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About this book

If you are looking for a succinct overview of the ideas and debates that shape the field of interagency working, then this is the book for you.

Jon Glasby and Helen Dickinson's A-Z of Interagency Working provides an expertly organised source of clear explanation and astute commentary on a topic that is of importance to anyone working in the health and social care field today.

Capturing key policies, concepts and perspectives across the fields of adult and children's services, the book distils a complex subject into 70 pivotal ideas. Cross-references cleverly aid navigation and help the reader see how ideas connect up. This flexible source book makes sense of current policy, explains the latest terminology and engages with the evidence base for what is happening on the ground. It is also packed with excellent recommendations for further reading.

This is an ideal starting-point for students needing to get to grips with current debates, and a perfect point of reference for practitioners and policy-makers engaged in collaboration and partnership day to day.

Table of Contents

A

Accountability

Abstract
When we read newspapers or watch television, many of the news stories that we come across are underpinned by discussions of responsibility and accountability. When a national (or local) football team loses a game, we ask who is accountable for this — is it a single player, the team, the manager or the owner of the club? When there is a serious failing in the care of an individual or a group of service users, is this the fault of an errant individual or team, or is this caused by the fault of the wider organization or even the health and social care system that professionals and organizations operate within? Thus, the issue of the accountability is an important one, which is at the heart of many of our conversations about the everyday world.
Jon Glasby, Helen Dickinson

Acute Care

Abstract
In the United Kingdom (as in most developed countries), the health care system is dominated by acute care. This is partly because many health systems were initially set up to provide episodic care in a crisis, treating the individual and (if possible) returning them to full health. With demographic changes, this model no longer feels in keeping with the changing nature of disease — and most users of health services are (often older) people with a number of long-term conditions or chronic diseases. Such people may need a hospital in an emergency, but the bulk of their care and support is based around self-care and around back-up support at home and in the community. Arguably, this shift requires a very different mindset and service configuration.
Jon Glasby, Helen Dickinson

Area-Based Initiatives

Abstract
Although many UK welfare services operate on a single department basis (e.g. the Department of Health focuses primarily on health care), there has been growing recognition over time that many welfare issues interact. Thus, some very disadvantaged communities might experience greater crime and anti-social behaviour than other areas, have poor access to health care and to education and experience higher unemployment — all at the same time. In response, a number of policies over time have encouraged local services to work together across traditional agency boundaries (including with local voluntary and community services and with local residents and communities). These have had different names and a slightly different focus, but are often described as ‘area-based initiatives’ or ‘zonal’ approaches. Examples include the following:
  • The Children’s Fund: a national programme established in 2000 to prevent social exclusion in children and young people aged 5–13 across 150 local authorities in England (Edwards et al., 2006).
  • Health Action Zones: an early policy from the New Labour government (1997–2010) to tackle health inequalities, focusing on a series of cross-cutting initiatives in 26 deprived areas across England (Barnes et al., 2005).
  • New Deal for Communities: New Labour programme to tackle deprivation in 39 communities with some £2 billion investment over a ten-year period (Department for Communities and Local Government, 2010).
  • Sure Start: cross-cutting New Labour programme to reduce child poverty (Belsky et al., 2007).
Jon Glasby, Helen Dickinson

Assessment

Abstract
Both health and social care are made up of a number of relatively autonomous professions (including medicine, nursing, social work, occupational therapy and so on). Before care or services can be delivered, these professions and other workers have to carry out an assessment — both to determine whether people’s needs qualify for services and to decide how best to meet those needs. Typically, each profession will have slightly different responses and interventions at its disposal, and will assess for different things in different ways. For example, a surgical intervention will require a particular kind of attention focused on particular medical and biological factors, while a nursing assessment may focus more on issues such as personal care, pain, tissue viability, nutrition and so on. An occupational therapy assessment might focus more on equipment or adaptations to help people negotiate the built environment, while a social work assessment might focus more on the needs of the individual in their broader social context.
Jon Glasby, Helen Dickinson

