Over the past few years, there has been an increase in emphasis on inter-professional working and joined up thinking (Fraser & Matthews 2007). This joint collaboration cuts across all sectors. Whereas this development applies to all areas of public welfare, over the recent years, it has become more evident in health and social sector (Dowling 2004). It has become a central feature of the British social welfare policy, with the UK government emphasizing on partnership working across the National Health Service (NHS), social services, voluntary sector and the community sector as well (Tait& Shah 2007).
Today, the quality of services delivered in health and social care is dependent upon different professionals working together in partnership (Barrette et al. 2005). Advancement in knowledge and development of innovative approaches to service delivery has led to increased specialization such that it has become impossible to have one professional with sufficient knowledge and skills who can respond to the needs of the society. As such, partnerships have become the key to responding to these needs especially in situations that involve complexities.
This emphasis on partnership working can be attributed to the fact that it plays a critical role in effective delivery of services. There is a general contention that partnership working provides a wide range of services that better meet service user needs and leads to more efficient delivery of these services (Fletcher 2006).It is seen as a powerful for tackling complex and multi-faceted problems that are difficult to be solved by any individual body working alone (Audit commission 2006). According to an Audit commission report (1999) Partnerships can be used to solve difficulties facing local agencies such as policy and operational problems; and is a more productive way of ensuring use of scarce resources more effectively.
Whilst there are undeniably many gains to be drawn from partnership working, making partnerships work can be difficult especially where there are too many partners involved. This is arguably one of the toughest challenges that managers often encounter in the public sector. There are complexity and ambiguity issues that may result when working with too many partners which can generate confusion and weaken accountability (Audit commission 2006)
In this regard, this paper explores the topic of partnership working. It discusses the statement: the ‘problem with partnership working is that there are too many partners’;while drawing on evidence from theory, policy and practice.Further, the paper explores some central concepts of partnership working and evaluates the impact of different policies, professional codes and organizational frameworks on partnership working. Additionally, the paper discusses some of the critical factors that promote or hinder partnership workingsuch as culture, equality and diversity.
Before we further delve further into this topic, we will first define what we mean by partnership working and explore the origin of multi-agency partnership working.
Partnership working concept
The conceptof partnership working is often used in reference to business partnerships that involve two people working together to achieve a common goal. As pointed out by Taylor & Le Riche (2006), this concept remains loosely defined in literature and is often expressed through multiple terminologies. According to a definition on Princeton website, partnership refers to a contract in which two or more persons come together to pool talent and resources with the aim of achieving a common purpose. Others have defined partnership as a business entity in which partners agree to share both profits and losses from the business undertaking.
Perhaps a more succinct definition of ‘partnership’ is that put forth by Huxham & Vangen (2005). These authorsused partnership working in reference toany situation wherein people work across organizational boundaries towards a positive end (Huxham & Vangen 2005).Despite the varied set of definitions, the notion of sharing and agreement is clearly evident from these definitions.
Origin of multi-agency partnership working
It is important to note here that partnership working is not a new phenomenon and has been in existence since the early mid nineteenth century when agencies were working together to reduce poverty in England (Carnwell & Buchanan 2008). However, it was during the years of the Thatcher government that partnership working gained its foundations. With the establishment of the Children Act 1989, inter agency collaboration became a statutory requirement in the provision of health and social care services to children and young people
Whereas this term has been used in the past in the business domain, it has gained grounds in health and social care setting as well over the past few decades.However, in health and social care, this term is strongly influenced by policy. In this regard, Gallant et al. (2002) describes the changing trend of partnership in the past few decades. First, emphasis of partnership was initially on equitable sharing. Thirty years down the line, the WHO stressed the need for citizens to take control over their health and become more self-reliant.
Towards the end of the 21st century, the informed public challenged the quality of services provided in health and social care and began searching for more meaningful interactions with providers (Carnwell & Buchanan 2008).Since then, emphasis has been made on the need for multi-agency partnership working and public involvement in service provision. This is reflected in the recent policies such as the Health Act (1999), New NHS Modern Dependable, and Every Child Matters among many others.
Attributes of multi-agency partnership
Multi-agency partnership working is defined by the following core attributes:
Coexistence: – existence of clarity about the roles played by the different agencies
Cooperation: – sharing of information among the agencies and recognition of the mutual benefits and value of such an approach (Douglas 2008).
