The Other side of Partnership working in the British NHS and Social Care

Services.

A case discourse on how Partnership networking in Britain Social Services

and the National Health Services can compromise service deliveries.

In Britain, the ideology of partnership working in health and social care delivery was
initially conceived by the New Rights who argued that rather than decentralisation
professionals would be more accountable to customers through a market approach
and through greater managerial control over service. Their vision was for a service
that provided a seamless care, reduce waste and control spiralling cost, increased
user’s choice and made services responsive. Labour’s founding theory behind
partnership working was that “joined up problems require joined up solution.”
Sullivan and Skelcher (2002).

While the rationales and motivations behind these partnership ideals were seemingly
virtuous, experience has shown that translating such dreams into best practice in
health and social care to stakeholders with varied interests and needs will always be
problematic. Additionally, the very concept of partnership is a social construct; a
concept whose extreme malleability means that, its meaning is not only contextual
but depends on the dexterity of its manipulators and the purpose for which
conceptualisation is sort. ,Conscious not just on this lack of specificity it definition but
the reality that service deliveries are operationalised within a volatile, social,
economic and political environment; achieving best practise through effective
partnership working in the British Health and Social Care Services will always be
relative rather than comprehensive. Thus, while the initial euphoria of partnership
networking might have subjectively posited the concept as the panacea to systemic
practice shortcomings in myriad of Health and Social Care Service deliveries, this
analysis seeks to show how without critical construction, application, monitoring and
appropriate ‘MOT’, the concept can create more problems than it aspires to solve.
Needless to suggest that maybe it was as a result of such realisation that the Audit
Commission (2004a) “set out guidelines on issues regarding; objectives, purpose,
strategies, decision-making, roles and responsibilities, resourcing, conflict resolution,
information sharing, and evaluating success.” in partnership collaborations.
In the British National Health and Social Care Services, as in most statutory service
deliveries, partnership working can only be effective, efficient and appropriate when
the right things are consultatively done at the right time, by the right people, in the
right way, honestly and transparently. Core to achieving these ideals is the essential
need for effective communication between and amongst all stake holders. For
example, in service provision to children with severe learning disabilities, the Audit
Commission, (2004a), states that these can be very effective, efficient and beneficial
if “the views, objectives and values of the partnership are not only clearly
communicated, but if all stake holders such a service users, carers, their families,
staff, other agencies, funders and the community are consulted in relevant decision-
making” Unfortunately, the consistent and systemic failures in the duty of care and
duty to protect service users and similar stakeholders; as typical of child abuses
cases, are symptomatic of concerns increasingly expressed about the structures,
processes and procedures of partnership collaborative networking.

The most obvious constraint to effective partnership collaboration at all levels is the
fact that stakeholders are not a homogeneous entity with identical interest and
needs, but consist of amalgamation of heterogeneous groups, individuals and
agencies who prevalently rather seek to maximise their interests or gains within the
framework. This occurrence gives plausible reasons to suggest that the seeds of
partnership ineffectiveness and conflict are inherent in its very concept and
structures. Power struggle, vying for recognition and ego boosting, has transformed
previous mutually constructed partnership structures into conflict and battle
environments.
It is the central role of the National Health and Social Care Services in our daily lives
that make them ideal samples for validating preceding assertions. To better
understand the problematic side of partnership networking in the National Health and
Social Care Services it is essential to highlight those characteristics typical of the
ideal partnership and how their misapplications or mismanagements can render
them, liabilities rather than assets to best practice. While at the managerial and
executive levels formal partnership structures may provide for some degree of
effective, consultative and equitable power relationship or holistic proactive
participation, the reality is that segregation is endemic in partnership networking
based on credentialism, gender, race etc. As earlier mentioned, stakeholders in the
health and care system are otherwise independent and heterogeneous who have
come together to create structures or processes for jointly working; sharing risk and
rewards on the path to achieve common goals or outcomes. Thus, partnership is
inescapable from conflicts inherent with such inherent diversity; identity, interest and
power relationships. Moreover, the advanced approach to effective partnership
collaboration is more suitable to the articulate professionals as opposed to most
service users; some with multiple communication impairments or their advocates
who may lack the ability to be assertive within such a segregated framework. Within
the latter context, transport and set yourself in the typical daily occurrence on the
NHS hospital ward round;
- The visibly credentialed hospital consultant immaculately turned out in his
white office regalia and stiltedly poised to openly highlight and expose the
faults of junior doctors as they report on the health circumstance of their
assigned patients;

- Each junior doctor apprehensive of the scourge of the consultant and the
trepidation of being humiliated in front of colleagues, and their patients;

- The patient’s social worker who is comprehensively petrified and dare not be
proactive in decision-making and related negotiations and arrangements due
to social stereotyping and the awareness of their lack of equivalent or
comparative credentials vis-a-vis the medics.

