Foreword
This paper highlights the importance of partnership while working in a health and social care. Partnership working indicates a shift from an organisational competition culture of public organisation to a service user need-guided approach to service delivery. In other words, it indicates that the needs of the service user are more important than the needs of the organisation. This paper analyses philosophies and concepts of partnership by drawing from two cases in health and social care. Further, it makes important recommendations on how different parties can have a mutually beneficial partnership where the needs of each party are met.
Executive Summary
Partnerships play an important role in ensuring quality service delivery by public organisations. Through partnerships, different organisations and parties come together to establish a strong relationship that guides how they are going to ensure that the needs of each party are met. In doing so, communication becomes an important aspect in a successful partnership since it acts as the channel through which goals and expectations are communicated together with their mode of achievement.
However, when partnerships fail, the parties are bound to suffer as evidenced in the two cases that are discussed in the paper. This paper highlights the key concepts, principles, and philosophies of partnerships. It relates them to the two cases to highlight where and how failures on the part of the organisations contribute to the unfortunate events in the two cases. Lastly, recommendations to avoid barriers of partnership are also discussed.
Introduction
Health and community care service providers and bodies have a constitutional obligation to provide sufficient, pertinent, and open services that fulfil the demands of their particular confined people. According to Burke (2001), for health and social care providers to meet their obligations, it is important to engage in partnerships that will facilitate this process. The concept of partnership is central to government’s public services policy. It indicates the breaking down of organisational barriers and fostering a strong relationship between service providers, local authorities, and the people being served (Henneman, Lee, & Cohen 2003).
Partnerships indicate a shift from a competition culture of public organisations to a structure that fosters openness and public involvement and an emphasis on the needs of the population and not the demands of the institution (Bahador 2000). In this paper, two cases in health and social care (HSC) will be analysed with an aim of understanding how various concepts of partnerships can be applied effectively to ensure best service delivery to populations.
Philosophies and Concepts of Working in Partnership in the Health and Social Care
There are three key principles of partnership working, namely openness, trust, and honesty between partners, agreed shared goals and values, and regular communication between partners (Stewart & Reutter 2001). For a partnership to work, these principles must be implemented wholly. In the first case of David Askew, a 64-year-old man who died after a decade of harassment by gangs of youth in Hattersley, Greater Manchester, the police officer’s actions of protecting or not protecting the man are put into question (Carter 2010).
The local community questions whether the police had done enough to protect the man who had learning difficulties from harassment from youths over a period of ten years. From this case, it is clear that the philosophies and principles of partnerships were not implemented. Like any other social service, policing requires collaboration between the community and police authorities (Davies, Nutley, & Smith 2000). Firstly, it is evident that the principle of regular communication between partners was not effectively implemented in this case.
According to Secker and Hill (2001), active communication between parties is of great importance since it allows a clear understanding of the expectations of each other. In the case of David Askew, his neighbours clearly indicate that after complaining several times to the police on the apparent harassment of the man, they had to stop since there were no actions that were taken by the police to address the issue (Doran 2001). Further, the family of Askew had made numerous reports to the police regarding the harassment and no actions were taken to satisfactorily protect the victim (Carter 2010). In their relationship, the police and the community do not trust each other since there is no openness. This situation leads to lack of shared goals and visions, and hence a difficult policing process.
In the second case, approximately 1,200 deaths at Mid-Staffordshire Trust have been linked to ‘appalling standards of care’ at the hospital. According to the article, it is evident that the hospital has lost its focus by striving to meet its internal targets at the cost of the quality of care that patients receive at the facility. Barador (2007) puts it that health and social care providers must focus on the needs of the population but not on their needs. However, Mid-Staffordshire was keen on meeting the internal target of saving over £10 million in its annual budget. In its quest, it ‘lost sight’ of its responsibilities of offering quality and relevant patient care.
