Bob Hudson

Interprofessionality in health and social care : the Achilles' heel of partnership

Partnership working is now a central plank of public policy in the UK, especially in the field of health and social care. However, much of the policy thrust has been at the level of interorganisational working rather than at the level of interprofessional partnerships. The empirical and theoretical literature is largely sceptical about the feasibility of effective joint working between separate but related professionals--the pessimistic tradition. Based upon an empirical study of general practitioners, community nurses and social workers in northern England, this article challenges such a tradition and proposes an optimistic hypothesis for further investigation.

From Adolescence to Young Adulthood: The partnership challenge for learning disability services in England

The transition from adolescence to young adulthood is acknowledged to be difficult for all young people, but the problems facing those with a learning disability will tend to be greater. This article identifies these additional difficulties, and considers the extent to which new policy requirements and expectations in England can address them. At the heart of this new approach is the need for partnership working between a complex range of agencies and professionals. What is at stake is not only a better system of support for some vulnerable young people, but also—in microcosm—the viability of partnership working as a policy tool for addressing complex issues.

Prospects for collaboration in primary care: relationships between social services and the new PCGs

The article considers the relationships established between the new Primary Care Groups (PCGs) in England and Social Services Departments. It reports on qualitative research into localisation and collaboration in PCGs and reviews the main factors involved in the creation of collaborative relationships. Collaboration is a required element of planning in primary care but the extent and nature of its realisation is shaped by the particular interaction of local history with the new structures. Four localities were chosen for the qualitative stage of the research in order to learn how local configurations and existing relationships affected, and were affected by, the PCG. The article identifies the complex relationships which exist between PCGs and social services and the discusses the main features in promoting or undermining collaboration.

Circumstances Change Cases: Local Government and the NHS

The role of local government in health care matters in Britain has never been trouble-free. From the dissolution of the Boards of Guardians in 1929, through to the creation of the NHS in the 1940s and the introduction of the internal market in the 1990s, there have been political and professional arguments surrounding the issue and, for the most part, the case for democratic local governance of health care has failed to carry the day. This paper looks back to earlier debates, examines the current policy context, and looks ahead to possible future scenarios. It argues that the changing circumstances of both the NHS and local government makes this an apposite time to rethink established structures.

Localization and Partnership in the ‘New National Health Service': England and Scotland Compared

This article examines some important and interesting differences in the designs of the ‘New NHS’ in England and Scotland in respect of two common guiding imperatives – localization and partnership. In examining the view of key local stakeholders faced with introducing the changes, we contrast the generally more flexible and less prescriptive approach in Scotland. In England there was, initially, a raft of guidance from the centre: in Scotland, by contrast, there was virtually none. In England the prime bases for localization will be PCGs and PCTs: in Scotland they will be Local Health Care Co-operatives (LHCCs). The latter, like the English PCGs, are to be GP-led; but unlike PCGs, membership is voluntary. Underlying such redesign of the organizational architecture are some important changes in cultures and modes of governance. In particular, we note the rhetoric of a shift, at macro-level, from hierarchies and quasi-markets to networks and the perceived reality of a micro-level shift from individualism to collegiality amongst GPs.

Ten Reasons not to Trust Care Trusts

Within the space of three years, the Department of Health oscillated between a commitment to partnership working and the imposition of structural change in the pursuit of integrated care. The idea of care trusts which integrate health and social care functions acquired political currency, despite the absence of any evidence base to inform the model. This article urges caution and suggests that the partnership model deserves a chance to deliver results.

Working Together in Children's Services: A Time to be Bold?

The number of children in England, and the number who may need additional support from services, is large and growing. At the latest count there are approximately three million children aged under five, 6.4 m aged 5‐14, and 3.1m young people aged 15‐19. Children and young people from ethnic minority backgrounds make up about a fifth of the total population under 20 ‐ much higher than for other age groups. In total there are reckoned to be 12m children, 400,000 children in need, 59,700 looked after children, 320,000 disabled children, 600,000 live births a year and approximately one million with mental health disorders (DoH, 2003a).No single agency or profession can cater for such a large and disparate number of individuals, but increasingly their needs are crossing traditional organisational and professional boundaries. The partnership imperative that has become so influential in services for adults is now set to re‐shape the domain of childrens services. Accordingly, the aim of this article is to examine the genesis of this imperative, to explore the emergent policy responses and to gauge their likely effectiveness.

Primary Health Care and Social Care: Working across Professional Boundaries: Part Two: Models of Inter‐Professional Collaboration

In the second part of this two‐part feature, four models of inter‐professional collaboration are explored, each of them representing points on a continuum from lower to higher levels of collaboration.The four are:• Communication: interactions are confined to facilitating the exchange of information.• Co‐ordination: individuals remain in separate organisations and locations, but develop formal ways of working across these boundaries.• Co‐location: members of different professions are physically located alongside each other.• Commissioning: professionals with a commissioning remit develop a shared approach to the activity

Community Care Plans and Children's Services Plans: The Renaissance of State Planning in Welfare?

Although the most prominent guiding concepts in the welfare reforms of the Thatcher years were those of quasi‐markets and competition, there were also significant developments in state planning and co‐operation between agencies. The most obvious expression of this relates to the legal obligation to undertake community care planning, and this has now been supplemented by a parallel requirement to plan services for children. This Case Study looks back at the early experiences of community care planning, looks ahead to the issues which will have to be addressed in the new childrens services plans, and teases out the messages for transferred learning. It warns that local inter‐agency planning has no qualities of spontaneous growth or self‐perpetuation, and that without safeguards the process is at risk of becoming marginalised.

Keeping it Personal: Supporting People with Complex and Multiple Needs

As the social care system ‐ and potentially the health care system and other public services ‐ move increasingly towards a model of personalised support, questions arise about whether and how it can work for people with multiple and complex needs. The evidence is that it is possible to achieve this, and that the outcomes and quality of life can be dramatically improved, but many councils and their partners have yet to move into this demanding activity, and face considerable obstacles in the form of conventional approaches to policy and practice if and when they do. This article draws on the findings of a special study undertaken for the Commission for Social Care Inspection. Alongside some of the difficulties of personalising support for people with multiple and complex needs are inspirational stories of innovative developments which have transformed the lives of people and their carers.