Coordination: – involves joint planning, sharing of tasks and resources and accepting the need for changes in order to avoid overlap (Douglas 2008).
Collaboration: – long term commitment and agreement to contribute towards an overarching purpose.
Co-ownership: – commitment towards achieving the shared vision.
Over the past few decades, there have been a series of government funded initiatives aimed at promoting integration of services and inter-agency collaboration. A prime example can be seen with the introduction of Private Finance Initiative (PFI) in the early 1990s which led to the collaborative working between the public and private sector in management and delivery of services.
Initiatives such as the Children’s Fund, Sure Start, Best and Connexions, and Youth Offending Teams have been established with the aim of promoting multi-agency working to tackle complex cross-cutting issues. Recently, the Department of Health established a policy that requires local service providers to collaborate and work together in partnership in order to address the wider societal problems of poverty, unemployment, lack of education and poor housing. As part of the commitment towards promoting multi-agency partnership working, the local authorities and primary care trusts are the key partners leading and driving this change (Carnwell & Carson 2005).
Too many partners stultify partnership working
Whilst emphasis has been made on integration of services and joint working especially in health and social care, the effectiveness of this approach has received very little attention. On several occasions, these multi-agency partnerships have failed to deliver the expected outcomes. This is especially the case when there are too many partners involved. A prime example can be seen with the case of Victoria Climbie, a young African child who died from child abuse. The public inquiry reported potential confusion of roles and failure to share information across the various agencies involved as having contributed to the death of Victoria Climbie (Douglas 2008).
The failure of this collaborative partnership working can also be seen with the case of Maria Colwell, a seven year old who tragically died after being abused by her step-father. Inquiries into both cases, Maria Colwell and Victoria Climbie, found considerable confusion and poor inter-agency collaboration (Douglas 2008). Following the death of Victoria Climbie, the effectiveness of multi-agency partnership working was questioned. And as part of the commitment to strengthen partnership working,the Children Act 2004 required Partnerships arrangement to:
Identify needs of children
Identify contribution of each agency towards meeting these needs
Improve information sharing and ensure effective collaboration between the various agencies in the delivery of services.
Although emphasis continue to been made on the need to strengthen collaborative efforts between agencies, failure to coordinate these efforts continues to be seen. This is evident with the recent tragic death of ‘Baby Peter’ (Welstead 2013). This case was also linked to problems with interagency collaboration.
Whilst these failures may have resulted due to many partners, it is not necessarily true that many partners can stultify partnership working. For example, the partnership between the NHS, local voluntary organizations, colleges and service users in Avon and West Wiltshire has so far been a success. This partnership has helped tons of people with serious mental illness back into employment. Another prime example of this successful collaboration can be seen with the Turning Point, an initiative aimed at promoting public health partnerships (Bella 2001). Despite the uniqueness of each partnership, they were all united together to achieve an overarching purpose. This partnership has resulted in improved local health services to the community and increased access to health care.
Partnership working indeed plays a major role in addressing complex societal problems that cannot be addressed solely by any one individual or agency. Many areas especially health and social care require many agencies to work together to address complex health care needs. Having identified the importance of partnership working, it is worthwhile exploring some of the factors that promote partnership working as well as the factors that hinder this joint collaboration. A significant overlap exists between these factors, with some factors that promote partnership working also identified as hindering collaboration if not paid sufficient attention.
Factors promoting and hindering partnership working
Effective communication is critical for the success of a partnership. This has been reported to enhance joint working and improve service delivery. Having an informal and open communication promotes effective collaboration within the multi-disciplinary team and is thought to lead to improved service outcomes (Harris 2003).
Joint working requires adequate funding for supporting the initiative. Agencies may need additional resources for supporting the venture. These additional funds are used to support joint initiatives such as provision of joint training to the various agencies involved and improving access to a range of facilities (Cameron et al. 2012).
Strong leadership and management
In order for a joint working to be successful, there must be strong leadership and management structure in place. The importance of having a strong leadership and integrated management structure has been identified by Rutter et al. (2004)
Aims and objectives
Practitioners from the various agencies involved in the joint working should understand the ultimate goals, aims and objectives as well as the eligibility criteria for the new initiative to become a success (Cameron et al. 2012).
