Working in partnership in health and social care

Working in partnership in health and social care

Section A

            The Mid Stafford hospital attracted public scrutiny after causing hundreds of deaths, which is beyond the expected numbers. The deaths resulted from grave neglect and patient maltreatment. Senor nursing staff was charged with failure to provide adequate staffing levels, maintain the requisite record keeping measures, ensure proper hygiene, administration of medicine, provide required nutrition and fluids and ensure dignified care. The betrayal of patients indicated how between 2005 and 2008, the NHS prioritized its corporate interests above those of the service users. Following investigations, the health secretary authorized that the trust that was in charge of the hospital’s administration be dissolved. It is because the trust had misled priorities that focused on cutting costs and meeting particular targets (BBC.com 2014).

The trust had tolerated ineffective care where critically ill patients were left to the devices of inexperienced doctors and receptionists that made decisions on which patients required treatment. Patients would also be denied pain relief and their food and drinks were kept without their reach. As of 2014, Stafford hospital and Cannock hospital that were under the trust’s administration were put under other local provider’s operations. The senior nurse was also struck off the nursing register after been found guilty of creating an unpleasant working condition where staff was discouraged from reporting patient abuses. The decision was aimed at availing safe and quality health care services to the Stafford residents (BBC.com 2014).

In relation to the Mid Staffordshire hospital case study, there are four important groups requiring working in cooperation based on a common understanding of values, attitudes and viewpoints to foster a culture of openness, compassion and safety in health care. Family, friends, service users and patient advocates consist of the first important group. They are the first people to identify problems in the care system. The second group consists of front-line workers who are required to work together in strong teams (Scragg 2006). They require having optimal cooperation based on values and behaviours that foster change and allow staff to provide better care to patients. The other group consists of those in charge of leadership such as boards. They have the responsibility of overseeing appropriate care for all patients carried out in compassion and dignifying ways (Department of Health 2013).

The fourth group consists of the external structures that serve an important role in overseeing that hospitals provide good care and taking necessary action to resolve arising concerns in the spirit of addressing poor performance in a swift way. The cruelty and victimization at Stafford hospital went unreported for a three-year period. The regulators, commissioners, the strategic Health authority, and other commissioning entities were unable identify warning signs and take swift action to address the poor health issue (Department of Health 2013).

            The philosophy of working partnerships in health and social care is perfected when relevant institutions work as partners in the health and social necessity of its patients. It is thus essential for a health and social care partnership to focus on collaboration before integration. Collaboration entails the process of sharing ideas on how to revolutionize care with an aim of creating appropriate medical concept for modifying an institution. Without collaboration, integration efforts such as investing funds and training would not be effective if the social and health care fail to share their revolution ideas first.

In the Mid Staffordshire hospital, it would be essential for both medical and social care corporations to identify areas of collaboration in order to modify the situation. Health and social care services receive influence in the design and provision of service through greater consumer participation in designing care. It views patients as active consumers rather than passive recipients of services. Partnership in health and social care is essential because the complexity of client problems requires input from a number of services. For instance, service users can benefit from fully packaged services consisting of both health and social care in a single institution. The partnership philosophy allows for a one-stop-shop because partnerships meet particular problems (Billingsley & Lang 2002).  

Relationships between partners in health and social care are established through negotiation to assist both parties to work effectively. The parties require focusing on the work at hand rather than their medical titles, and position ranking in the institution.  There is the need for both health and social services to adopt a non-hierarchical relationship approach when resolving problems. Focusing on knowledge sharing and delegating responsibilities based on expertise rather than roles and titles is also essential. Other important contributors to effective relationships in the partnerships include working together through a team working and networking approach. It is also very essential for the partnership relationship to adopt participation in planning and decision making based on trust and respect in collaborators and have low expectation of reciprocation for the joint venture to succeed.

Effective relationship of health and social care experts in partnership at the Mid Staffordshire might have addressed the chronic putative problems. Expert healthcare professionals provide medical care for service users and the expert social care experts address the social concerns that service users have regarding accessing medical care.

Had the social care aspect been available in the Mid Staffordshire hospital, they would have detected elements such as the predominant lack of compassion in care. Social care intervenes to improve service users’ comfort during hospital stay. Social care would have negotiated a strategy with the expert medical personnel to ensure that patients receive pain relief and access to food, drinks and baths.

