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To begin with I would like to focus on the policies and legislation which have identified partnership working. There is a large body of policies and legislation that focuses on collaboration and partnership working; some include duties for statutory organisations in relation to inter-agency working. I have examined only some of the key polices and legislation as there are too many to examine for the purpose of this essay. First of all I looked at the UK wide policies/legislations and then I focused on Welsh policy; these are set out in chronological order.
To start with the Seebohm Report (1968) argued for a co-operation across the spectrum of welfare state services and more effective co-operation by different professionals. It proposed a major restructuring of personal social services into a unified social service department. The National Health Service and Community Care Act (1990) gave a duty to local authorities to assess and where applicable meet a person’s needs for community care services by collaboration with other agencies. Following this Building Bridges (1995) encourages interdisciplinary and multi-agency care planning.
The Health and Social Care Act (2001) aimed to develop partnerships and provide integrated care by building on existing health and local authority powers to develop care trusts. The National Service Framework for Older People (2001) set out standards for care of older people across health and social services. It aimed to remove age discrimination, provide person centered care, and promote independence, fitting services around people’s needs. Means for achieving these aims included the single assessment process and integration in commissioning arrangement and service provision. Valuing people: a new strategy for learning disability for the 21st century (2001) highlighted partnership. Working through local partnership boards and inter-professional/inter-agency co-operation are seen as central to achieving the four key principles; rights, independence, choice and inclusion for people with learning disabilities. National Service Framework (NSF) for Older People (2001) highlighted that professionals should become more engaged in assessments and for agencies to minimise any duplication of work.
Community Care (Delayed Discharge) Act (2003) introduced a new dynamic in interagency and inter professional relationships. It made Social Services authorities liable to reimburse the NHS for delays where patients in hospital are medically fit but unable to be discharged due solely to Social Service’s inability to provide assessment and community care services within a required timescale. Every Child Matters (2003) in response to the Victoria Climbié inquiry proposed: improved interagency information sharing and co-operation; work in multi-disciplinary teams; a ‘lead’ professional role; creation of local safeguarding boards. In the long term integration of key services for children and young people in children’s trusts will be under a director of children’s services. Children Act (2004) allowed the creation of database to support professionals in sharing information. The Carers (Equal Opportunities) Act (2004) placed a duty on Social Service’s to inform carers of their right to an assessment. It also enabled Social Services to ask other public bodies including the health organizations to provide services to carers. Single Assessment Process Implementation Guidance (2004) sets out how the single assessment process described in the Mental Capacity Act (2005) where social workers and care professionals acting on behalf of someone who lacks capacity, must act in a person’s best interest.
Working Together to Safeguard Children (2006) addressed to practitioners and managers, sets out how organisations and individuals should work together to safeguard and promote the welfare of children, stressing shared responsibility and the need to understand the roles of others. It described the role of local safeguarding children’s boards (LSCBs), training for inter-agency work and the detailed processes for managing individual cases. These elements are ‘statutory” guidance, which required compliance. Mental Health Act (2007) amended the 1983 Act broadening the group of professional practitioners who undertake approved social worker (ASW) functions, to be known as Approved Mental Health Professionals. Concurrently, the code of practice of the 1983 Act was updated, stressing inter-professional collaboration in assessment and after care planning and involvement of patients and carers. Building brighter futures: next steps for the children’s workforce (2008) sets out components of integrated working as they emerged from Children’s Trusts. It considered the contribution of the Common Core of Skills and Knowledge and the pros and cons of professional identities and boundaries. It looked forward to achieving a broad vision of integrated working that has support across the whole children’s workforce.
Now I would like to focus upon the policies that are specifically within Wales. Firstly, The Review of Health and Social Care in Wales, (WAG, 2003) emphasized the importance of multi-agency working. It looked at decision-making processes, the capacity and effectiveness of existing services, the capacity of management, the processes governing standard setting, information management, resource flows, and incentives and sanctions. The Report of the Wanless Committee (WAG, 2004) focuses on shared decision-making between professionals and users and patients. It also highlights that there needs to be integrated thinking across health and social care boundaries. It also highlights the need for a new approach for funding health and social care. Making the Connections: Delivering Better Services for Wales: The Welsh Assembly Government Vision for Public Services (WAG, 2004) policy aims to involve communities and people by putting them in the centre of service planning and delivery, it hopes to achieve this by having effective and efficient co-operation between public services.. Children and Young People: Rights to Action, Stronger Partnerships for Better Outcomes (WAG, 2005)is paper outlines the expectation from the Assembly Government for local agencies to take a joint approach in planning services to make them as effective as possible. Fulfilled Lives, Supportive Communities: Improving Social Services in Wales from 2008-2018 (WAG, 2006) this focuses on partnership arrangements which put the citizen at the centre and work effectively across sectors and organisations using care pathways to support people. Lastly, Sustainable Social Services for Wales – A Framework for Action (WAG, 2011) highlights the importance of developing more integration of health and social services for children, young people, and frail older people, and in respect of re-ablement services. Joining up in this way will help break down barriers that can often get in the way of providing services and drive out duplication. This sets out the current vision for partnership working within Wales until 2016.
As highlighted above there are many key pieces of legislation and policies which focus on the importance of multi-agency working. Since the 1960’s there has been a focus on partnership working for social services. The main emphasis is that welfare services could be improved if statutory organisations worked together (WAG, 2003). There appears to be a fastening pace to make partnership working more effective. Perhaps this is down to the increased budget cuts therefore eliminating duplication of work and improving service delivery may be more important than ever before.
