Care Trusts

Partnership Working in Action

Jon Glasby, Edward Peck

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315344836
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book explores the Care Trust concept promoted by central government for improving partnership working between health and social care. Using case studies and examples to raise current issues related to partnership working, it explains how Care Trusts are bridging the gap between health and social care, and considers how they are delivering more co-ordinated services and improved outcomes. All healthcare and social care professionals with responsibility for, involved in or affected by the new partnership working arrangements will find this book useful reading.

PART ONE

Partnership working

The first half of this book explores our existing knowledge about partnership working, much of which will apply to health and social care communities wishing to establish, or at least consider, care trusts. For example, those agencies that have been working together to develop intermediate care services, to pool financial resources or to integrate provision will all have encountered barriers and learned lessons that may equally apply to care trusts.

In particular, Part One covers:

• existing lessons from the partnership working literature (Chapter 1)
• the national evaluation of the Health Act flexibilities (Chapter 2)
• the evaluation of the Somerset Mental Health Partnership Trust (Chapter 3)
• the national evaluation of intermediate care (Chapter 4)
• a service user perspective on user involvement in health and social care partnerships (Chapter 5 ).

CHAPTER 1

What makes effective partnerships between health and social care?

Richard Poxton

The New Labour government which came to power in 1997 was determined to address the failure of public agencies to work together and espoused a political philosophy based more on collaboration than on competition. Frank Dobson (the then Secretary of State) famously stated his intent to break down the ‘Berlin Wall’ between the NHS and social services. This determination was crucially within the wider policy agenda of social inclusion that places health and social care as supporting partners in a wider mission. Thus, the Public Health Green Paper (DoH, 1998a) outlined the role of the NHS not just in terms of ‘curing’ and treating the ill, but rather as part of a network of public functions concerned with promoting a full and healthy lifestyle - alongside local government, employment agencies and others.

The specific policy framework applying to health and social care subsequently built in proposals to operationalise this intent. The NHS and social services (DoH, 1998b, 1999a) White Papers proposed placing a ‘duty of partnership’ on each agency, while health authorities and PCGs were required to have representation on their boards from the local authority. More flexible ways of working across agencies were introduced in the Partnership in Action discussion document (DoH, 1998c; see also Chapter 2). As an example of the current emphasis on partnership working, a series of New Labour policy initiatives are set out in Box 1.1.

Box 1.1 Partnership working under New Labour

Partnership initiatives include:

• A duty of partnership between health and social care.
• Joint planning frameworks (such as joint investment plans between health and local government with regard to continuing and community care services, or health improvement and modernisation plans (HImPs) for improving local health and healthcare).
• New powers to enable health and social care agencies to work together more flexibly (for example, by pooling budgets or integrating provision; see Chapter 2 for further discussion).
• New intermediate care services to prevent unnecessary hospital admissions, facilitate swift hospital discharges and prevent premature admission to long-term residential or nursing care (see Chapter 4).
• Single assessments for older people so that they do not have to give the same personal information to a large number of different health and social care professionals during assessments.
• Integrated community equipment stores.
• Health action zones (HAZs) to improve the health of local communities in areas of high social exclusion.
• New national service frameworks (NSFs) applicable to both health and social services to ensure consistent access to services and quality of care across the country. The first frameworks focus on mental health, coronary heart disease and services for older people.
• Overarching strategic frameworks (local strategic partnerships (LSPs)) to bring together key players locally from the public, private and voluntary sectors (see later in this chapter).
• New children’s trusts to integrate health, education and social care (see Chapter 11 for further discussion).

As a result of New Labour’s emphasis on partnership working, an array of new joint working has begun to develop at an operational level, including joint investment plans, joint assessments of older people’s needs and the establishment of joint rehabilitation schemes. However, the question remains as to whether the policies described in Box 1.1 will be sufficient by themselves to overcome the obstacles that have prevented previous efforts such as joint commissioning from having a greater impact. Also, this emphasis on partnership working between health and social care came at a time when local NHS agencies (increasingly with PCTs at the fore) and social services departments were increasingly being required to work more closely with other areas of local government, as well as with other public agencies and independent and voluntary organisations. Health and social care had struggled with different aspects of partnership working for several decades. The new challenge was not only to make quick and sustainable progress here, but also to make new alliances that would contribute to broader aspects of community and individual well-being.

The purpose of partnerships

One problem in any consideration of what makes for effective partnerships is trying to address the issue of their purpose. If it is clear what partnerships are trying to achieve then it should be less difficult (at least) to determine the degree of success. This challenge is compounded when there is less than total clarity over what is meant by partnership in the first place.

According to one evaluation of a partnership working initiative (Glendinning et al., 2002; see also Chapter 2), partnerships are often established in order to:

• improve efficiency (reduce duplication, use scarce resources better)
• provide more flexible, seamless patterns of services
• redistribute services more equitably across the locality
• enhance the experiences of service users.

