The importance of being efficacious: English health and social care partnerships and service user outcomes

Abstract

Outline The need for health and social care agencies and their professionals to work in partnership is a central component of contemporary English health and social care policy. As in many other countries, partnership is predicated on the notion that this way of working improves services and outcomes for service users. However, as there is little evidence that partnerships improve service user outcomes some commentators suggest that this indicates either a failure of the policy or a deficit in terms of implementation. The aim of this thesis was to investigate the link between English health and social care partnerships and service user outcomes. Rather than adopting the types of rationalist and instrumental approach which the majority of studies in this field have done, the thesis develops a new conceptual framework for partnership which is interpretive and performative. Introduction Partnerships take a number of different forms and do not constitute a particular model of care. Some of the more theoretical discussions around partnership involve debate over whether partnerships are synonymous with a particular mode of governance (i.e., network, hierarchy or market). However, in practice partnership has been implemented as all of these different modes and through a range of different means. The one commonality is that health and social care partnership are conceptualised as instrumental tools of improvement, introduced in order to bring about positive changes to service user outcomes. Yet, an analysis of the policy context indicates that there are a range of reasons that partnerships might be introduced, beyond simply being a means to bring about better service user outcomes. The thesis identifies four dominant ‘frames' that seek to explain why it is that health and social care partnerships exist and what it is that they should achieve (see Table 1). Although central government has predominantly cited improved service user outcomes as the motivation of these frames, this does not appear to be a central driver of any of these frames suggesting that service user outcomes are therefore not the sole driver of partnerships. This may also go some way to explaining why there is a lack of empirical evidence linking partnerships and service user outcomes. This thesis argues that the power of partnership is not as an instrumental mode of improvement, but instead in terms of its symbolic and cultural power. A new conceptual framework of partnership was constructed that is interpretive and performative in nature. This framework is developed and tested with four exploratory care study sites in the thesis. Data was collected using the Partnership Outcomes Evaluation Toolkit (POET), an evaluation framework that was designed specifically for this thesis [1]. Results/findings The findings of this study conclude that partnership is not necessarily simply an instrument of improvement in a traditional sense. Although all of the partnerships involved in the research claimed to be driven by the aim of improving service user outcomes, the observations made in the thesis suggest that their local enactment was rather different. It appeared that there were other factors driving local changes that were not being explicitly articulated. Partnership was being used as a means of framing a series of changes and engaging a variety of stakeholders towards some specific local changes, and actions that might otherwise have been resisted. The power of partnership therefore lies in its cultural and symbolic value. This takes partnership beyond traditional discussions of partnership and governance; rather than representing a particular mode of governance, instead arguing that partnership is an active tool of governance. Implications for integrated care For the readers of the IJIC it is of special interest to learn that the impacts of integrated care are more extensive than simply in terms of efficiency or organisational effectiveness. In England, notions of partnership and its implications extend beyond service improvement processes to include notions of politics and power in the reform of health care. It may be of interest to compare these findings across other countries and other service areas. The results presented in this review are based on the author’s thesis presented at the University of Birmingham in December 2010. Further articles by this author in the International Journal of Integrated Care Glasby J, Dickinson H, Miller R. Partnership working in England—where are we now and where have we come from? International Journal of Integrated Care [serial online] 2011, forthcoming. Dickinson H. Is leading and managing in inter-agency settings really that different? International Journal of Integrated Care 2009 Sept 16; 9. Available from: http://www.ijic.org/. URN:NBN:NL:UI:10-1-100562. Glasby J, Dickinson H. Greater than the sum of our parts? Emerging lessons for UK health and social care. International Journal of Integrated Care [serial online] 2008 Aug 20; 8. Available from: http://www.ijic.org/. URN:NBN:NL:UI:10-1-100488.