Social care professionals are entirely concerned with the wellbeing of a patient while receiving care and treatment in a hospital. They escalate issues such as patients being left in soiled beddings, lacking assistance to use toilets and maintaining adequate standards of hygiene necessary for reducing secondary infections. The inspector of hospital care works effectively in partnership with social care practitioners as in identifying the root causes of the problems reported by the inspector of social care. Some of the root causes in the mid Staffs case study included shortage of experienced doctors and nursing staff. Shortage was the underlying reason for the substandard care in the Mid Staffordshire hospital. The inspector of hospitals also ought to have engaged staff to identify the root causes of low morale and work environment, which was characterized with rampant bullying. His efforts would also have been effective in identifying the cost cutting ploys that the hospital engaged in to earn the foundation Trust status at the expense of deteriorating patient care.

External professional organizations are also part of the partnership relationship that is important in detecting problems together with the social care professionals. Professional must liaise with the social care identifying problem areas. The professional bodies then scrutinize the trust boards on performance and establish inquiries into the best ways to address issues of care quality. Independent external groups such as the Cure NHS formed by the Helene Donnelly and Julie Bailey are also vital in the social care aspect of the health and care partnership. They provide important whistleblowing avenues that are necessary for bringing to attention patient care issues. Such individuals serve as important channels of escalating matters to the senior officials in a hospital for appropriate action (Gallegher 2013).

Section B

There are limits to collaborative effort that can be called a partnership. Tension between partners in partnerships is inevitable because they have unique identities despite having a shared commitment to improving service users’ health outcomes. Partnership models thus differ based on the nature each partnership’s commitment.  The model of partnership may either be a project partnership, problem-oriented partnership, ideological partnership or an ethical partnership.   Social care and health care professionals may adopt a project partnership to benefit both the social care and social care aspects of the institution within a specified period.  A project partnership ceases when the aims of a particular project has been achieved. For instance, in the Mid Staffordshire case, health and social care may collaborate to address the staffing needs over a given period and cease the project upon achieving the ideal staffing levels.

Problem oriented partnership model address specific problems in the institution. Health and social care professionals may establish such partnerships to respond to identified problems and they remain as long as the problem persists. The Mid Staffordshire health and social care professionals may for instance establish a strategic multidisciplinary approach to monitor the provision of required nutrition and dignified care for all children. It is a partnership model that recognizes that children do not always receive appropriate nutrition and the belief that a partnership response is the most effective way to address the issue.

An ideological partnership model is relates to the problem orientation model although it has a different focus. While the problem orientation partnership focuses on a particular problem, the ideological approach focuses on a particular view point. An ideological partnership is based on the shared outlook or point of view towards certain issues. For instance the health and social care professionals at Mid Staffordshire may form a partnership aimed at reducing the length of stay for users. Their shared point of view about reducing patients length of stay may inform both medical and social care professionals to undertake interventions such as hospital at home rather for acute cases. It is also highly likely that health services may favour a medical ideology while social services may favour a social ideological approach.

Ethical partnership models in health and social care have a strong focus on particular ethical agenda. Concluding that health and social care partnerships are ethical because their overall goal is to help people is reasonable. Health and social partners engage in considerable negotiation to arrive at shared understanding of the nature of collaborative effort across multidisciplinary boundaries as well as the process of relinquishing power. For instance, a problem oriented approach in Mid Staffordshire, nurses may have to carry their duties in provision of nutrition, fluids, and dignified care based on a social worker’s assessment of a child’s health needs and vice versa.

In partnership working decisions, health and social care decision makers require exploring the different models of partnerships prior to settling on a particular working arrangement. They may explore the separate organization type which results in the formation of a distinct organization that has an independent identity from that of the individual partners. This type of partnership considers plans to employ staff and oversee activities in a medium or long-term lifespan. This is the partnership working type that the Mid Staffordshire hospital adopted. It is because the hospital remained as a separate legal identity from the organization controlling its operations. It is also a large partnership with a medium-long term lifespan requiring employment of additional staff and need to oversee its activities (Tait & Shah 2007).