Roles and responsibilities
The agencies involved should understand their roles and responsibilities to prevent conflicts. Responsibilities may include administrative tasks, budget management and coordination of material resources(Cameron et al. 2012).
Another factor that is likely to promote joint working is team-building and arranging for weekly meetings. Regular team-building events and subsequent weekly meetings allows for the various agencies to share information and to discuss issues arising (Clarkson et al. 2011). Additionally, such team meetings enhance the understanding of the different professional roles and prevent conflict between the different professions by building trust and rapport between the various agencies or groups involved.
Other factors that may promote joint working include mechanisms for sharing information such as using shared information technology systems and shared documentation. Such effective sharing mechanisms lead to timely assessments of needs (Cameron et al. 2012)
Factors hindering joint working
Aims and objectives
Whilst we have shown that an understanding of the aims and objectives is key to success of a partnership, it should be noted that such shared purpose can be problematic as well. For example, studies by Clarkson et al (2011), Asthana & Halliday (2003) and Glasby et al (2008) which examined some of the integrated care services found a general lack of understanding of the central aim of partnership working among the health care practitioners. Without a shared understanding of the aims and objectives among the various agencies involved, then it becomes difficult to develop a sense of purpose. Further, this difficulty is made worse if there are conflicting roles and responsibilities.
Roles and responsibilities
Roles and responsibilities should be clearly defined to avoid conflicts between the professionals involved. In their study, McCormack et al. (2008)found that a shortage of clarity of the roles and responsibilities of the professionals involved in the joint working resulted in delays in treatment and inappropriate referrals.
Partnership working can also be undermined by competing organizational visions. If organizations are in competition about the joined-up agenda, the initiative may not be successful. This is evident in a study by Young (2003) on partnership working between the local authorities and NHS. Young’s study foundthe partnership as undermined by the differences in resource and spending criteria between the parties involved.
Poor Communication and coordination
As noted above, communication is critical to the success of a partnership working. Poor communication hampers collaborative efforts which may result in delays in service delivery. Using specialist languages that some partners are not familiar with and communicating selectively may fuel suspicion and personal agendas leading to conflicting messages which undermine collaborative efforts (Cameron et al. 2012).Almost all tragedies which have resulted have been a direct result of poor communication and failure of professionals to coordinate with each other. This is especially the case where there are too many partners involved and where there is a lack of clarity of the responsibilities of each partner.
Power and hierarchical relationships
Partnership can also be hindered by power and hierarchical relationships. Some practitioners may perceive others to be below them in terms of their status. When perceived status differences occur, the dominant high status professions such as the medics may silence the contribution made by the others (Clarkson et al. 2011). Such kind of perceived status difference hinders integrative efforts and can stultify effective partnership.
There is a host of other factors that may hinder partnership working including difficulty in information sharing due to incompatibility of the IT systems, lack of trust and respect, relationship between agencies, and financial uncertainty among many others. These barriers can perhaps be addressed by arranging for a local forum where practitioners can meet regularly and share issues arising.
Whereas there many benefits to partnership working, such joint collaboration can prove to be extremely difficult especially where there are too many partners involved. Partnerships that involve too many partners often suffer from poor communication and coordination, competing organizational visions, lack of clarity with regard to the roles and responsibilities of the professionals involved, duplication of roles, unclear accountability, too many referrals between agenciesand lack of trust and respect among several other factors (Douglas 2008). These barriers tend to hinder the effectiveness of partnership working and can ultimately lead to failure in delivery of services as seen with the case of Victoria Climbie.
However, there are many success stories where many partners were involved. The future holds promising for more partnership involvement and collaboration as more community development workers are increasingly funded by primary care trusts. Further, many government funded initiatives are currently being implemented to promote the integration of services and multi-agency partnership including the Sure Start, Best and Connexions, Youth Offending Teams, and Children’s Fund (Cheminals 2009).
It is very hard to predict the dynamics and outcomes of partnership working especially where there are many partners involved due to continually evolving nature of such partnership. Partnerships that involve too many partners suffer from a range of factors that may stultify joint working including poor communication and coordination, competing organizational visions, duplication of roles, unclear accountability, and too many referrals between agencies among several other factors.
