Partnership and Services for Elderly People
Partnership is one of the key words for the new millennium
in health and social services. In September 1998 the Government produced
a discussion document entitled (in England) “Partnership in Action”. It
is the backdrop for half a dozen initiatives with a bewildering array of
acronyms designed to promote a more collaborative way of working. But anyone
who has ever tried knows that in practice, as opposed to in meetings, it
is extremely difficult to deliver.
Why is that, and what can we do to make it easier?
What’s the problem?
You can only co-operate to do something when you have agreed what it is
you want to do. In the introduction to its discussion paper the Department
of Health says, “We must address the frustrations and distress people
in trying to organise the kind of care they want...... It is essential
that health and social services authorities..... work together towards
Collaboration between health and social services professionals to develop
a more strategic approach to their (joint) services has a long but not
very fruitful history. The recent Government initiative has given it new
impetus but the first key step is to agree explicit common objectives.
It is not easy to do that and the necessity is not always recognised.
There are many problems but no common agreement about what they are and
which are most important so we need to find some. Perception depends on
the rôle of the beholder and we are all part of somebody else’s problem.
Consider these two examples taken at random.
A GP practice abandons its appointment system for morning surgery resulting
in a very long wait for patients. The measure is introduced as a rationing
process to contain rising demand and growing pressure. But the solution
for the GPs creates a problem for the patients.
Continuing care (between hospital and community) seems as intractable as
ever in spite of considerable guidance and litigation. Health and local
authorities, each with their own financial priorities, define the problem
in diametrically contrary terms.
The four major stakeholders are the political/administrative authorities,
the professionals, the carers and families and the patient/client consumers.
Of course they are all internally diverse. They must all contribute to
a description of the target problems to be addressed first. The voices
of the latter two are weak and fragmented. And there is often an
unspoken colonialism underlying the attitude of the two powerful
The beginnings of a solution lie with effective leadership and the
and management of diversity.
To enable the stakeholders to collaborate effectively requires strong
from people who are able to facilitate the interests of all the groups
without partiality. Leaders must avoid:-
Leadership of this kind is required throughout the services. It is not
just a matter of how top level strategic meetings are chaired. In fact
the most important leadership rôle in enabling clients/patients and
carers to take their responsibility for influencing the services needs
to come initially from staff with face to face contact.
setting the agenda in terms of their own knowledge or power base;
giving greatest attention to the loudest voices and those with the most
“going through the motions” by setting questions which lead people by the
nose to a limited range of answers.
There is no agreed definition about who meets the description “elderly
people”. Even if there were the idea that have common needs, demands or
opinions is plainly absurd. But the range of services and the kind of demands
which the group makes of the health and social services is plainly different
from those of the other major patient/client groups. Though the principle
of engaging service users in partnership is universal the ways to approach
them are specific to each group.
Elderly people are, for the most part, fully responsible adults in
control of their own affairs. They are however frequently infantilised
and marginalised. The dependency which creates a demand for the service
in the first place is often exacerbated by their own feeling that they
make no contribution to it. But the services need their contribution and
they need to make it. They need encouragement to regard themselves as having
a responsibility to influence the quality of the services by making
their views known.
Before joint work is possible you have to create some broadly agreed targets.
They will not be seen nor described in the same way from the perspectives
of the different stakeholders. Imaginative facilitation is needed to produce
commonly agreed objectives out of them. Once agreed the next steps are
Who to engage in tackling them and how.
Whether to review existing structures.
Who to take the lead on each target.
How to make sure that voices are heard.
How SSSP can help
Every situation is different but we can most frequently be of help in
creative ways of involving users and carers in the evaluation of services.
Secondly we can facilitate the progress towards agreement about
and achievable objectives by searching for the common ground beneath the
About Keith Fletcher
Keith Fletcher has written “Best Value Social Services” and “Negotiation
for Health and Social Services Professionals”. He writes regularly on best
value in “Community Care”. He runs seminars specifically on targeting for
best value. He undertook a major feasibility study on behalf a large Germany
voluntary organisation providing integrated services for elderly people
with a view to their establishing a United Kingdom presence. He was formerly
Deputy Chief Inspector in the Social Services Inspectorate for Wales.
What to do now
If you think we may be able to help just send me an e-mail or contact me by other means and we will take it from there. Thank you for your interest. I look forward to hearing from you.
© SSSP Ltd., September 2003