C

Care Trusts

Abstract
In England, the most integrated health and social organizational structure has historically been the Care Trust. Introduced following The NHS Plan of 2000 (Department of Health, 2000), Care Trusts were fully merged organizations that were either provider-based (often mental health trusts providing health and social care) or PCT-based (i.e. both commissioning and providing integrated health and social care). Although ministers initially claimed that all services for older people would be provided by Care Trusts within five years, this did not come to fruition — with a maximum of around ten such organizations at any one time (see Glasby and Peck, 2004; Miller et al., 2011 for a summary). In many cases, this was due to hostility from local government, who saw Care Trusts (which were technically NHS organizations with social care responsibilities and staff delegated to them) as an NHS ‘take-over’ and as representing loss of local democratic control over local services.
Jon Glasby, Helen Dickinson

Carers

Abstract
Although debates about health and social care often focus on formal services and on the role of professional and paid workers, the bulk of support to a range of user groups is provided by family, friends and neighbours on an unpaid basis. While this is often described as informal care, this term can sometimes be interpreted in a slightly dismissive manner (as if ‘informal’ care is less important than formal care — when arguably the opposite is true). This entry therefore uses the term ‘carer’, albeit that this can sometimes cause confusion and that many ‘carers’ may not define themselves in this way (but as spouses, children, siblings, friends and so on). Initially, official policy in the United Kingdom did not recognize the needs and contribution of carers — despite the fact that carers make a contribution that has been estimated at £119 billion per year and more than the entire NHS budget (Buckner and Yeandle, 2011). Over time, however, there has been a growing awareness of the vital role that carers play — often driven by the work of carers’ campaigning organizations and by research. This has culminated in a range of legal measures and a national strategy to promote the rights of carers and provide greater support (see, for example, HM Government, 2010a). Despite this, the value base of policy makers has not always been clear — are we supporting carers because this is a cheap and effective way of supporting service users? Are we supporting carers because it helps them remain in the labour market (and thus continue paying tax and National Insurance etc.)? Or are we supporting carers because they are citizens too with the same right to a good life as everyone else (see Glasby et al., 2010 for further discussion)?
Jon Glasby, Helen Dickinson

Children’s Trusts

Abstract
In English children’s services, a key influence has been the Lord Laming review, Every Child Matters agenda and the 2004 Children Act introduced in response to the tragic death of Victoria Climbié (Department for Education and Skills, 2003; Laming, 2003). Over time, this has led to the creation of separate children’s services, with Councils establishing new children’s directorates (made up of education and children’s social care) and new adult directorates (with titles such as ‘Adults and Communities’, ‘Health and Social Care’ or ‘Social Inclusion and Health’). More recently, some Councils have felt that this creates too great a divide between adult and children’s services, with some reuniting these directorates (sometimes into new ‘people’ directorates, incorporating both children’s and adult services). In addition, a key part of the broader Every Child Matter agenda was a greater emphasis on the co-location of staff, information sharing, common assessment and improvements in safeguarding. While many of these mechanisms were already in place in many adult services, such formal integration was probably less common in some children’s services — except in particular pockets (such as teams supporting disabled children or child and adolescent mental health services).
Jon Glasby, Helen Dickinson

Clinical Commissioning Groups

Abstract
As explained in the commissioning entry, CCGs are the latest in a long line of primary care-led forms of health care commissioning. Introduced by the Health and Social Care Act of 2012, they will take responsibility for commissioning the vast majority of local community and acute health care (responsible for around £60 billion of the NHS budget). They will be authorized by a new NHS Commissioning Board (which will be accountable to the Secretary of State for the overall outcomes achieved by the NHS) and will be able to choose where they get their commissioning support from (although the NHS is developing a series of local Commissioning Support Services who will offer their services to the new CCGs). In difficult financial circumstances, these reforms aim at placing primary care clinicians (especially general practitioners or GPs) centre stage and to give general practice greater control of the system and a greater financial incentive to use scarce resources as effectively as possible. However, there has been significant professional and media debate as to whether this will change the nature of GPs’ relationships with their patients, whether GPs will want to be commissioners, what support they will need and how much the new system may cost. A more detailed history of NHS commissioning is provided in the commissioning entry.
Jon Glasby, Helen Dickinson

