By Keith Fletcher.

(A version of this article first appeared in “Community Care” on 2 September 1999 and is reproduced here with the agreement of the editor.)

Last September the Department of Health produced a discussion paper, “Partnership in Action”, demanding closer collaboration between health and social services. They surely don’t think nobody has insisted before. But such exhortations create a focus and an opportunity to strengthen partnerships and build new ones. The question is: how?

First, what is the Partnership in Action proposing? In the longer term the Government intends to remove some of the more obvious structural barriers by introducing powers to pool budgets, establish lead commissioners and provide integrated provision. Those changes will certainly help; there are always administrative obstacles to overcome and to see some of them disappear will certainly be welcome.

The rest of the paper contains the standard phrases: national priorities, performance frameworks, joint review and of course inspection: the medicinal compound to cure all ills. But monitoring partnership is not really the point. Virtue lies in providing a better service, more closely in line with what the client wants. It just happens that, in social services, it always implies effective collaboration with a host of other services. Because working together is necessary to achieve objectives does not mean that you will achieve objectives simply by working together.

All the agencies have different purposes; that is why they are different. There might be considerable overlap and interface between the health and social services and they are often serving the same groups of people but they are not providing the same services. They are accountable for different things and have different objectives. Collaboration works best where there is an over-riding objective which all the agencies sign up to. Finding those objectives and defining them precisely and unambiguously is the first key step to effective partnership.

The new idea, largely driven by the “best value” initiative, is to engage clients/patients and carers actively in the process of identifying the objectives. The top down “strategic co-ordination” model simply cannot achieve this because it is about top management coming together and working out a strategy. Users and carers don’t have any “top management” and attempts to create a surrogate for it are token gestures. Partnership needs to become a multi-level, multi-lateral process which engages operational staff, informal carers and service users in an active dialogue. The strategy agreed between senior management and politicians should address already explicit demands and expectations which have been raised by the process.

Staff with face to face contact with service users have always worked together, sometimes in spite of the system. Because they do have face to face contact they should have a better understanding of how users experience things than senior managers. For the first time the technology is available to aggregate information and make it accessible to inform all sorts of decisions. To open up those pathways of information but it requires managers and staff to recognise what a powerful resource they already possess and that requires training. Staff need to recognise the value of what they know and the organisations need a system to enable them to store it easily and retrieve it when they want it.

The biggest obstacle is the users and carers perception of their place at the margin of the process. They are already vulnerable simply because they need the service. They often feel they have few rights and no responsibilities. Staff sometimes exacerbate these feelings quite unconsciously: for example how many elderly people actually like to be called by their first name by staff a third their age? Operational staff are best placed to enable service users to recognise and assert their rights and to demand that they accept their share of responsibility for the quality of the service. Leadership is about asserting those rights and responsibilities throughout the organisation.

Created 8 September 1999