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 experience in trying to organise the kind of care they want...... It is essential that health and social services authorities..... work together towards shared objectives.”

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.

Agreed definitions

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.


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 stakeholders. The beginnings of a solution lie with effective leadership and the recognition and management of diversity.


To enable the stakeholders to collaborate effectively requires strong leadership 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.

Elderly people

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 these.

How SSSP can help

Every situation is different but we can most frequently be of help in exploring creative ways of involving users and carers in the evaluation of services. Secondly we can facilitate the progress towards agreement about understandable and achievable objectives by searching for the common ground beneath the different perceptions.

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.

Keith Fletcher.

© SSSP Ltd., September 2003