Improving partnership working to reduce health inequalities

Tammy Boyce, Professor David Hunter

Working in partnership is central to reducing health inequalities – one department acting alone cannot tackle an issue that does not respect organisational boundaries.

Publication:  The King's Fund website
Reference:  The King's Fund website, 4 December 2009

But unfortunately, all too frequently, only lip service is paid to partnership working in place of real engagement with practicable and sustainable outcomes.

The King's Fund, in partnership with the Strategic Review of Health Inequalities Post 2010 led by Professor Sir Michael Marmot, held a seminar to discuss how to improve partnership working and health inequalities.So, what general principles could help the NHS to facilitate and create better partnerships?

Identify bespoke solutions. Not all partnerships are of equal stature, and there isn't one type of partnership that fits all situations – bespoke solutions with bespoke partners will best meet local needs. For example, Merseyside Fire and Rescue Service has more than 200 partnerships, some formal and others informal.

Structure matters less than purpose. If there's a lesson from successive NHS reorganisations it's that getting the structure right is a never-ending and futile quest. Instead, more appropriate models are urgently needed, such as looser partnerships and networks that shift and change according to the issues and tasks.

Focus on outcomes. One way to make partnerships more successful is to become more outcome focused and define the purpose or added value of partnerships from the outset. Partnerships may be desirable for some issues and tasks, but may not always be necessary. They aren't simply a badge of collaborative working or a way of meeting people – their true value lies in what they can add to a project through shared objectives, aims and outcomes.

Pool budgets where appropriate. Pooling budgets may be part of the answer, and already happens, but their potential is often not fully exploited (as shown in a recent report by the Audit Commission). Governance and accountability are most important in delivering productive partnerships.

Clarify responsibilities. In most partnerships it's unclear who's responsible or accountable for what does and doesn’t happen.  This needs to change – an individual or organisation must be made responsible for delivering outcomes. For example, who 'owns' or is responsible for delivering Local Area Agreements, Local Strategic Partnerships or Joint Strategic Needs Assessments (JSNA). In some areas these are effective documents and activities that change local lives, but in others they are less effective and are often just paper or 'tick box' exercises, particularly the JSNA. Perhaps it's because no one 'owns' these policies or is tasked with making them effective agents for change. We need to make them matter so that partnerships are seen to 'own' targets and share responsibilities.

Give partnerships time to yield results. It can take time to see the outcomes from partnerships. This is partly because it takes time to establish trust and joint methods of working, although this shouldn't be used as an excuse for delay and inaction.

Lead by example. Central government needs to practice what it preaches. The Health Select Committee pointed out that partnership working has been heavily promoted by the Labour government under the title 'joined-up government', but examples of best practice at national level are hard to find. The Cabinet Office Capability Reviews of the Department of Health (2007 and 2009) are critical of the absence of effective joined-up working. It would be helpful if central government demonstrated how effective partnership working can be, thereby setting a good example for those working locally.

Above all, we need to be clear about what partnerships are trying to achieve. Only then are we likely to have partnerships that truly make a difference to health inequalities.

Tammy Boyce is a research fellow in public health at The King's Fund. Professor David Hunter is Professor of Health Policy and Management at Durham University.

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