Clinical Networks

Abstract
Over the last decade or so, there has been sustained interest in the notion of clinical networks from UK governments and local health care organizations alike. This interest also reflects wider international attention that has been paid to these forms (see, for example, Braithwaite et al., 2009). In the UK, clinical networks have largely focused on creating links between health care organizations. Typically this has been as a way of linking secondary and tertiary care organizations with primary health care organizations. In integration terms then, clinical networks have primarily been used as a way of attempting to create vertical links (i.e. between health organizations) rather than horizontal links (i.e. between health and other sectors).
Jon Glasby, Helen Dickinson

Clinical Pathways

Abstract
As the fields of health and social care have become increasingly specialized in terms of the focus of individual agencies and professionals and as the range of agencies and organizations has expanded, the journeys of care that patients experience have often become more complex. Clinical pathways have become a way to manage quality and experience of care and also a way in which care processes can be standardized. Bryan et al. (2002, pp. 77–78) describe an integrated care pathway as ‘a map of the process involved in managing a common clinical condition or situation. It should detail what to do, when to do it, by whom the action should be undertaken and where the task should be performed.’ A key component of clinical pathways is also their evidence-based nature, with The NHS Plan (Department of Health, 2000) emphasizing the importance of planning care around the patient and the use of protocols for each condition to ensure evidence-based practice.
Jon Glasby, Helen Dickinson

Commissioning

Abstract
Under the ‘internal market’ of the 1990s, the NHS adopted a series of more market-based reforms. Henceforth, one set of agencies was to be responsible for deciding what services an area needed, finding a provider and paying for these services, while other agencies were responsible for providing health care. The organizations responsible for securing services on behalf of the local population (later described as ‘commissioning’) have included a range of agencies over time: in England, the key agencies were health authorities, GP fundholders, Primary Care Groups, PCTs and CCGs.
Jon Glasby, Helen Dickinson

Community Services

Abstract
Health care has historically been organized on the basis of primary care/general practice, community services and acute care — with the middle of these arguably neglected at the expense of the others. Acute hospitals are often very popular and powerful institutions, while GPs have a key role as a gateway into the rest of the system and are often very trusted by the public. In contrast, community health services (such as district nursing, health visitors, etc.) — although crucial — can sometimes seem like something of an afterthought in policy terms. Although social care organizes itself in different ways, there are clear opportunities for community health and social care services to work together in a number of different ways — whether through multi-professional teamworking, co-location and/or more formal integration (perhaps via new integrated social enterprises or Community FTs).
Jon Glasby, Helen Dickinson

Co-Production

Abstract
In the context of a text about inter-agency working, the notion of co-production illuminates a different form of collaboration. This mode of collaboration focuses on the relationship between service users and public services — and not the more horizontal linkages between different public sector agencies. The concept of co-production has a significant history that originally arose from the civil rights movement from the United States (New Economics Foundation, 2008).
Jon Glasby, Helen Dickinson

Culture

Abstract
In discussions of inter-agency working, one topic seems to recur more than any other: culture. In reading accounts of inter-agency work, we often hear that some initiative was not successful because the partners coming together had very different cultures, or conversely that joint working was successful because the cultures were very similar. Indeed, the wider commercial sector literature on mergers and acquisitions suggests that these most often fail because structural factors take precedence over the more human (cultural) factors. However, despite the frequency of its occurrence, this concept has often been treated in a rather simplistic manner as a factor that should be attended to, but without being any clearer about what that factor might actually look like in practice. This can be problematic as culture is a rather complex concept with many different underpinning models suggested by various commentators.
Jon Glasby, Helen Dickinson

D

Data Protection

Abstract
There are many examples where the failure to share information between professionals has been a contributory factor in the failure of public services. The Bichard inquiry into the Soham murders cited the failure of Humberside police to pass on information about Ian Huntley as a key failing. Similarly, the Laming report into the death of Victoria Climbié highlighted the failure to collect information and share concerns across multiple agency boundaries. In both these cases, a failure to share data was a key focus of the subsequent inquiries.
Jon Glasby, Helen Dickinson