There are several legislations and organizational practices and policies that encourage partnership working in health and social care. The previous focus on the international declaration of human rights as a basis to provide equitable and just health care is now redundant. The new approach is where citizens proactively take control over their health. The contemporary service users are more educated and they adopt participatory interactions with service providers.  There are policies that promote public involvement and partnerships between service providers. Some of the policies include the new modern dependable; the children trust policy, the children act 2004, the health and social care act, the NHS Act, modernizing health and social services: developing the workforce and the health act.

The Health Act of 1999 allowed flexibilities to enable health and social care to establish pooled budgets. It also allowed the two to provide leadership for commissioning arrangements for integrated health care providers. The health act requires that health and social services engage in collaborative effort through planning agreements outlining the various services provided through each agency. It also demands that the agreements also stipulate how individual assessments are conducted. Implementation of the health act in Mid Staffordshire would ensure that social care professionals make assessments on the living conditions such as access to baths, nutrition, fluids and general grooming and make recommendations to nurses or administrators to uphold dignity.

The Children Trust policy resulted in the partnership between the health and social care as well as the local authority. It was with the intention of ensuring greater information sharing and co-location of different professionals working towards children welfare. Implementation of the policy in Mid Staffordshire would have prevented the abuse, neglect and subsequent deaths of children.  It is a vital policy that would significantly change the working practices when implemented together with the Children Act 2004.  The Children Act was established to promote multiagency partnership. It strengthens different agencies working with children to for improved outcomes. It also required local authority’s partnership through children trusts (Datta & Hart 2008).

The NHS Act 2006 allows pooling budgets between the health and social care organizations and authorities. It also allows local partners to customize their services to suit local needs of the population. The modernising health and social services policy encourages collective action towards education and employment as well as deployment of employees in a bid to meet the needs of the local population. The health service for all talents: developing the NHS workforce policy addressing partnership in health and social care cultivates a culture of flexible careers through emphasizing the need for teamwork and collaboration. It also eliminates boundaries that postulate that only nurses and doctors can offer certain forms of care.

A partnership to implement these legislation and policies would have been useful in addressing the chronic staffing needs at Mid Staffordshire in a timely fashion. It would have culminated into mutual agreements about services such as sanitation, pain relief and appropriate nutrition through combined effort of social workers and nurses among other health practitioners because all the partners have a right and obligation to be involved. It would also have allowed resources to be utilized where they are most needed.  

The government legislation ensuring health and wellbeing amongst locals through partnership with the NHS, social care, children services, and public health is propagated through the 2012 Act on health and social care. It achieves commissioning in a bid to provide better quality care to larger populations through the respective local authorities. It gives patients a voice through a national or local health watch that is commissioned by local authorities. Its implementation would give Patients in Mid Staffordshire hospital the chance to choose experienced practitioners and lodge complaints that to ensure that health and social care providers engage in effective joint action (Disability Rights UK 2012).

            The differences in working practices and policies of health and social care providers influence their view of their separate identities. The uniqueness of their identities acts as an impediment to collaborative working because integration lessens their longstanding commitment to a previous, separate identity.  Health and social care providers may view partnerships as a threat to their working practices that are unique to their identity. It may lead to a failure to collaborate because it is often perceived as threatening the existence of professional boundaries or failing to develop a particular profession (Masterson 2002).

Inter-professional differences resulting from policies and working practices such as the medical model and the more holistic social model may also threaten collaborative partnerships. The two have different perspectives on appropriate care and they may strive to preserve their own professional identity is a risk to collaboration (Brown, Crawford, & Darongkamas 2000). To address the working practices and policy barriers to collaboration in 

Mid Staffordshire, it would be essential to develop service level agreements (SLAs) to encourage partners to work together. The purchasers of health care and NHS trust can develop SLAs based on health improvement programmes. It also places each personnel at the organization in the partnership as the same level to prevent disagreement and encourage collaborative working (Doran 2001).

Section C

            Partnership working results in organizational efficiency because multifaceted problems are tackled through holistic multidisciplinary action (Cameron et al. 2012). It reduces duplication of services because each agency is aware of that certain agency is providing such services (Dickinson 2006). It also addresses the problem of omission of provision of services as well as addresses the problem where some agencies may provide services that are counterproductive to each other.  Partnerships are also useful to service users because it involves them in decision making processes. Their participation promotes transparency in a bid to improve service quality.  Professionals also benefit because they learn from the service user’s experiences (Masterson 2002).       The professionals also use their skills cooperatively rather than competitively.

