Do health and social care partnerships actually work?
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Do health and social care partnerships actually work?



Keynote presentation from the TSA Internatonal Conference 2012 sharing psychological and organizational research on health and social care partnerships

Keynote presentation from the TSA Internatonal Conference 2012 sharing psychological and organizational research on health and social care partnerships



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Do health and social care partnerships actually work? Do health and social care partnerships actually work? Presentation Transcript

  • Health and Social CarePartnerships:Can they really work?Jim McManus, CPsychol, CSci, AFBPsS, FFPH, MCIPDDirector of Public HealthHertfordshire County Council/NHS Hertfordshire
  • Sometimes it feels like another planet
  • Five partnership meetings this week
  • What do you mean the partnership plan wasdue today?
  • Context – change and transformation Financial challenges Traditional barriers and approaches havedelivered some gains others have remained elusive and barriersoften seem embedded between agencies. The perennial problem - some partnershipsbuilding a “third culture” which competeswith the existing cultures. Partnerships are a given because they seemto be a necessity
  • The cynics view of partnerships A loose confederation of warring tribes A group of people all united, but against what nobodyreally knows A group of people whose hands are so deeply in eachothers budgets they can’t get out again A set of people who have come together to discussgovernance while people die around them Take minutes and waste hours
  • Content learning from experience, filtered through research evidence onculture and partnerships identify some critical success factors wherepartnerships work or do not. Informed by behavioural sciences
  • The NHS structure from April 2013 – a very DHcentrist viewParliamentFundingAccountability Departmentof HealthNHSCommissioningBoardCQC+ HealthWatch EnglandMonitorProvidersPatients and PublicLocalHealth WatchLocal Authorities + PHClinicalCommissioningGroupsLocalpartnership ContractAccountability for resultsLicensing“Health &Wellbeing Boards”CommissioningSupport Services
  • Environmental Health& Regulatory Services NHSPolice, Fire,Community Safety Third Sector andCommunity BodiesPublic HealthEnglandSpecialist Public Health Agencies with Major Public Health RolesNHS Public Health(moving into HCC)County CouncilDistrict Councils
  • The Literature Partnerships vague multi-meaning concept(Glendinning,2002) Evaluation needs to take account of multiple outcomes(Gillies, 1998) Some positives but depends on behavioural andgovernance factors (Kodner, 2006) Co-ordination across systems is big on most countryagendas in West (Leichsenring ,2004) Wicked issues to be addressed (Ailsa Cook, Alison Petch,Caroline Glendinning, Jon Glasby,2007) Evidence not always clear (Walid El Ansari, Ceri J. Phillips,Marilyn Hammick,2001) So why not just redesign the system?
  • Research in the commercial sector Salience of Value Salience of strategic benefit (money, marketshare, customer) Structures and governance fits strategic benefit (Rondinelli and London, 2003;Waddell & Brown,1997) Private sector – Intellectual Property Issues Public Sector – Inter-professional issues
  • Public sector partnerships research Assets Understanding key issues and drivers Focused action Problems Far too process and governance obsessed Doesn’t learn lessons from commercial sector Takes on a life of its own
  • A smallsample….
  • Summary A problem in many nations Understand what you want toachieve They can work They often don’t Blunt instrument As many positives as negatives No one got any better ideas? And no, we won’t reorganise theuniverse so get on with it –partnerships are a necessity insome areas of public lifeDr Thomson hadn’tQuite undertstood theTelemedicine project
  • So how do we make it happen? A public healthperspective population, outcome, salience, Intervention System capabilities Lifecourse of the humanperson Lifecourse of thepartnership
  • Admit your limits of knowledge andcompetence – it’s liberating!
  • Contributors to overall health outcomes arein multiple agency controlSmoking 10%Diet/Exercise 10%Alcohol use 5%Poor sexual health5%HealthBehaviours30%Education10%Employment10%Income 10%Family/SocialSupport 5%CommunitySafety 5%SocioeconomicFactors 40%Access tocare 10%Quality ofcare 10%Clinical Care20%EnvironmentalQuality 5%BuiltEnvironment5%BuiltEnvironment10%Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.Used in US to rank counties by health statusWhile this is from a US context it does have significant resonance with UK Evidence, though I wouldwant to increase the contribution of housing to health outcomes from a UK perspective.
  • Partnerships don’t think often enoughabout timeframes of yieldYears0 1 5 10 15PlanningEducationVitaminSupplementsAir PollutionDecentHomesJobsPrimaryCare20CVDEventsSelf CareVitamin D and TBRicketsCVD EventsAcute Bronchitis AdmissionsRespiratoryMental Health overcrowding educational attainmentLife ExpectancyHealthier space use Changing culture of activityLife ExpectancyMental Health
  • The Lifecourse impact of health, little evidence most partnerships think of this
  • Degrees of PartnershipCheminais, 2008 Coexistence – clarity as to who does what and with whom. Co-operation – pooling the collective knowledge, skills andachievements available. Co-ordination – partners planning together; sharing some rolesand responsibilities, resources and risk-taking; avoiding overlap. Collaboration – longer-term commitments with organizationalchanges bringing shared leadership, control, resources and risk-taking. Partners from different agencies agree to work togetheron strategies or projects, each contributing to achieving sharedgoals. Co-ownership –different agencies commit themselves toachieving a common vision, making significant changes in whatthey do and how they do it.
  • Blast from the past 2003, republished 2011 Innovative partnerships Blend of private and publicsector insights Where this has been used
  • From thePartneringToolbook
  • Critical success factors
  • Critical Success Factors – the people Psychological Contract Within and betweenagencies andindividuals Clarity of outcomes Clarity of processes Clear advantage to eachagency Control and governance fitfor purpose
  • Critical Success Factors 2 – the why! Understand need Identify the priorities to meet that need Understand timescale, yield and salience Identify effective candidate interventions Identify who is best placed to deliver what Implement well - fidelity to the evidence/theory Build from the person not the agency Psychological Contract
  • A helpful friend for improvement Tools for serviceimprovement Available frominternet
  • CaseFindingandtargetingusinglocallydesignedguidelinesandprotocolsIntervention Components linking NHS with sports for inactive peopleHealth Psychology for intervention design, public health for programme design and leadership, primary care for case finding, screening and referral, sports sector for delivery andalso for screeningClinical Engagement and Support across programmePublic Health, Clinical and Sport Leadership across programmeBehavioural Change Training for Sport and Primary Care StaffEvaluation including pre and post intervention measuresCall in andScreenusingHealthChecks(multiplesettings)RegulargoalchecksandpositivefeedbackOne to oneand groupsupportwith Sportprescribed.Individual“feelinggood,feeling fit”plans madeOngoingmotivationfrom NHSand fromSports staffto stay onprogramme
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