Devolution

Abstract
Trusts (Northern Ireland); Joint Future (scotland) At its most simple, devolution essentially means the granting of powers from a national level to a regional or local level. In terms of UK health and social care, there are at least two ways in which devolution has occurred. The first is in terms of the political devolution from Whitehall to Scotland, Northern Ireland and Wales. The second is in terms of the devolution of power within individual institutions and the sorts of responsibilities and accountabilities that NHS and social care organizations have in practice. This section mainly focuses on the first on these issues, although before moving on to this we reflect briefly on the latter point.
Jon Glasby, Helen Dickinson

E

Evaluation

Abstract
At its most simple, evaluation is the ‘process of determining the merit, worth or value of something, or the produce of that process’ (Scriven, 1991, p. 139). Evaluation then is something we all do on a daily basis in going about our everyday lives. This is a fairly broad term and so in the context of social sciences has been described as a family of research methods that involves the ‘systematic application of social research procedures in assessing the conceptualization and design, implementation, and utility of social intervention programs. In other words, evaluation research involves the use of social research methodologies to judge and improve the planning, monitoring, effectiveness and efficiency of health, education, welfare and other human service programs’ (Rossi and Freeman, 1985, p. 19).
Jon Glasby, Helen Dickinson

F

Foundation Trusts

Abstract
In England, the creation of an internal market in the early 1990s saw hospitals become self-managing ‘NHS Trusts’, with Boards based on private sector models and a business model based around NHS commissioners purchasing their services. In practice, there was relatively little competition (especially in some part of the country) and hospitals remained very powerful organizations, often able to resist the desire of some commissioners for more radical service redesign. From 2003, high-performing Trusts were strengthened yet further with the advent of Foundation status (under the Health and Social Care (Community Health and Standards) Act 2003). Under this new model, hospitals could apply to a new regulator, Monitor, to become FTs: legally independent organizations or Public Benefit Corporations no longer subject to direction from the Secretary of State. They not only have a Board similar to a non-FT, but also have a Council of Governors made up of people chosen by partner agencies and elected from patients, staff and local people. They also have a ‘membership’, with local people, patients and staff able to become a member of the Trust and, in principle, become more involved in the life of the hospital (see Ham and Hunt, 2008 for an early study into FT membership).
Jon Glasby, Helen Dickinson

G

Governance

Abstract
Governance is a broad topic and one that has received substantial interest over the past thirty years or so — although the meaning of this term is far from straight forward. As Newman (2001, p. 12) highlights, ‘governance has become a rather promiscuous concept, linked to a range of theoretical perspectives and policy approaches.’ Governance acts as a ‘descriptive and normative term, referring to the way in which organisations and institutions are (or should be) governed’ (p. 16). Although definitions of governance vary, most contain common themes such as those of direction, control, values and accountability.
Jon Glasby, Helen Dickinson

H

Health Act Flexibilities

Abstract
When New Labour were elected in 1997, an early pledge was to develop more co-ordinated services (often described as ‘joined-up solutions to joined-up problems’). This happened in a number of ways (see the entry on area-based initiatives), but in health and social care a key element of this commitment was embodied in the 1999 Health Act. In 1998, a consultation paper on health and social care partnerships (Partnership in Action) gave a very hard-hitting but accurate critique of the current state of play (Department of Health, 1998, p. 3):
All too often when people have complex needs spanning both health and social care good quality services are sacrificed for sterile arguments about boundaries. When this happens people, often the most vulnerable in our society … and those who care for them find themselves in the no man’s land between health and social services. This is not what people want or need. It places the needs of the organisation above the needs of the people they are there to serve. It is poor organisation, poor practice, poor use of taxpayers’ money — it is unacceptable.
Jon Glasby, Helen Dickinson

Health Boards (Wales and Scotland)

Abstract
With the introduction of the devolved administrations for Scotland, Wales, and Northern Ireland, the policy detail and structures of health and social services are becoming increasingly diverse. While Northern Ireland has integrated Health and Social Care Trusts, arguably England is at the other extreme of the spectrum with a clear division between the payer (PCTs/CCGs) and providers (through a mixed economy of care). Wales and Scotland both have organizational structures known as Health Boards, which are essentially responsible for the local health services of a particular geographical area — although there are slight differences between the precise features of these countries. What is consistent across these two countries, though, is that they have rejected the purchaser-provider split associated with the English NHS (and the phrase ‘strategic planning’ may be used more often than the more English notion of ‘strategic commissioning’).
Jon Glasby, Helen Dickinson