The complexity of relationships among the multidisciplinary team is a potential barrier to partnership working. Scepticism may arise amongst partners in regards to the extent to which particular people can adequately represent the wider public or that some groups might have excessive influence or turn down offers for involvement. Other barriers to partnership working may include resistance to share information about care owing to confidentiality policies. Some professionals may also view professional issues such as accountability and role boundary issues as barriers. It is essential that partners embrace diversity and anti-discriminatory practice to overcome the barriers to partnership (ElAnsari & Phillips 2001).

            Providing effective mechanisms for communication and sharing documentation through compatible information technology systems is imperative for the success of joint working health and social care. It allows professionals to prioritize cases more efficiently and supports integrated services as a way of proving outcomes for service users (Asthana & Halliday 2013). It is also pertinent to train the professionals in the joint working group on the targets and goals of the different eligibility criteria and referral processes. This may involve ensuring their participation in the development of the different policies that guide service. All professionals must also receive induction and on-going training to foster a common understanding of the goals among all partners involved (McCormack 2008).

It may also help to collect feedback from the users and carers on how to tailor services in a way that ensures success of partnership. Such information is then carefully analysed to provide important information on how to customize service to suit the organization, users and carers. Mid Stafford’s operational control by a different health institution requires careful consideration of the possible hindrances to joint working like professional issues, policy issues and communication challenges. It requires a strong management team and on-going training to inculcate the targets and goals of the organization to foster successful joint working. It may also require that the organization implements efficient communication systems for improved shared information processes within the joint care setting.

References

Asthana, S & Halliday, J 2013, ‘Intermediate Care: Its Place in a Whole Systems Approach’, Journal of Integrated Care, vol. 1, no. 4, pp. 15-24.

Billingsley, R & Lang, L 2002, ‘The Case for Interprofessional learning in Health and Social Care’, Building Knowledge for Integrated Care,  vol.10, no.4, pp. 31-34.

Brown, B, Crawford, P & Darongkamas, J 2000, ‘Blurred Roles and Permeable Boundaries: The Experience of Multidisciplinary Working in Community Mental Health’  Health and Social Care in the Community, vol. 8, no. 6, pp. 425-435.

Cameron, A, Lart, R, Bostock, L & Coombe, C, 2012. ‘Factors that Promote and Hinder Joint and Integrated Working Between Health and Social Care’, Social Care Institute for Excellence, pp. 1-22.

Datta, J & Hart, D 2008, ‘Shared responsibility: Safeguarding Arrangements Between Hospitals and Children’s Social Services’, National Children’s Bureau, pp.1-51.

Department of Health, 2013, Patents First and Foremost: The Initial Government Response to the Report of the The Mid Staffordshire NHS Foundation Trust Public Inquiry,

Dickinson, A 2006, ‘Implementing the Single Assessment Process: Opportunities and Challenges’, Journal of Interprofessional Care, pp. 365-379.

Disability Rights UK 2012, The Health and Social Care Reforms at a Glance, viewed 2 June 2014, http://www.disabilityrightsuk.org/policy-campaigns/health-and-social-care-reforms/health-and-social-care-reforms-glance

Doran, T 2001, ‘Policy and Practice: Providing Seamles Community Health and Social Services’ British Journal of Community Nursing, vol. 6, no. 8, pp. 387-393.

ElAnsari, W & Phillips, C 2001, ‘Interprofessional Collaboration: A Stakeholder Approach to Evaluation of Voluntary Participation on Community Partnerships’,  Journal of Interprofessional Care, vol. 15, no. 4, pp.351-368.

Masterson, A 2002, ‘Cross-boundary working: A Macro-political Analysis of the Impact on Professional Roles’, Journal of Clinical Nursing, vol. 11, no. 3, pp. 331-339.

McCormack, B 2008, ‘Older Persons’ Experiences of Whole Systems: The Impact of health and Social Care Organizational structures’, Journal of Nursing Management, vol 16, no. 2, pp.105-114.

Scragg, T 2006, ‘An Evaluation of Integrated Team Mangement’, Journal of Integrated Care, vol.14, no.3, pp.39-48.

Tait, L & Shah, S. 2007, ‘Partnership working: A Policy With Promise for Mental Healthcare’, Advances in Psychiatric Treatment, vol. 13, pp. 261-271.

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