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The concepts of 'partnership' and 'collaboration' have become amongst the most critical themes of 'new' Labour's social policy, particularly in respect of the delivery of health and social care. (Lymbery, M, 2005) This is the reason why a reflective summary will be produced in which concepts of partnership, the philosophies and the reducing of negative outcomes for professional, client and organization will be discussed in greater depth. Proposals for minimising negative outcomes will also be covered.
CONCEPTS OF PARTNERSHIP
The definitions of partnership according to Collins English dictionary, 1991 is equal commitment or the state of being a partner. Partnership is also defined as a shared commitment, where all partners have a right and an obligation to participate and will be affected equally by the benefits and disadvantages arising from the partnership as defined by Carnwell, R. and Carson, A. in 2008. Partnership defining attributes are trust and confidence in accountability, respect for specialist expertise, joint working, teamwork, blurring of professional boundaries, member of partnerships share the same vested interests, appropriate governance structures, common goals, transparent lines of communication within and between partner agencies, agreement about the objectives, reciprocity and empathy. Antecedents of partnership are as follow: individual, local and national initiatives, commitment to shared vision about joint venture, willingness to sign up to creating a relationship that will support vision and also value cooperation and respect what other partners bring to the relationship. Partnership provides a number of benefits such as social exclusion will be tackled more efficiently, service provision from different organisations will be less repetitive, activities by agencies will be less diluted and the chance of agencies producing services that are counterproductive to each other will be reduced. However, there are also barriers in working in partnership for instance, complexity of relationships, representativeness of wider public, tokenism and excessive influence of the vocal groups, desire of individuals not to be involved in making decisions about their care, threat to confidentiality, role boundary conflicts, inter-professional differences of perspective and threats to professional identity. (Carnwell, R. and Carson, A. , 2008)
PHILOPSOPHIES OF WORKING IN PARTNERSHIP
In working in partnership, there are few philosophies that underpin partnership working. The philosophies are empowerment, independence, humanity, equity, trust and respect. Empowerment in the context of health and social care is a process through which people gain greater control over decision and actions that will affect their health. (World Health Organisation, 1998) The reason why empowerment is important in the partnership of health and social care context is because they are the vital foundation of developing an honest relationship between client and professional. They also have become accepted principles in social work practice and have received legislative endorsement as the foundation stones of quality relationships between users and providers of community care services as mentioned by Braye, S. and Preston-Shoot, M., in 1993. Without empowerment, a partnership working will not be effective.
Independence according to Oxford, 2010 is free from outside control; not subject to another's authority. Independence in terms of partnership in the health and social care perspective is the ability to make decision that will affect the life of a person without the control of others, be it health professional, family member etc. Other than that, it can also be described as a situation in which a person is not under the power of others. An example for independence in partnership is between a patient and a health professional, the patient should be given the autonomy to choose the choice of treatment that he wants to undergo, not chosen by the professional.
Humanity is the quality of being humane according to Oxford, 2010.
Equity means fairness. Equity in health means that people's needs guide the distribution of opportunities for well-being. (WHO, 1998) Equity in partnership means that every client should be treated and given the access to health services equally. The WHO global strategy of achieving Health for All is fundamentally directed towards achieving greater equity in health between and within populations and between countries. This implies that all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health. (WHO, 1998)
A commitment to partnership working can only be fostered if the partnership itself displays openness in the way it conducts its affairs, 'open book accounting' has to be taken to the extreme if a partnership is to be successful. The reason why trust is important in a partnership is because once distrust enters into a relationship, it is bound to fail. As mutual confidence grows at the individual level so it becomes much easier for the partnership as a whole to become more transparent in its working and thus, encourage trust between partners. (Geddes, M., 2005) Trust in the health and care setting is essential because without trust, it is difficult for a client to be open and honest to the professional.