Health and Social Care Trusts (Northern Ireland)

Abstract
In recent years Scottish and Welsh health services have become increasingly divergent to that of England as the devolution of powers has led to different decisions being taken about the structure and organization of these services.
Jon Glasby, Helen Dickinson

Health and Well-Being Boards

Abstract
Following the creation of a Conservative-Liberal Democrat coalition in 2010, the Liberating the NHS White Paper set out a series of reforms (Department of Health, 2010a) later enacted in the Health and Social Care Act 2012. Although the bulk of the White Paper focused on changes within the NHS (and in particular on clinical commissioning), a key theme of the paper was also about creating greater local accountability. As part of a broader ‘localism’ agenda, a key mechanism is the Health and Well-Being Board, described in the White Paper in the following terms (p. 34):
The Government will strengthen the local democratic legitimacy of the NHS. Building on the power of the local authority to promote local wellbeing, we will establish new statutory arrangements within local authorities — which will be established as ‘health and wellbeing boards’ or within existing strategic partnerships — to take on the function of joining up the commissioning of local NHS services, social care and health improvement. These health and wellbeing boards allow local authorities to take a strategic approach and promote integration across health and adult social care, children’s services, including safeguarding, and the wider local authority agenda.
Jon Glasby, Helen Dickinson

Hierarchies

Abstract
Traditional organizational theory suggests that there are three primary ways that organizations interact with one another: through hierarchies, markets or networks. Each of these different modes is characterized in a number of different ways, such as what factors link partners, how they communicate, how flexible these arrangements are and how they resolve conflict (see Table 1). Often these ways of interacting are set in contrast to one another and they are seen as distinct ways of organizing — although in reality modes might be settlements of these ideal types. In this section we provide an overview of hierarchies, but readers may also find it helpful to read entries on markets and networks to get a complete picture of these concepts.
Jon Glasby, Helen Dickinson

Hospital Discharge

Abstract
Kingdom (and indeed in many other developed countries too), the issue of hospital discharge is one of the most controversial and longstanding. Whenever someone likely to have ongoing needs (often a frail older person or someone with multiple long-term Conditions) is nearing discharge, they can often feel too well for hospital but not well enough to be home without support (either temporary as they regain their confidence or ongoing). This can sometimes be described as a ‘discharge’ from hospital (where the hospital’s responsibility ends when they person is medically ready to leave). However, more recently (and more accurately) policy makers have begun to describe it as a ‘transfer of care’ (to reflect the fact that the person may have ongoing needs that should now be met in the community). Thus, hospital discharge — or transfers of care — require careful co-ordination, planning and joint implementation between hospital and community and between health and social care. As Henwood (1994, p. 1) suggested as far back as 1994:
Effective hospital discharge is dependent upon the various agencies involved acknowledging their complementary responsibilities. The benefits of getting it right can include maximizing individuals’ chance of recovery; improved hospital bed usage; more effective targeting of scarce assessment skills, and well informed community health staff knowing exactly what contribution they need to make to the care of the individual. The costs of getting it wrong include: a poor service to patients, and unnecessarily slow recovery; GPs not knowing what has happened to their patients; social services staff receiving inappropriate referrals; disputes breaking out; un-planned readmissions, a general waste of resources, and the risk of bad publicity on bed blocking. [Despite our traditional focus on hospital ‘discharge’] … it is also apparent that a discharge from hospital is an admission — or transfer — to community care; and an admission to hospital is a transfer from the community. It is crucial, therefore, to recognize that actions and decisions made at any point in a care episode can have consequences for other parts of the health and social care system.
Jon Glasby, Helen Dickinson