Whereas the practicalities of adopting a multi-agency approach can prove to be difficult, promoting integration of services and joint approach to service delivery is key to addressing key societal problems which cannot be constrained neatly within traditional boundaries such as poverty, crime, social exclusion, community safety and inequality. These problems are highly complex in nature and since no single actor or entity has sufficient knowledge and information required to solve them, it becomes extremely important to have multi-agency partnership working.
Asthana, S and Halliday, J., 2003.‘Intermediate care: its place in a whole-systems approach’, Journal of Integrated Care, vol.1, no.6, pp.15-24
Audit Commission, 1998.A Fruitful Partnership: Effective Partnership Working. Audit Commission.
Audit Commission, 2006. Governing Partnerships: Bridging the Accountability Gap. Audit Commission.
Barrett, G., Selman, D. & Thomas, G., 2005.Interprofessional Working in Health and Social
Bella, 2001. Turning point: collaboration for a new century in public health. Washington DC: the National Association of County and City Health Officials.
Cameron, A., Lart, R., Bostock, L. and Coomber, C., 2012. Factors that promote and hinder joint and integrated working between health and social care services. Research briefing 41. Social Care Institute for Excellence.
Care: Professional Perspectives. Basingstoke: Palgrave Macmillan.
Carnwell, R. and Buchanan, J., 2008. Effective practice in health, social care and criminal justice: a partnership approach. McGraw-Hill International
Carnwell, R. and Carson, A., 2005. ‘Understanding partnerships and collaboration’,in R. Carnwell and J. Buchanan (eds) effective practice inhealth and social care: a partnership approach. Maidenhead: Open University Press.
Cheminals, R., 2009. Effective multi-agency partnerships: putting every child matters into practice. Sage Publications
Clarkson, Brand, C., Hughes, J and Challis, D., 2011. ‘Integratingassessments of older people: examiningevidence and impact from a randomized controlled trial’, Age and Ageing, vol 40, no 3, pp 388?391.
Douglas, A., 2008. Partnership working. Routledge.
Dowling, B. Glendinning, C. and Powell, M., 2004. Conceptualising successful partnerships Health and Social Care in the Community 12(4) 309-317
Fletcher, J. K., 2006. Partnerships in Social Care: A Handbook for Developing Effective Services London: Jessica Kingsley
Fraser,S. and Matthews, S., 2007. The Critical Practitioner in Health and Social Care London:Sage publications
Gallant, M.H., Beaulieu, M.C. and Carnevale, F.A., 2002.‘Partnership: an analysis of theconcept within the nurse–client relationship’, Journal of Advanced Nursing 40(2): 149–57.
Glasby, J., Martin, G. and Regen, E., 2008. ‘Older people and the relationship between hospital services and intermediate care: results from a national evaluation’, Journal of Interprofessional Care, vol 22, no 6, pp 639?649.
Harris, S., 2003.‘Inter-agency practice and professional collaboration: the case of drug education and prevention’, Journal of Education Policy 18(3), pp.303-314.
Huxham, C. and Vangen, S., 2005. Managing to Collaborate: The Theory and Practice of Collaborative Advantage. London: Routledge
Ling, T., 2002. ‘Delivering Joined-Up Government in the UK: Dimensions, Issues and Problems’, Public Administration, Vol. 80 No. 4, 615-642
McCormack, B. Mitchell, E.A., Cook, G., Reed, J., and Childs, S., 2008. ‘Older persons’experiences of whole systems: the impact ofhealth and social care organizationalstructures’, Journal of Nursing Management,vol 16, no 2, pp 105?114.
Rutter, D., Tyrer, P., Emmanuel, J., Weaver, T., Byford, S., Hallam, A., Simmonds, S., and Ferguson, B., 2004. ‘Internal vs. externalcare management in severe mental illness:randomized controlled trial and qualitativestudy’, Journal of Mental Health, vol 13, no 5,pp 453?466.
Tait, L and Shah, S., 2007. Partnership working: a policy with promise for mental healthcare. Journal of continuing professional development. 13: 261-271
Taylor, I., Sharland, E., Sebba, J. and Le Riche, P., 2006, Knowledge review 10: The learning, teaching and assessment of partnership work in social work education, London: Social Care Institute of Excellence.
Welstead, M., 2013. Child protection in England-early intervention. [Viewed on 13th November 2013] available from http://www.law.harvard.edu/programs/about/cap/cap-conferences/pp-workshop/pp-materials/27_welsteaddoc.pdf