Respect in partnership is important because in partnership, partners work together to achieve common goals and this relationship is based on mutual respect for each other's skills and competencies and recognition of the advantage of combining these resources to achieve beneficial outcomes. Partnership in the health and social care context can be linked to the key of successful doctor-patient partnerships in which that patient will be recognised as the experts by the doctor. The doctor is, or should be, well informed about diagnostic techniques, the cause of disease, prognosis, treatment options, and preventive strategies, but only the patient knows about his or her experience of illness, social circumstances, habits and behaviour, attitudes to risk, values, and preferences. Both types of knowledge are needed to manage illness successfully, so both parties should be prepared to share information and take decisions jointly. (Bristol Royal Infirmary Inquiry, 2001)
MODELS OF CARE IN RELATION TO PARTNERSHIP PHILOSOPHIES
Models of care are made up of two models. They are the medical model and social model. In medical model, their thinking is that the disability of a person is of their own fault, their future is on the result of the diagnosis, they also tend to be labelled, their impairment becomes the focus of attention, assessment, monitoring, programmes of therapy are imposed to them, separation and alternative services are the only options, their ordinary needs are also put on hold, they are also only allowed to re-enter the ordinary world if they are normal enough otherwise it is permanent exclusion and society remains unchanged. (BFI, 2009) In this model, the independence of patient is being violated as their therapy is imposed on them, not their own choice. Their equity is also defied as they are being excluded socially.
On the other hand, in social model thinking, the disabled person is valued, strengths and needs are defined by self and others, barriers are identified and solutions will be developed, outcome based programme are designed, resources are made available to ordinary services, training for parents and professionals are also provided, relationships are nurtured, diversity are also welcomed and child is included and society evolves to accept the disable. (BFI, 2009) In this model, the client is empowered such as the NHS 'Expert patient programme' in which client take control of their own live without the relying on others. Another strategy that fosters empowerment is the 'Prosumers' in which providers (the disabled person) are also the consumers (supporting other disabled person as a support team). (Dickerson, F., 1998)
THE OUTCOMES & RECOMMENDATIONS
As mentioned in the working in partnership concept, partnership offers various advantages to different level of service user be it users, practitioners and organisations. Alas, it also has its own disadvantages which both will be looked into briefly.
In working with partnership, the advantage is that workload between practitioners will be distributed equally according to one's own expertise. For example, the partnership between family nurses, the supervisor and social worker in safeguarding vulnerable child. If babies and young people who may have been, or are likely to be, abused or neglected. Family nurses will refer a child to social worker as a 'child in need', when appropriate, and will act on concerns that the child may suffer or likely to suffer significant harm. Family nurses will also receive weekly supervision and together with the supervisor work closely with social worker with safeguarding responsibilities. (HM Government, 2010) This benefit both the service user (in this case is children) and organisation that the practitioners work for as work will become more efficient. The Working Together 1999 initiative sets out how organisations and individuals should work together to safeguard and promote the welfare of children and young people in accordance with the Children Act 1989 and the Children Act 2004. (HM Government, 2010)
Partnership with other organisations both involving statutory and voluntary will benefit service users as competition will arise. This will enhance the service being offered by the organisations involved. As an example is the British Red Cross as the voluntary organisation and local department of social work as the statutory. The NHS and Community Care Act in 1990 split the role of health authorities and local authorities by changing their internal structure, so that local authority departments assess the needs of the local population and then purchase the necessary services from 'providers' such as the Red Cross. Community care ensures people in need of long-term care are now being able to live either in their own home, with adequate support, or in a residential home setting. (UWIC, 2010) This adequate support can be obtained from the Red Cross, such as support after being discharged from the hospital until they are fully empowered of themselves to be independent again. Support is important as seeking help from professional can help client to recover better. This will benefit both client and also organisation.
Albeit partnership offers benefits to everyone, it also has its own challenges. One of the major problems of working in partnership is confidentiality. The more people working together on a case, the chances of information to be breached will increase. Along the way, information could also get lost as well. This is because one party will think specific information is not as important as what other parties will think. To overcome this problem in protecting personal data of a client, the 1998 Data Protection Act is the key legislation which covers all aspects of information processed. Additionally, especially in health and social care, to ensure that this act is put into operation, the Caldicott principle is introduced. (Department of Health, 2010)
In general, working in partnership is a great way to tackle issues effectively. However, the idea of partnership does not usually work as what is expected ideally in reality. Partnership working can be difficult to do well, it can be costly if not properly managed and it may not deliver the desired outcomes if the aims and objectives are not clear. On the other hand, it can be reduced by having plans and strategies as a guidance that must be revised after a certain period of time by local authority. The principal purpose of guidance is to provide a framework against which to 'test' potential new partnerships and examine existing ones, to ensure that the Authority can be reassured that the partnership under consideration is one which will contributes positively to its agenda. (Rochford District Council, 2009)
Working in partnership in health and social care is beneficial to all service users, inter professional working and organisational that is involved although it has its own negative consequences. These negative outcomes however can be reduced by referring to guidelines and policies that needs to be updated from time to time.