I

Inter-Professional Education

Abstract
The different professions that are involved in delivering and designing health and social care services often have quite different values and perspectives. As such, professionals do not always entirely understand each other’s views and approaches and this can cause difficulties or even confrontation when working together. Inter-professional education (IPE) has been seen as a solution to the practical difficulties associated with inter-agency working and a way of this reducing conflict between professionals. The essence of IPE is that professionals should ‘learn together to work together’ and this has been seen as a way to overcome ignorance and prejudice between health and social care practitioners. By learning together, it is assumed that professions will better understand each other and value what others bring to the practice of inter-agency working. In the longer run, it is thought that this might ultimately improve working relations and hence improve the quality of care and outcomes for service users.
Jon Glasby, Helen Dickinson

Inter-Professional Working

Abstract
SEE partnership working
Jon Glasby, Helen Dickinson

Intermediate Care

Abstract
As the nature of acute care has changed over time, hospitals have found themselves caring for people with more complex needs and significantly increasing throughput. This has made them focus in ever greater detail on the most effective use of hospital beds — a scarce resource for which demand can sometimes outstrip supply. In the late 1990s in particular, this seemed to culminate in an annual ‘winter crisis’, with high-profile media reports of busy hospitals unable to admit patients to A&E because wards were full of patients unable to be discharged back to the community. While this later led to a series of policy attempts to provide ‘the right care, in the right place at the right time’, an early response was to develop a series of local pilot projects such as rapid response nursing teams, step-up or step-down beds in the community and additional out-of-hours support. From 2001 onwards, many of these were swept up into a broader concept of intermediate care — a range of local services designed to work with local older people in order to prevent inappropriate admissions to hospital, ensure timely hospital discharge and prevent premature admissions to permanent residential/nursing home placements. In many ways this is similar to more recent emphasis on concepts such as re-ablement and on measures to make acute hospitals more responsible for people’s after-care in the first 30 days after discharge. Identified as a key priority in the 2001 National Service Framework for Older People (Department of Health, 2001a), intermediate care was boosted by the announcement of £900 million government funding to develop this new approach (albeit that questions remained as to how ‘new’ some of this funding was in reality).
Jon Glasby, Helen Dickinson

Involvement

Abstract
Although this book focuses on collaboration between different professions and agencies, it is also important that health and social care work collaboratively with people using services and their families. There is further discussion of this in entries on topics such as co-production and personalization, as well as broader consideration of issues such as power. However, both health and social care have long traditions of attempts to involve service users and patients in decisions about their own care and about services more generally. Typically, a number of different terms are used (from consultation to engagement and from empowerment to participation). Behind these different terms is a sense that health and social care professionals may have technical skills and be experts in how the system works — but it is people using services and their carers who are experts in their own lives and in what works best for them (in the context of their families, communities and individual circumstances). Thus, there is a desire — at least in principle — to create some sort of partnership of equals, whereby each party recognizes and builds on the expertise of the other. In the current policy context, this is often articulated most in relation to people with long-term conditions, where the concept of an ‘expert patients programme’ tries to capture a sense of the different expertise which different people bring to the table.
Jon Glasby, Helen Dickinson

J

Joint Appointments

Abstract
Although health and social care often remain separate organizational entities, many localities have tried to embed joint working through the use of joint appointments. This can be at a very senior level (e.g. someone who is both PCT Chief Executive and Director of Adult Social Services), at a practice level (e.g. a jointly appointed person to lead an integrated team or an intermediate care project) and/or at a level somewhere in between (a joint appointment to head up a joint commissioning nit). Over time, one of the most common options has probably been for the local authority and the NHS to appoint a joint Director of Public Health — although the degree of jointness seems to vary in practice.
Jon Glasby, Helen Dickinson

Joint Commissioning

Abstract
Although health and social care agencies are essentially independent of one another, the work that these agencies do often overlaps — particularly for individuals or groups with complex or chronic needs.
Jon Glasby, Helen Dickinson

Joint Future (Scotland)

