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“Collaboration is a interprofessional process of communication and decision making that enables shared knowledge and skills in health care providers to synergistically influence the ways service user/patient care and the broader community health services are provided” (Way et al, 2002). The development of collaborative working will necessarily entail close interprofessional working” (Wilson et al., 2008). According to Wilson et al, (2008) and Hughes, Hemmingway & Smith, (2005) interprofessional and collaborative working describes considering the service user in a holistic way, and the benefits to the service user that different organisations, such as Social Workers (SW), Occupational Therapists (OT) and District Nurse (DN) and other health professionals can bring working together can achieve. These definitions describe collaborative working as the act of people working together toward common goals. Integrated working involves putting the service user at the centre of decision making to meet their needs and improve their lives (Dept of Health, 2009).
This paper will focus first see why health care students learn about working together then reviewing government policy and how this can be applied in a Social Care context, then on influencing factors on the outcomes of collaborative working references within the professional literature, and finally, reviewing evidence on collaborative practice in health and social care.
Learning to work collaboratively with other professionals and agencies is a clear expectation of social worker in the ‘prescribed curriculum’ for the new Social Work Degree (DoH 2002). The reasons are plain:
â- Service users want social workers who can collaborate effectively with others to obtain and
provide services (Audit Commission 2002)
â- Collaboration is central in implementing strategies for effective care and protection of
children and of vulnerable adultsas underlined, respectively, by the recent report of the
Victoria Climbié Inquiry (Laming 2003) and the earlier ‘No Secrets’ policies (DoH 2000)
â- Effective collaboration between staff at the ‘front-line’ is also a crucial ingredient in delivering the Government’s broader goals of partnership between services (Whittington 2003).
Experience is growing of what is involved in learning for collaborative practice. This experience promises valuable information for Social Work Degree providers and others developing learning opportunities but has not been systematically researched in UK social work programmes for a decade (Whittington 1992; Whittington et al 1994). The providers of Diploma in Social Work programmes (DipSW) represented an untapped source of directly transferable experience in this area of learning and were therefore chosen as the focus of the study.
Making collaborative practice a reality in institutions requires an understanding of the essential elements, persistent and continuing efforts, and rigorous evaluation of outcomes. Satisfaction, quality, and cost effectiveness are essential factors on two dimensions: outcomes for patient care providers; and outcomes for patients. Ultimately, collaborative practice can be recognized by demonstrated effective communication patterns, achievement of enhanced patient care outcomes, and efficient and effective support services in place. If these criteria are not met, collaborative practice is a myth and not a reality in your institution. Simms LM, Dalston JW, Roberts PW. Collaborative practice: myth or reality? Hosp Health Serv Adm. 1984 Nov-Dec;29(6):36-48. PubMed PMID: 10268659. http://www.ncbi.nlm.nih.gov/pubmed
Health care students are thought about collaboration so that they can see the unique contribution that each professional can bring to the provision of care in a truly holistic way. Learning about working together can help prevent the development of negative stereotypes, which can inhabit interprofessional collaboration. (Tunstall-Pedoe et al 2003) Health care students can link theory they have leant with practice and bring added value of successful collaborative practice. (www.facuity.londondeanery.ac.uk) Learning collaborative practice with other professionals is the core expectation in social work education both qualifying and post grad.
Effective collaboration and interaction can directly influence a SU treatment, in a positive way, and the opposite can be said about ineffective collaboration that can have severe ramifications, which has been cited in numerous public inquiries. Professionals should also share information about SU’s to keep themselves and their colleagues safe from harm.
Working together to safeguard children states that training on safeguarding children and young people should be embedded within a wider framework of commitment to inter and multi-agency working at strategic and operational levels underpinned by shared goals, planning processes and values. The Children Act 1989 recognised that the identification and investigation of child abuse, together with the protection and support of victims and their families, requires multi-agency collaboration. Caring for People (DH, 1989) stated that successful collaboration required a clear, mutual understanding by every agency of each others’ responsibilities and powers, in order to make plain how and with whom collaboration should be secured. It is evident from the above that Government has been actively promoting collaborative working, and this is reflected in professional literature. Hence, the policy climate and legislative backdrop were established to facilitate inter-agency and intra-agency collaboration. The stated aim has been to create high quality, needs-led, co-ordinated services that maximised choice for the service user (Payne, 1995). Political pressure in recent years has focused attention on interprofessional collaboration in SW (Pollard, Sellman & Senior, 2005) and when viewed as a “good thing”, it is worthwhile to critically examine its benefits and drawbacks just what is so good about it. (Leathard, 2003). Interprofessional collaboration benefits the service user by the use of complementary skills, shared knowledge, resources and possibility better job satisfaction. Soon after the new Labour government in 1997 gave a powerful new impetus to the concept of collaboration and partnership between health professionals and services, they recognised this and there was a plethora of social policy initiatives official on collaborative working published. A clear indication of this can be found in NHS Plan (DH, 2000), Modernising the Social Services (DH, 1998a). Policies concentrated on agency structures and better joint working. This was nothing new, since the 1970s there has been a growing emphasis on multiagency working. 