According to Brown, Crawford and Darongkama (2000), partnership working is composed of a complex network of relationships that are important in the commissioning and delivery of services. These networks are important in six main areas of partnership working, which include preparation, recruiting on contractual basis, educating, interacting with customers and attendants, personnel growth and tuition, joint assignment and intertwined service provision, and checking, re-examination, and instruction. In the case of Mid-Staffordshire, networks are lacking, as it is apparent from the casual manner in which services are provided.
For instance, following an investigation by Healthcare Commission, it was revealed that nurses were overstretched and poorly trained. The situation led to human error in the running of equipments as well as poor hygiene of the facility where patients were left with soiled bedclothes and unattended to for long hours (Smith 2009). The failure of the hospital to provide quality patient care is a clear indication of its failure to adhere to the principles of partnership that call for frankness, confidence, and integrity between associates, agreed shared objectives and standards, and customary contact between the associates.
Partnership Relationships within Health and Social Care
Partnership working must adhere to the guidelines of law or any other related guidance with linkages to local policies, protocols, and procedures. For these partnerships to work effectively, it is important to ensure that the relevant laws, policies, and guidelines are applied to the corresponding areas of health and social care (HSC) (Glasby 2009; Carnwell 2005).
For instance, the Police Reform and Social Responsibility Act of 2011 calls for cooperative working where local policing bodies must work together and closely with the local communities to ensure that relevant areas of priority in terms of security are identified for each responsible body (Nolan 2007; Dicknson 2008; Clear & Hamilton 2011). Further, the legislation recognises the importance of close collaboration between different policing agencies in providing good policing services to the community.
In the case of David Askew, the legal guidelines and frameworks of the time under the Police Act of 1996 called for close partnership between local communities and policing authorities (Liamputtong 2003; Stevens 2002). However, the policing agencies failed to follow the guideline of the existing legislation and frameworks. Despite the victim’s plight being known by the Manchester Police Force, its lack of action, and the subsequent death of David from the harassment, it can be said that the legislation and framework that govern community safety and crime prevention were not applied as it was expected.
The reason behind this failure was lack of strong collaboration between different policing agencies in the area. Further, lack of collaboration between the local community and the policing agencies was also a major player in the case (Gulliver, Peck & Towell 2002). The guidelines and frameworks that govern community policing are sufficient. They can be very effective in preventing such crimes when implemented through close partnership between all relevant parties (Fletcher, 2006; Miller & Karen 2005).
In the second case of Mid-Staffordshire Trust, legal guidelines and frameworks were not effectively implemented. According to DoH (1999), based on the NHS and Community Care Act of 1990 and Fair Access to Care Services of 2002, it is important for healthcare providers to put the needs of patients ahead of the needs of their institution. It is the right of the patients to receive the highest quality and relevant healthcare since this requirement is enshrined in existing legislation (Gulliver, Peck, & Towell 2002).
However, the fact that the management of the facility focuses on cutting costs at the peril of its patients is a key indicator of ignorance and disregard of the core purposes of the facility. The fact that nurses are untrained and the facility understaffed when it is obvious that not all is well signifies a lack of responsibility for those who are trusted to ensure patient care takes precedence over all other needs. Elaborate legislation and frameworks serve healthcare sector due to its sensitive nature. Consequently, although the existing frameworks and guidelines are sufficient, the management fails to ensure that they are followed to the latter to benefit patients who should be the focus of healthcare facilities.
Models of Partnerships Working Across the Health and Social Care Sector
Different authors have suggested various models of partnership working. The implementation of such models is critical in the successful delivery of health and social care. For instance, Vangens and Huxham (2003) suggest five models of partnership working, which include decision-making groups, consultation and training, centre-based delivery, co-ordinated delivery, and operational team delivery.
On the other hand, Rocket Science (2003) suggests three models of partnership working that include synergy or benefit model, transformation model, and budget enlargement model. Saint-Onge and Armstrong (2004) support the models that Rocket Science advances. They claim that organisations must find a balance between the effective implementation of these models to reach their ultimate goal of delivering quality and relevant care to the communities that they serve.