Abstract
The notion of health and social care working jointly has a significant history in a Scottish context (for an overview see Petch, 2008a), but received increased impetus in late 1999 when the Joint Future Group was established by the Minister for Health and Community Care. The ultimate aim of this group was to ‘improve joint working in order to deliver modern and effective person-centred services’ (Scottish Executive, 2000, p. 54). Prior to this, Modernising Community Care: An Action Plan (Scottish Office, 1998) had set out the policy priorities for joint working between health and social care in Scotland. The Joint Future Group aimed at building on the principles that had been articulated in the previous plan and at delivering against four main aims:
  • to agree a list of joint measures which agencies need to have in place to deliver effective services, and to set deadlines;
  • to advise on the balance between residential and home-based care;
  • to advise on options for charging for care at home;
  • to advise on how to identify and share good practice.
Jon Glasby, Helen Dickinson

Joint Strategic Needs Assessment

Abstract
In addition to commissioning services in a more aligned way and developing more integrated service provision, health and social care have often been tasked with trying to understand jointly the needs of their local population. This has had a slightly different focus and ethos over time from the joint planning of the 1970s to the community care plans of the early 1990s. However, under section 116 of the Local Government and Involvement in Health Act, PCTs and local authorities are tasked with conducting an annual JSNA, defined by the Department of Health (2007b, p. 7) as follows:
A systematic method for reviewing the health and wellbeing needs of a population, leading to agreed commissioning priorities that will improve the health and wellbeing outcomes and reduce inequalities.
Jon Glasby, Helen Dickinson

L

Leadership

Abstract
Over the last decade or so, leadership has become recognized as an increasingly important component in producing high-quality public services. There is no end to calls for ‘better’ and ‘stronger’ leadership on the assumption that this should lead to more effective outcomes for service users.
Jon Glasby, Helen Dickinson

Learning Difficulties

Abstract
There are an estimated 1.2 million people in England with learning difficulties, including nearly 300,000 children and some 900,000 adults (of whom 191,000 or 21 per cent are known to learning disability services; Emerson et al., 2010). Although formal definitions vary, the Department of Health’s previous Valuing People strategy (2001c, pp. 14–15) provides a helpful overview:
Valuing People is based on the premise that people with learning disabilities are people first. We focus throughout on what people can do, with support where necessary, rather than on what they cannot do. Learning disability includes the presence of
  • a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with;
  • a reduced ability to cope independently (impaired social functioning);
  • which started before adulthood, with a lasting effect on development.
Jon Glasby, Helen Dickinson

Local Government

Abstract
While health care is organized nationally, both children’s and adult’s social care is run locally as part of a broader system of local government. Thus, these are services where practitioners and managers are accountable to locally elected politicians, funded in part by the local taxes people pay through their Council Tax. If people do not like the services they are getting or feel they are paying too much local tax, then they can vote for someone else at the next local election and, if enough people feel the same, change the nature of the administration. This is a very different kind of accountability to that which exists in the NHS, and the political nature of the system (with a small ‘p’ and sometimes with a capital ‘P’) can be very alien to NHS colleagues.
Jon Glasby, Helen Dickinson

Long-Term Care

Abstract
Historically, a range of long-term bed-based services for a number of community care user groups were provided in long-stay hospitals. However, from the 1960s and 1970s onwards, there was a growing reaction against this model of provision following a series of high-profile hospital scandals and with greater recognition that these older people, people with learning difficulties and people with mental health problems were not ‘sick’, did not need to be in hospital and could live more independent lives in the community. Over time, therefore, services that would once have been based in hospital were re-provided in the community, and support that would once have been the responsibility of the NHS has fallen under the remit of adult social care (see Means et al., 2008; Glasby and Littlechild, 2004 for a summary). While many people would support this change philosophically, it also meant that long-stay services that were once free became the responsibility of means-tested social care (and hence that people began to pay — often very large amounts). At the same time, this shift in the health and social care divide caused significant confusion for local services and for patients/service users — with people unclear about their rights and responsibilities (and with significant local variation in interpretation). As Means and Smith (1998, p. 153) have suggested in their review of the community care reforms more generally:
Such a situation was bound to encourage health authorities to run down their remaining nursing-home and continuing-care bed provision. Another certainty was that some local authorities would deny they had a responsibility for some people referred to them from acute hospitals, on the grounds that their needs ere essentially those of health care and not social care. The boundaries of health and social care had shifted once more, with people previously perceived as ill now being increasingly defined as having social care needs which are the responsibility of local authority and not the NHS … This has emerged as one of the most significant features of the health and social care reforms of the 1990s.
Jon Glasby, Helen Dickinson