1974 saw the first big press involvement in the death of a child (Maria Coldwell) and they questioned why professionals were not able to protect children who they had identified as most at risk. The pendulum of threat to children then swung too much the other way and the thresholds for interventions were significantly lowered, which culminated with the Cleveland Inquiry of 1988 when children were removed from their families when there was little concrete evidence of harm (Butler-Sloss, 1988), with too much emphasis put on the medical opinion. An equilibrium was needed for a collaborative work ethic to share knowledge and skills and Munro (2010) states that other service agencies cannot and should not replace SWs, but there is a requirement for agencies to engage professionally about children, young people and families on their caseloads. The Children Act 2004 (Dept of Health, 2004) and associated government guidance, introduced following the Public Inquiry into the death of Victoria Climbié in 2000, including Every Child Matters (Dept of Health, 2003), were written to stress the importance of interprofessional and multiagency working and to help improve it. The failure to collaborate effectively was highlighted as one of many missed opportunities by the inquiry into the tragic death of Victoria Climbié (Laming, 2003) and Baby Peter (Munro, 2009). There is an assumption that shared information is information understood problems with information sharing and effective commination are cited again and again in public enquiry reports Rose and Barnes 2008; Brandon et al, 2008). These problems can simply be about very practical issues, such as delays in information shearing, lost messages, names and addresses that are incorrectly recorded (Laming 2003 cited in Ten pitfalls and how to avoid them 2010)
An explicit aim was to motivate the contribution of multiagency working. By 1997 Labour had been re elected and rolled out a number of studies into collaboration. These studies revealed the many complexities and obstacles to collaborative working (Weinstein, 2003). The main drivers of the government’s health and social care policies were partnership, collaboration and multi-disciplinary working. One of the areas covered by Working Together to Safeguard Children 2010 (Dept of Health, 2010) stated that organisations and agencies should work together to recognise and manage any individual who presents a risk of harm to children. The Children Act 1989 (Dept of Health, 1989) requires multi-agency collaboration to help indentify and investigate any cases of child abuse, and the protection and support of victims and their families. It should be remembered that everyone brings their piece of expertise/ knowledge to help build the jigsaw (Working Together 2010) and to assess the service user in a holistic way. Although the merits of collaboration have rarely been disputed, the risk of conflict between the professional groups remains.
Some of the barriers to collaboration are different resource allocation systems, different accountability structures, professional tribalism, pace of change and spending constraints
The disadvantages are if commissioning was led by health, an over-emphasis on health care needs, and inequities between patients from different practices
There are challenges in terms of professional and personal resistance to change; it is difficult to change entrenched attitudes even through inter-professional education. Sometimes professionals disagree about the causes of and the solutions to problems, they may have different objectives because of different paradigms (Pierson & M, 2010). There are also several concerns for SWs which include not knowing which assessments to use, appearing to be different or work differently from others in the team, not being taken seriously or listened to by colleagues and not having sufficient time or resources because of budget constraints (Warren, 2007). Some of the reasoning for this pessimistic mood is feelings of inequality and rivalries, the relative status and power of professionals, professional identity and territory. Different patterns of accountability and discretion between professionals, are all contributing factors to these feelings (Hudson, 2002). Thompson (2009) suggests that instead of the SW being viewed as the expert with all the answers to the problems, they should step back and look at what other professionals can contribute. Collaborative working offers a way forward, in which the SW works with everyone involved with the clients; carers, voluntary workers and other professional staff, to maximise the resources, thus giving an opportunity for making progress and affording the service user the best possible care.
Weinstein, et al, (2003) stated that although there are problems with collaborative working, the potential positive outcomes out-weight the negatives. There could be a more integrated, timely and coherent response to the many complex human problems, fewer visits, better record keeping and transfer of information, and some reduction of risk; therefore the whole is greater than the sum of the parts. If SWs work in ‘silos’, working in a vacuum, they are unlikely to maximise their impact (Brodie, 2008). It is important to use collaboration and an interprofessional/multi agency working culture in Social Work in order that the most vulnerable service users receive the best possible assessments of their needs.
The advantages are better understanding of the constraints of each agency and system overall, shared information on local needs, reduction in duplication of assessments, better planning, avoiding the ‘blame culture’ when problems occurred and accessing social care via health less stigmatising. Greater knowledge of the SWs roles and responsibilities by other health care professionals will ensure that the SWs role is not substituted in assessment of the service users circumstances and needs (Munro, 2010). The Munro Report (2010) also states that if everyone holds a piece of the jigsaw a full picture is impossible until every piece is put together.
Working together to Safeguard Children states a multi-professional approach is required to ensure collaboration among all involved, which may include ambulance staff, A&E department staff, coroners’ officers, police, GPs, health visitors, school nurses, community children’s nurses, midwives, paediatricians, palliative or end of life care staff, mental health professionals, substance misuse workers, hospital bereavement staff, voluntary agencies, coroners, pathologists, forensic medical examiners, local authority children’s social care, YOTs, probation, schools, prison staff where a child has died in custody and any others who may find themselves with a contribution to make in individual cases (for example, fire fighters or faith leaders).
In a study by Carpenter et al (2003) concerning the impact on staff of providing integrated care in multi-disciplinary mental health teams in the North of England, the most positive results were found in areas where services were fully integrated.
There is much evidence to suggest that collaboration represents an ethical method of practice where differences are respected, but used creatively to find solutions to complex problems. In essence the service user should be cared for in a holistic approach and to achieve this collaboration is the answer. (1516)
Professor Munro askes “Some local areas have introduced social work-led, multi-agency locality teams to help inform best next steps in respect of a child or young person, including whether a formal child protection intervention is needed. Do you think this is useful? Do you have evidence of it working well? What are the practical implications of this approach?” (http://www.communitycare.co.uk/Articles/2011/01/04/116046/munro-asks-frontline-workers-what-needs-to-change.htm)
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