There are some key principles and ethical issues to partnership working that are highlighted below. Gasper (2010) highlights that partnership working can improve access to services and avoid duplication; this means services can be delivered in more of a cost-effective way. Although Gasper reflects positively on partnership working there are other areas of partnership working that could lead to several dilemmas. Glasby (2004) defines inter-professional working as two or more people from different professions communicating and co-operating to achieve a common goal. Adams et al (2006) highlights the importance of having a professional identity to partnership working. Adams et al (2006) suggests that a professional identity gives a person a set of values, expertise, role and responsibilities; for example, social workers side more with the social model and health more with the medical model. Partnership working can be complex and often brings people together who have different views on what is ‘right’ for a service user with different approaches (Gasper, 2010). Whittington (2003) suggests that if professionals can understand what they have in common, what they can contribute individually, what can be complementary and identify the possible tensions between them; it could improve the effectiveness of partnership working. By identifying these areas clients could benefit to better services.
Keeping (2006) highlights a general uncertainty from other professionals around what social workers actually do. Lack of knowledge of what each professional involved, can lead to stereotyping each worker (Lymbery, 2006). There is often no clarity around the roles of voluntary and service users in partnership working (Marks, 2007). This means that it is important for social workers and other professionals to remember what responsibilities lay with them and try to understand other professionals’ responsibilities to make partnership working more efficient.
Seden et al (2011) suggests that social workers are often caught between care and control, finding their way through complex relationships with service users, other professionals, peers and the public. Trust is an important factor when facilitating open discussion and successful role negation, both of which are important features of inter-professional working (Barrett and Keeping, 2005). Where professionals trust each other’s motives, competence and dependability they are more able to manage risky situations (Lawson, 2004). Trust is an important element of a successful collaborative working relationship.
Issues may arise within partnership working when there is a use of specialist language that not everyone understands (Maguire and Truscott, 2006). For example health professionals may have abbreviations that the social workers may not understand and vice versa. Communication across professions can be difficult, especially when they are not in the same location. Not being based in the same location can result in a breakdown and delays in services; this can be seen in hospital discharges for example (McCormack et al, 2008). There may be differences in status between professionals and this must be acknowledged to understand the impacts it can have on communication (Barrett and Keeping, 2005). Some practitioners perceive threats to their professional status, autonomy and control when asked to participate in more democratic decision making forums (Lloyd and Wait, 2006).
There may be issues around different resources available across different professionals. Resources can be split into three areas; money, information and time. Issues around money can be acknowledged in numerous areas. One is that there are different funding cycles, separate budgets and financial pressures (Frye and Webb, 2002). Also professionals may be reluctant in funding services if there are pressures on budgets (White and Harris, 2001). Information sharing can pose constraints for partnership working. For example in Health and Social Care there are different ICT systems in place, there is a need for a universal and shared systems between Health and Social Care to improve the exchange of information (WAG, 2003). There is also reluctance around sharing information with different professionals for fear of breeching confidentiality (WAG, 2003). Partnership working also needs a sufficient amount of dedicated time for it to be effective (Atkinson, 2007). Frost and Lloyd (2006) suggested that time is needed for relationships to develop and trust to be built. These are key components for agreements to be made around protocols and reflection upon new professional identities (Frost and Lloyd, 2006). Partnership working may involve travelling to meetings, some of which may be long distances; this requires a lot of time (Atkinson, 2007).
Currently my practice learning level three is based within the Adult Community Care Team (ACCT) which implements care plans for clients with presenting eligible needs. To ensure that clients’ needs are met there is a process which involves various professionals within the information gathering and care planning stages; for example social worker, health, brokerage, finance team and carer assessors. ACCT works daily with other professionals; some are within the same location such as occupational therapists and some are offsite, like doctors based in hospitals. There is a wide range or partnership working; some work more successfully than others. I have found those on site tend to be more successful as information exchange is more effective and there is a better understanding of each other’s roles.
One particular experience I would like to focus on is during one unified assessment (UA) when I worked collaboratively with an assessor nurse. Assessor nurses are based within the local health board in another location. The reason for our partnership working was to identify if this particular client was in need of a nursing home rather than a residential home. The expertise of the nurse was vital to complete the assessment. However there were some issues within this process. Firstly we have different ICT systems so we both have access to different information; Health could only see medical records whereas I could only see Social Service records. Having two separate ICT systems also made it difficult to complete the UA and there was a duplication of work. I had to use the Social Service UA documentation and the nursing assessor had to use the health UA documentation. If there was one ICT system only one UA form would have needed to be completed. This would have saved both of us having to complete two different lots of paperwork, which essentially had the same outcomes. There was another issue of understanding specialist language and abbreviations used within Health. I found myself regularly asking for clarification. There was also a reluctance to explore continuing health care from the assessor nurse even though there were triggers. This could be down to the sheer amount of time needed to complete the decision support tool and perhaps budget restraints. There are a few examples of good partnership working that I have experienced on placement but the majority had difficulty around budgets, communication, different ICT systems, difference in languages and a lack of understating other roles.
Overall this essay has highlighted the increasing focus on partnership working from a UK wide perspective and a Welsh specific context. Some policies reflect upon the issues mentioned within this essay. There appears to be a faster pace to improve partnership working within a policy context. For partnership working to be positive, there is a need for collaboration from professionals to overcome particular issues and great outcomes can be achieved.
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