In the two cases discussed in this paper, there were systematic failures to implement some of the models. The result was poor service and care delivery. However, it is evident that some of the requirements of models of partnerships have been met by the organisations in question. For instance, in the case of the NHS facility and Mid-Staffordshire Trust, the organisation has realised its unsustainable budget and operational costs and hence put on efforts to save over £10 million in its ballooning budget (Smith 2009).
This plan is in line with the budget enlargement model, which advocates maximisation of resources that are brought in the health and social care organisations to address complex policy and welfare problems (Ranade 2004). In the second case of David Askew, no particular models were implemented effectively. For instance, from the case, it is evident that decision-making groups failed to take proper actions to deliver policing services that would have saved the victim from a decade of harassment, despite the fact that the local community did its part by reporting the matter numerous times. Ideally, the situation would have been a wakeup call for the police to act.
Models of partnerships are important and beneficial if implemented effectively. However, if not implemented well, they may be a hindrance to quality care and service delivery (Wildridge et al. 2004). For instance, in the case of Mid-Staffordshire, while it was in order to put cost-cutting measures, doing so at the expense of the quality of patient care revealed how improper the implementation of the models could have negative consequences.
According to Peterman and Peterman (2000), partnership models should act as facilitating agents towards excellent and community-focused healthcare and services. This process calls for the effective communication, well-understood goals, and trust between parties in the partnership. In the case of David Askew, the failure of one party to deliver as expected in a partnership highlight the need for engagement and responsibility for each party to carry the expected duties.
Legislation and Organisational Practices and Policies for Partnership in Health and Social Care
The legislation that exists in health and social care was adequate to address the issues that the two cases have brought forward. For instance, the Police Act of 1996 has a provision for community safety and crime prevention. Proper implementation of this policy requires close partnership working to ensure that policing agencies and local communities understand their roles and expectations of each other (McGuire 2006; Peckham & Exworthy 2003).
However, it is important for the practices and policies at the organisational level to conform to the requirements of the existing legislation in order to have a good service delivery. In the healthcare sector, the NHS and Community Care Act of 1990 and Fair Access to Care Services of 2002 guide how healthcare providers can conduct their businesses to ensure that the given care is patient centred.
However, the policies and practices at the organisations are not adequate to address the two cases effectively. For instance, at the healthcare facility, policies that guide the facility to prioritise on patient care were not effective. Instead, the cost and resource management policies took precedence. In the case of policing, policies that guide close partnerships between the local community and the police agencies had broken down. In addition to lack of adequate internal policies and practices to guide resources effectively to handle such cases, this situation led to the unfortunate turn of events.
Differences in Working Practices across the Health and Social Care Sector
In the provision of quality and relevant health and social services, partnerships play a pivotal role. According to Bahador (2000), differences between the parties in partnership are likely to derail any progress that may have been achieved in the process of creating a collaborative working environment. For example, shared goals and visions, which are a key principle of partnership, call for a clear understanding between parties on what they are expected to do to achieve the overall goal of providing adequate, timely, and relevant health and social care services to the recipients of the service (Billingsley & Lang 2002; El Ansari & Philips 2001).
In the two cases, it is evident that there were differences in working practices between the various parties in the partnership. The result was lack of a clear understanding of the goals of the partnership and clear boundaries on the responsibilities of each party.
For instance, in the case of Mid-Staffordshire Trust, lack of a clear understanding of the main goals of the organisation led to incompatibilities and paradoxes. This outcome was intrinsic to the pursuance of diverse goals, including coordination and co-governance (Chassin et al. 2010) and problems in stability and control of the activities of each party (Henneman, Lee, & Cohen 2003; Masterson 2002). In this case, the organisation adopted new goals of saving costs. It abandoned its legally required roles of providing patient-centred care.