- The vulnerable and virtually helpless patients who is bed-ridden and being
bombarded with impressive but totally incomprehensible medical jargons.
Indeed on a unique occasion when I was admitted into hospital for a served
finger, I laid helplessly listening to the medics describing and discussing
parts of my anatomy I never knew actually existed. To date, the memory of
the consultant’s regimented attitude still plays in my mind.

In contemporary consumerist or market approach to service deliveries in our

National Health and Social Care Services where the service user is supposed to be
core and proactive partners to the provider-consumer partnership; or where care
workers are supposed to constitute the essential advocates where clients are
incapable of exercising their rights, it is astonishing how partnership structures have
colluded to disempower and oppress the service user. Indeed, despite myriad of
thesis and propaganda about responsive service deliveries derived from inclusive
client’s partnership in decision-making, experiences show that in most cases
credential deficiency and powerlessness means that patients and their advocates
are perceived and treated by management and medics prevalently as passive and
inanimate objects.

Presuming that with reservation, the supposed joint collaboration between the
consultant, the junior doctors, the social workers and the patients or service users
can be described as a partnership; then there is convincing reason to argue that the
autocratic power relationship between stakeholders will reciprocate non-responsive
services. For example, where commonsense would expect the social work model to
risk-assess the circumstance, environment and network support to be inclusive in
hospital discharge decision-makings, it is the top-down medical model where the
decision of the consultants is supreme that supersedes. While the autocratic
leadership of consultants and similar professionals are ideal in regimented
frameworks where total obedience is core to performance, in the National Health and
Social Care Services, it is only assertive leadership that would produce responsive
and empathetic service delivery. By assertive leadership, I mean that while
consultants decide on matters of medical interventions, issues on the discharge and
related support for service users or patients should be consultative and based on the
social work model. Indeed where is the rationale behind hastily discharging patients
into unsafe and unsupportive environments to free bed space only to readmit them
due to shortcomings derived from such power dominance in the medic-client
partnership?

My brief experience as a service user admitted into hospital for a severed finger
showed that, rather than a formal partnership structure with clear objectives and
defined outcome expectations, most partnership collaborations beyond the executive
echelon in the British Health and Social Care Services is presumed. In fact there is
no formal structure to ensure that at client level, the voice or views of the client is
inclusive in decisions affecting their lives. Within this state of anarchy or laissez-faire,
the consultant with his envious credentials has hijacked and exploited the
disproportionate power relationship. The consequences are that decisions can be
irrationally subjective and biased; with significant negative impact on the quantity and
quality of service deliveries.

As such, in the National Health and Social Care Services and other statutory service
providers, where decisions are to be made on the processes and procedures to
achieve responsive outcomes, there is vital need to explore every empowerment
avenue including advocacy to enable, promote and consistently practice inclusive
partnership working. Rather than just a presumed partnership at front line level, a
structured framework acting as point of reference would ensure that the aims,
purpose, roles and responsibilities; equality and diversity; accountability are
safeguarded. Most importantly, rather than being dictatorial, consultants and similar
professionals should learn the vital skills of assertive leadership.

Assertive leadership in partnership working in the NHS and Social Care Services
should enable partnership leader or leaders to stand up for his, her or their rights,
while respecting and promoting the views and rights of others; especially service
users and their advocates (social workers, key workers and nurses). This is because
rights in partnership include not only legal rights but also rights to individuality, to
have and express personal preferences, feelings and opinions. Thus core to
effective partnership leadership is assertive listening to empathetically understand
and objectively accommodate the views of relevant stakeholders; especially service
users. To date the culture of credentialism has meant that social work professionals
and service users have been socialised into subjectively believing that it is the right
of doctors to dictate while they and their clients passively consumed orders
irrespective. Similarly, with the highly stratified hierarchy within the medical
profession, the trainee or junior doctors, just as the social workers and their clients
are helpless, petrified and incessantly apprehensive faced within the power-wielding
consultants. Holistically, this and similar visible autocracy in supposed partnership
collaboration are recipes for problematic, ineffective, inefficient, inadequate and
inappropriate outcomes.
These are my observations and opinions. In the reader–author partnership where I
relish and value your perspectives, what are your opinions?
Contact me directly on 07951622137 or email Dr Ignatius at
antichildtraffic@yahoo.co.uk. I value your contributions.
Bibliography

Audit Commission (2004a) Making ends meet: partnership. London: Audit

Commission

Sullivan, H. and Skelcher, C. (2002) Working Across Boundaries: Collaboration in

Public Service. Palgrave Macmillan.