Improving partnership working to reduce health inequalities

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

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.


Sena Ovcharova

Healthcare Support Worker,
North Middlesex University Hospital
Comment date
20 November 2017

As it is stated in the article from King's Fund, governance and accountability are most important in delivering productive partnerships. When all partners have their responsibilities clarified and they are accountable for what does and doesn’t happen, it is efficient to organise and manage the partnerships according to the issues and tasks. This leads to generating of appropriate purpose centred models which will use looser partnerships and networks to serve through shared clear objectives and aims. Analysing the difference between the outcomes expected and the outcomes achieved will help to evaluate the partnerships and to create the right bespoke solutions for improving partnership working to reduce health inequalities.
Instead of looking at Local Area Agreements, Local Strategic Partnerships or Joint Strategic Needs Assessments (JSNA) as un act of collaborative working, we have to take action for implementing them in an effective net of flexible partnerships with determined shared targets as result of JSNA findings, so they can serve the purpose they were created for.

Mohamad Dowlut

Health Care Support Worker,
Comment date
03 November 2017

Structure matters less than purpose : Ultimate purpose of effective communication should be towards achieving its aims .
Clarify responsibilities : Each individual need to be aware of their respective roles and responsibilities towards maximizing team communication, in terms of timescales, boundaries to sharing information, documentation and clear language with minimal use of technical jargon.
Thirdly ; lead by example: where each individual takes a practice role to ensure effective use of communication achieves optimum outcomes for patients/ service users and sets an example / precedents such that others may be motivated in doing so.

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