Partnership working between bodies whose activities affect health and social care is no longer simply a nice idea, but a government-imposed must.
These days few health and social care managers dispute the logic and value of partnership working, but believing in the principle is not enough. It must be made to happen on the ground, so the elderly Mrs Smith does not see her service suppliers in the same light as she views the utility companies who dig up the road outside her house.
It is, therefore, surprising so much attention is given to the whys of this, rather than to the hows. A characteristic Field Marshal Haig approach from the centre - order everyone to do it and shoot the laggards - will fail if it is not accompanied by some guidance.
There are six identifiable barriers to setting off on the journey to effective joint working and seven necessary pre-conditions for departure (see panel).
The barriers to partnership working in the UK public sector can be simply reduced to: money, turf and ego. If the barriers can be overcome and the preconditions met effective partnerships will begin to take shape.
The challenge is having the courage to start giving up ideals such as money, turf and ego in the interests of providing a better service - something which is ultimately far more professionally rewarding. Perhaps the best test of truly effective partnership working is when a colleague from a partnership agency can to go to a meeting at which their partner is not present and commit financially on their behalf.
The chief medical officer, professor Liam Donaldson, has a favourite mantra: 'If we keep doing what we always did, we're not going to keep getting what we always got.' For Mrs Smith's sake that is not good enough.
-Micheal Brereton, chairman of North Staffordshire Health Authority and Dr Malcolm Clarke, co-ordinator of the Morecambe Bay Health Learning Partnership.
See the Barriers and do it anyway
Clarity of roles between professions and threatened professional identities
Partnership working is not logical in traditional terms. Everyone is trained as a professional specialist and promoted because they are good at their specialism, not because they see the whole picture or understand the impact of their work on other professions. Any failure to do so is not because the staff are stupid, but because they are focused on what they are used to doing.
Staffing issues and workload planning
Making the partnership work is often not the top organisational objective. It
will not clinch the next promotion or tick many boxes on performance indicator returns. Staff may also be resentful that their opposite number in a partner agency is paid more than they are. So the partnership work may be done skimpily.
Different cultures and systems of governance
The NHS, local government and the non-statutory sector all have different cultures, values, management structures, reward systems, language, lines of accountability and time-scale 'norms'. In short, the 'way we do things round here' is very different from organisation to organisation. For example, the NHS is used to responding quickly to the centre's thirst for information, but is less used to local democratic accountability. Even concepts such as capital spending may have different meanings and procedures in different organisations.
Finance and budgets
Pooled budgets have relaxed the legal impermeability of the system, but there are still significant differences in budget-fixing processes, time-scales and audit requirements.
Different and incompatible information systems
Those in local government find it difficult to believe their systems are generally more advanced than those in the NHS, some of which are still quite literally, in the case of GPs' casenotes, written on the back of an envelope. On the other hand it generally has less rigorous requirements of security, privacy and confidentiality than the NHS.
Lack of geographical co-terminosity
This is not just a matter of incompatibility between health authority and social services boundaries. Other key agencies may have boundaries that are different again and the distribution of GPs' lists adds a further source of confusion.
Removal of organisational defensiveness
It is about changing staff's focus and primary loyalty away from their own organisation towards a wider vision. It means giving them time and space to do so and making it a priority in the objectives against which they are appraised.
Understanding the importance of user groups
The people who use services often know better than the suppliers as to what is required and what is wrong. Talking to users will highlight failures to apply joined-up thinking.
Respecting the changing roles of professionals
Professionals are the key to good service delivery. Though some well-established professional boundaries should be questioned, there is still a need for the highest standards of professional competence and training.
Understanding the discourse of success
This means good communication at all levels. It means telling the truth to partners, service users and the public, and creating an honest discourse
about service delivery and problem solving.
Have clear strategic objectives, agreed criteria and monitoring arrangements
Make sure objectives are unambiguous, clearly-defined and jointly-owned right from the start. To do this, all partners must look at the wider picture - not just their own performance indicators.
Commitment to the partnership, not the partner agencies
Link people are not enough. Everybody must be involved and committed to the vision. This requires the courage to try new solutions andideas.
Integrated training and management
Joint training will be essential because it develops a shared understanding and flushes out differences in perception about both service needs and the nature of the partner organisations.