Firstly I would like to focus on the policies and legislation which has shaped partnership working. The ideas of collaboration and partnership working now form a large body of policies and legislation, which include some duties for statutory 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. I have made reference to partnership working for each one. Firstly I look at the UK wide policies/legislations and then I focus on Welsh policy.
Firstly the Seebohm Report (HMSO, 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. National Health Service and Community Care Act (HMSO, 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. Building Bridges (DOH, 1995) this encourages interdisciplinary and multiagency care planning.
The Health and Social Care Act 2001 (Home Office, 2001) created new powers to establish care trusts by building on existing health and local authority powers to forge partnerships and provide integrated care. The National Service Framework for Older People (DOH, 2001) set out standards for care of older people across health and social services. It aimed to remove age discrimination, provide person center care, promoting independence and fitting services around people 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 (DH, 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 of rights, independence, choice and inclusion for people with learning disabilities. National Service Framework (NSF) for Older People (Department of Health, 2001) highlighted that agencies should not duplicate each other's assessments, and professionals should contribute to assessments in the most effective way.
Community Care (Delayed Discharge) Act (DoH, 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 inability to provide assessment and community care services within a required timescale. Every Child Matters (HMSO, 2003) in response to the Victoria Climbi inquiry, it proposed: improved interagency information sharing and co-operation; work in multi-disciplinary teams; a 'lead' professional role; creation of local safeguarding boas; in the long term integration of key services for children and young people in children's trusts 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 (DOH, 2004) placed a duty on social service 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 service to careers. Single Assessment Process Implementation Guidance (DOH, 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 (DfES, 2006) aaddressed 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 (DfE, 2008) set out the components of integrated working as they are emerging through 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 and 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 and 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). This policy aims to increase efficiency through more effective co-operation across the public services and to place people and communities at the centre, enabling active participation in service planning design and delivery. Children and Young People: Rights to Action - Stronger Partnerships for Better Outcomes (WAG, 2005). This 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 highlight the importance of multi-agency working. Since the 1960's there has been a focus on partnership working for social services. There are some key principles and ethical issues to partnership working and there can be some dilemmas to this. The next part of this essay will focus upon key principles and ethical issues.
There are many areas to partnership working that may lead to some dilemmas. Glasby (2004) defines inter-professional working as to or more people from different professions communicate and co-operate to achieve a common goal. Adams et al (2006) highlights the importance of having a professional identity is to partnership working. Adams et al (2006) suggests that a professional identity gives a person a set of values, expertise, role and responsibilities.
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 that are involved within the information gathering and care planning for example social worker, health, brokerage, finance team and carer assessors. During my placement I have been able to see the importance of working with other professionals to deliver effective services for the clients. During one unified assessment (UA) I completed I worked collaboratively with a nurse to complete the UA. The reason for this is to identify if this particular client was in need of a nursing home rather than a residential home. Therefore the expertise of the nurse as vital to complete the assessment. However there were some key issues that
Retaining professional identification
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 distinctively, what can be complementary and identify the possible tensions between them it can improve the effectiveness of partnership working. By identifying these areas professionals can complement each to benefit the client overall. Keeping (2006) highlights a general uncertainty from other professionals around what social workers actually do. Lack of knowledge of what each professional involved does can lead to stereotyping each worker (Lymbery, 2006). This means that it is important for social workers to remember what responsibilities lay with them when working with other professionals.
Building relationships and trust
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 in 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 collaborative working relationship.
Gasper (2010) highlights that partnership working can mean better access to service and an avoidance of duplication which means service can be delivered in more of a cost-effective way.
Differences in languages
Within partnership working there can be many professionals involved. Issues may arise when there is a use of specialist language that not everyone understands (Maguire and Truscott, 2006)
Communication across professions can be difficult especially when they are not in the same location, this can result in a breakdown of communication and delays in services (McCormack et al, 2008)
Inequalities in status and pay
There may be differences in status between professionals and this must be acknowledged to see if they impact upon 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).
Conflicting organisation and professional boundaries
There is often un-clarity around the roles of voluntary and service users in partnership working (Marks, 2007)
Resources can be split into three areas; money, information and time. Issues around money can be identified in several areas. One is that there are different funding cycles, separate budgets and financial pressures (Frye and Webb, 2002). Some professionals may be reluctant in funding services if there is a pressure on budgets (Roy and Watts, 2001). Information sharing can pose constrains for partnership working.
Partnership working needs a sufficient amount of time dedicated 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 identifies (Frost and Lloyd, 2006).