The 6 problems of joint working

Goverment is still trying to use the previous paradigm of inter-organisational alliances in a globe that has moved on. Photograph: Alamy

We could be forgiven for thinking we are getting into a healthcare partnering nirvana in England these days, with the arrival of various initiatives such as the Better Care Fund, the integration pioneers, overall health and wellbeing boards and the rest.

There is no doubt that there is a require for far better joint working, but these initiatives and structures have to be set against the scale of the challenges – and there are six huge ones.

Moving from horizontal to vertical integration

Classic joint working has consisted of strategic alliances amongst kindred organisations. The solution has been a plethora of unrealistic strategies that have gathered dust.

Vertical integration requires tracking and co-ordinating support for individuals all through complex inter-organisational and inter-expert journeys. It is considerably harder and we do not know how to do it.

Moving from institution-centred to neighborhood-centred relationships

The notion that partnering is simply about relationships amongst institutions is redundant. Two new community-centred relationships have to be formed. 1st with community “assets” – people and groups with untapped “social capital” – and secondly with the wider public through a lot more robust designs of representative and participatory engagement. These duties have barely begun.

Moving from an financial to a quality target

The early assumption was that partnership operating was all about being expense-efficient, but in reality the costs have been hardly ever calculated and the advantages have been tough to estimate. Increasingly the emphasis wants to shift towards demonstrating better outcomes rather than lowering charges. This is significantly far more complex.

Moving from an organisational to a consumer-centred point of view

The dominant partnership paradigm has been that of organisational “win-wins”, with an assumption that what is excellent for organisations will be very good for support customers. This will no longer wash. The views and experiences of those on the acquiring finish of “integrated care” want to be centre-stage – yet we know subsequent to absolutely nothing about them.

Moving from structural modify to cultural adjust

For more than 40 many years governments have pulled the levers of structural alter. The consequence has been instability and fragmentation which is inimical to settled joint relationships. The concentrate now needs to shift to cultural adjust. But, although official rhetoric is awash with the notion of “transformational alter”, there is no actual comprehending of how to adjust mindsets. In practice most organisations just depart it in the “challenging to do” box.

Moving from statutory to inter-sectoral partnerships

The previous model of partnership working consisted of two (or far more) effective statutory agencies operating collectively. This landscape has changed beyond recognition. The purchaser-supplier split in both the NHS and local government has brought fragmentation and this is additional challenging by the privatisation of provision in social care and, more and more, healthcare. Partnership fans definitely now seem at the organisational landscape and weep.

How do the most recent partnership wheezes measure up against these issues? Rather badly is the reply. They are nonetheless trying to use the previous paradigm of strategic, inter-organisational alliances in a planet that has moved on. There is no explanation to doubt that services end users want better joined-up care and there is practically definitely widespread enthusiasm between frontline practitioners. The issue lies more up the policy food chain.

The paradox right here is that the Department of Overall health parrots the partnership mantra, but promotes policies that undermine it even though doing little to get rid of longstanding obstacles.

A critical technique would, at a minimum, need to appear at the way resources are allotted, the way “the technique” is judged and functionality-managed, the way regulators and inspectorates operate and the way the workforce is created and specialist advancement secured.

The blunder of the 1970s by way of to the 1990s was to see partnership functioning as a “bolt-on” to every day enterprise rather than a mainstream concern. It was “everybody’s distant relative but nobody’s infant”, as Sir Roy Griffiths memorably explained of community care.

The mistake considering that 2001 has been even a lot more fundamental. First New Labour and now, far more aggressively, the coalition government, have subjugated co-ordination to competing policy imperatives. The leitmotifs today are competition, choice, tendering, outsourcing and value for income. This is a really crowded conceptual market place in which aspirations close to “partnerships” are struggling to obtain leverage.

What this reminds us is that partnership operating is not just a technical task, but the reflection of an ideological stance. A dedication to partnership functioning is also a belief in planning and in the thought that it is attainable to operate in a “complete program” way as prolonged as there is some degree of stability, understanding, support and dedication to carrying out so.

Alternatively, we are seeing apartheid among commissioners and companies. Legal threats to in-property contracts and competitors law are becoming utilized to outlaw even talks about services rationalisation. It is accurate that partnership doing work does not have a fantastic track record of achievement. That is due to the fact it has never been a severe policy goal.

This post is published by Guardian Expert. Join the Healthcare Experts Network to obtain regular emails and unique provides.

The 6 problems of joint working