Ailsa Cook

Partnership working and outcomes: do health and social care partnerships deliver for users and carers?

Working in partnership, both across social care and health and with service users, has been a persistent theme of the health and social care modernisation agenda in the United Kingdom. Despite a relatively underdeveloped evidence base, the development of health and social care partnerships has continued to feature in recent policy and legislative initiatives in the United Kingdom. At the same time there has been a major shift in focus towards the outcomes that support services deliver. A central question remaining is whether the policy initiatives driving the development of health and social care partnerships are delivering improved outcomes, particularly the outcomes valued by people who use services. This article outlines research designed to explore this issue across 15 health and social care partnerships in England and Scotland, building from previous research by the Social Policy Research Unit based at the University of York. It sought to assess the extent to which health and social care partnerships deliver the outcomes that people who use services value, and to determine the features of partnership working associated with the delivery of these outcomes. A robust outcomes framework was defined, which provided the basis for interviews with those receiving support from partnerships. Working with three user-researcher organisations, interviews were completed with 230 individuals in 2006. On the basis of this, some service users were able to identify features of partnership that particularly contributed to improved outcomes. These included continuity of staff and sufficient staff and a range of resources, including the availability of long-term and preventative services. Given the definitional and methodological complexity surrounding partnership working, and the challenges of attribution, the study faced some limitations in its ability to make wider inferences about partnership and outcomes. A theory of change should be employed in future studies of this type.

Building Capacity in Health and Social Care Partnerships: Key Messages from a Multi‐Stakeholder Network

Successful development of health and social care partnerships is contingent on the contribution of all stakeholder groups to overcome the ‘wicked’ issues that beset the field. This article explores four key issues, identified by a network of diverse stakeholders as vital to the future of health and social care partnerships, and proposes ways in which individuals and organisations from all stakeholder groups can support health and social care organisations to work together to deliver good outcomes to service users and their carers.

Alcohol-related brain damage: Narrative storylines and risk constructions

To date, the voice and experience of people with alcohol-related brain damage has been silent in the literature. Using narrative research methodology and a focus on risk and quality of life, this paper outlines the analysis of interviews with six people with alcohol-related brain damage who were resident on a specialist care unit for the condition. Of the six participants, four were interviewed twice in line with the study protocol and separate interviews were conducted with a key worker on the unit, a social worker and a relative of one of the female participants. Analysis of the interviews revealed three dominant, narrative storylines: Five Minute Memory; Fractured Lives; and Believing in Recovery. Risk was constructed and experienced in a variety of ways under each of these narrative storylines, but each participant was particularly vulnerable to the assimilation of alcohol-related brain damage as a component and projection of self and identity. In addition, the process of ‘prompting’ emerged as a way that care staff constructed and discharged their rehabilitative function on the care unit and worked to minimise risk factors. A more co-ordinated, robust and transparent funding, policy, education and service structure for people with alcohol-related brain damage is called for.

Outcomes for Users and Carers in the Context of Health and Social Care Partnership Working: From Research to Practice

There is currently much policy emphasis on both partnership working between health and social services in the UK and on the outcomes delivered by services. This article provides an account of two consecutive projects centred on these two themes. The first project, at the University of Glasgow, sought to address the lack of evidence about the outcomes delivered to service users by partnerships. Following from this project, the Joint Improvement Team of the Scottish Government commissioned the researchers to develop a toolkit to involve users and unpaid carers in performance management in community care in Scotland. The remit of this second project expanded during 2007 as it became linked with the development of the emerging National Outcomes Framework for community care in Scotland. This article outlines the outcomes-based piloting work currently under way in Scotland.

Education for integration: four pedagogical principles

Purpose – The purpose of this paper is to consider how postgraduate education can contribute to the effective integration of health and social care through supporting public service managers to develop the skills required for collaborative working. Design/methodology/approach – Review of documentation from ten years of delivery of a part-time postgraduate programme for health and social care managers, critical reflection on the findings in light of relevant literature. Findings – The health and social care managers participating in this postgraduate programme report working across complex, shifting and hidden boundaries. Effective education for integration should: ground learning in experience; develop a shared language; be inter-professional and co-produced; and support skill development. Originality/value – This paper addresses a gap in the literature relating to the educational and development needs of health and social care managers leading collaborative working.

Can we mandate partnership working? Top down meets bottom up in structural reforms in Scotland and Norway

Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals.,The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways.,The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources.,Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.