
However, current cases reflect an adverse view of the paternalistic state with its impressive narratives of fairness and equality, and a more optimistic view that wants to put the client at the heart of things. Without a doubt there seems to be many disadvantages within partnerships yet, improvements can be made by increasing the funds within the health sector by settling the dispute between social care professionals and the NHS. This will benefit the service users as they would be offered a more efficient care package.