In the second case, the working practices of the police agency are put into question. It is the mandate of the police to offer security to all members of the local community, regardless of their status. While the case was well known by the police and the community, lack of action by the police and the complaints expressed by the local community on their disappointment are a key indication that the police officers’ actions did not conform to the duties and responsibilities bestowed on them.
The case brings a blame game that is directed at the police officers who are quick to defend themselves concerning the allegations of their inaction. What can be learned from this case is that the guidelines of collaboration were not effective. Hence, the local community and the police did not subscribe to the same goals and vision. Without proper communication and shared goals, it was not easy to maintain a collaborative working between the agencies and the service users and hence the subsequent failures that were evident in the two cases.
Outcomes of Partnership Working for Use of Services Professionals and Organisations
In the two cases, it is evident that partnership working was a failure. This malfunction came with consequences to the organisations, professionals and service users. For service users, the outcomes included harm, anger, and a feeling of neglect. For instance, in the case of Mid-Staffordshire Trust, the 1200 excess deaths were uncalled for if only partnership and collaborative working practices could have been implemented effectively. Unless drastic measures are taken to change the situation, it will be difficult for service users to gain confidence in the patient care and services that are delivered at the facility.
In the case of David Askew and the local police, the failure of the partnership led to a feeling of neglect among the local community members. They felt that the police had been adamant in taking proper actions to stop the harassment that would have saved the life of the victim. For the organisation and professionals, the failure of the partnership led to breakdown of communication, which cost them their reputation whilst jeopardising their ability to deliver quality services to users. To achieve better partnership outcomes, it is important for the parties to have improved communication and practitioner involvement (ODPM 2005; Beer & Nohria 2001).
Barriers to Partnership Working in Health and Social Care
Several barriers to partnership working are in play in the two cases. Firstly, in the case of David Askew, there is a breakdown of communication between the police and the local community. This observation is evident when the two parties seem to be reading from different scripts on case. While the community is blaming the police for laxity in taking actions to prevent the victim from a decade-long harassment, the police officers are pointing out that they have been in constant communication with the family of the victim. In the second case of Mid-Staffordshire, the main barrier is lack of shared goals between the different professionals at the facility. By focusing cost-cutting measures, the management neglects the main goals of the facility of providing quality service and care to patients.
Strategies to Improve Outcomes for Partnership Working in Health and Social Care Services
To improve the effectiveness and outcomes of partnership working in health and social care services, Gulliver, Peck, and Towell (2002) suggest three categories of motivators and drivers of success. Firstly, it is important for organisations to focus on increasing efficiency, which leads to improved quality of communication, cost-effectiveness of services, and efficiency of the services to the users. Further, this strategy is important since it allows the sharing of ideas between partners on the best approaches of maintaining a mutually beneficial partnership. The second strategy is improvement of inclusiveness.
In this case, organisations must strive to create channels that will promote participation of all parties in the process of creating goals and visions that govern the collaboration. Lastly, integration between different agencies and parties to collaboration is important in ensuring that activities are neither duplicated nor overlooked since each party understands the responsibilities that must be performed to make the partnership mutually beneficial (Glendinning 2003).
Conclusion
From the above cases, important lessons have been learned on how failures in partnership working can have serious repercussions on service users as well as the organisation. It is evident that failure of communication and shared goals and expectations can lead to denial of quality services to those who deserve them. Issues such as the loss of 1200 lives at Mid-Staffordshire Trust and the death of David Askew in Greater Manchester show the devastating consequences of failed partnerships. Consequently, to ensure quality delivery of services, it is important for the principles, legislation, and policies that govern collaborative service delivery to be strictly adhered to.
Proposals
For partnership working to be effective, it is important for parties in the partnership to ensure effective and constant communication, create shared goals and visions, and lastly work collaboratively to ensure that the expectations of each other are not only met, but also in line with the existing legislation and policies in health and social care.
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