Additionally the Audit Commission (1998) has emphasised the importance of partnerships in addressing ‘wicked issues’ such as avoidable hospital admission for older people, as well as the inherent benefit of better co-ordinated services and less organisational fragmentation. More recently the partnership guidance for the learning disability White Paper Valuing People (DoH, 2001) has drawn attention to the impact of services on the lives of individuals. The purpose of partnership here is to achieve social inclusion for people with learning disabilities, based upon enabling them to lead fulfilling lives. This fundamental approach to partnership contains three key elements:

• the aspects of people’s lives embraced by partnership arrangements must encompass all aspects of a person’s aspirations (not just health and social care)
• the organisations involved in the partnership must therefore include all those with an interest or responsibility across this full range of issues (at strategic as well as operational management and practitioner levels)
• the partnership must operate with the person with a learning disability and their wishes and interests at the centre of the decision-making process.

In other policy areas both the extent and the specific applications of partnership working is now much clearer. For example, the National Service Framework for Mental Health (DoH, 1999b) made specific requirements in respect of integrated working at practitioner team level. It has also provided a major impetus for the development not just of partnership working between professionals, but also for the design of integrated systems that seek to present a ‘one stop’ approach to users. Local mental health NSF implementation teams have been set up involving the acute in-patient, community and primary care components of the local NHS together with social services, users, carers and local voluntary agencies. One of the performance measures against which these implementation teams have been assessed and rated by the DoH is the extent to which formal partnership arrangements (e.g. joint management) have been put in place; an early example of partnership working slipping from the permissive category into the obligatory one (see Chapter 11 for further discussion of this phenomenon).

It is also clear from more recent guidance that partnership should be broadened to include education providers, the Employment Agency, Income Support, the Learning and Skills Council, housing associations and others that have a part to play in meeting the comprehensive needs of users. The NSF was also established on the basis of a clear set of values that includes the need to increase the participation of users in the planning and delivery of care (see Chapter 5).

The NHS Plan remains one of the most important policy frameworks within which partnership working is required to operate (DoH, 2000). It offers the prospect of integration within significant parts of the health and social care systems. The emphasis is on the integration of services, whilst also leaving the door open for organisational reconfiguration. However, The NHS Plan has been criticised as focusing too much on hospital provision within the NHS and not doing enough to promote the notion of real ‘whole systems’ working that properly embraces community and primary care services as well as acute: there is still more than a hint of getting hospitals to work more efficiently and all will be well.

But for older people’s services in particular The NHS Plan gives some important directives on what partnership working should cover, including the following:

• a continuing development of a range of intermediate care services designed to cut down the time that people have to spend in hospital (see Chapter 4)
• exploring ways of reducing both the costs and the institutionalised approach to long-term care
• more emphasis on the promotion of healthy ageing and reducing the impact of disabilities
• placing the notion of rehabilitation at the heart of older people’s health and social care services: enabling older people to function at their optimal level regardless of their age or other circumstances
• ensuring that an engagement with users and carers drives policy, practice and service developments (see Chapter 5)
• service reforms that should include: joint health and social care assessments, personal care plans for certain groups of older people, integrated teams working from the same location and ‘one stop shop’ points of entry to the system.

Partnership working in practice

These policy frameworks (with partnership at the core) place the onus for determining ways forward upon local partners, but generally within a tightly defined set of expectations and process requirements. A common theme is that of organisations performing as though they were an integrated whole, even though they remain organisationally separate:

• at a strategic level, agencies are required to plan together and share information about the use of resources, for example through HImPs and joint investment plans
• at the level of operational management, a range of policies require a demonstration of partnership, for example, the Mental Health NSF expects integrated specialist health and social care teams, and the Older People’s NSF requires the implementation of a single assessment process that covers health and social care needs
• at the level of individual care and support, these operational requirements are taken further with expectations of a single point of access, shared information systems and joint training across health and social care staff.

Managing across professional and agency boundaries is a fundamental issue in the drive for ‘joined up’ health and social care. But real achievements will be made only if there is clarity around goals and outcomes for users of services, and if managing across boundaries is part of a broader approach that works at all levels of organisational decision making. For reasons of both effectiveness and efficiency there has been increasing attention given to breaking down old ways of working and replacing these with processes and practices that have users’ needs at the core.

In many ways the services that faced the government when it came to power in 1997 (despite the skills and commitment of many practitioners and managers) could be typified as having:

• multiple entry points
• unwieldy assessments
• user unfriendly care management
• too much emphasis on dependency
• unnecessary admissions to and delayed discharges from hospital
• funding disputes.

Whilst the health and social care system had:

• duplication of effort
• inconsistent collaboration
• limited finance and skills
• lack of community-based and out-of-hours services
• incoherent access arrangements
• confusing lin...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Contributor
• Acknowledgements
• List of abbreviations
• Introduction
• Part One: Partnership working
• Part Two: Care trusts
• Index