Long-Term Conditions

Abstract
Although one of the key popular images of the NHS is of emergency care and of hospitals, the bulk of patients are people who have long-term conditions (also known as chronic diseases) that cannot be cured but that need ongoing management over time (such as diabetes, asthma, coronary heart disease and so on). According to the Department of Health (see http://​www.​dh.​gov.​uk/en/Healthcare/Longtermconditions/tenthingsyouneedtoknow/index.htm for all statistics quoted in this paragraph), around 15 million people in England, or almost one in three of the population, have a long-term condition (including half of people aged over 60). People with long-term conditions account for 70 per cent of the primary and acute care budget in England (with around one-third of the population accounting for over two thirds of healthcare spend).
Jon Glasby, Helen Dickinson

M

Markets

Abstract
Traditional organizational theory suggests that there are three primary ways that organizations interact with one another: through hierarchies, markets or networks (see the entry on hierarchies for an overview of each approach). A market approach is described as one where the transaction between two parties is mediated by a price mechanism. In a competitive market, this price mechanism should assure both parties that the exchange is equitable and this demand for equity attracts transaction costs. Because of their relatively high transaction costs, markets tend to encourage organizations to be fairly independent and only collaborate when necessary.
Jon Glasby, Helen Dickinson

Mental Health

Abstract
In England, some 17.6 per cent of the population had at least one common mental disorder in 2007 (see Mental Health Network, 2011 for all key statistics in this entry), and it is often estimated that some one in four adults will seek help for a mental health problem at some stage of their life. For people with much more severe mental health problems, some 107, 765 people received inpatient mental health care in 2009–2010 (a 5 per cent increase on the previous year). In prison, around 70 per cent of prisoners suffer from two or more mental disorders (compared to 5 per cent of men and 2 per cent of women in the general population). People with mental health problems are also much more likely than members of the general population to be unemployed (7.9 per cent of people in contact with secondary mental health services are in paid employment), are much less likely to be homeowners, are disproportionately represented among homeless people and suffer significant discrimination and stigma. Despite widespread media attention on high-profile mental health homicides, these are very rare and are even rarer when concerning an attack on someone not already known to the perpetrator. Most homicide is actually carried out by people without mental health problems, and the proportion committed by people with mental health problems has been decreasing during a period when more people with mental health problems are living in the community.
Jon Glasby, Helen Dickinson

Mergers and Acquisitions

Abstract
Mergers and acquisitions are important in the context of health and social care collaboration as many of the attempts introduced to forge closer working relationships between health and social care bodies have been structural in nature. The United Kingdom has seen a number of different structural entities introduced to bring about better inter-agency working practices through, for example, Care Trusts. However, frequent structural reform of the NHS (and to a lesser extent Local Authorities) has also caused difficulties in forging effective partnerships between health and social care, as frequent reorganizations can disrupt working relationships locally.
Jon Glasby, Helen Dickinson

Mixed Economy of Care

Abstract
Although many people associate health care in particular with the public sector, welfare services in the United Kingdom have always been delivered by a mixed economy of care (i.e. by a mix of public, private, voluntary and informal provision). Rather than seeing health and social care as ‘public services’, therefore, it is more accurate to see them as funded and planned by public bodies — but potentially delivered by a wide range of organizations.
Jon Glasby, Helen Dickinson

N

Networks

Abstract
Traditional organizational theory suggests that there are three primary ways that organizations interact with one another: through hierarchies, markets or networks (see entry on hierarchies for explanation of these different forms). While markets and hierarchies have received much attention from organizational theorists and economists (see, for example, Weber, 1968; Arrow, 1974), work by sociologists and anthropologists (see, for example, Dore, 1973; Durkheim, 1933) suggested that these ideal types were insufficient in describing and explaining all contexts. These theorists recognized the power of cultural forces and observed that certain contexts encouraged the socialization of individuals into systems and under these circumstances individuals acted not according to the forces of price or the types of power associated with hierarchical relationships, but rather due to socio-cultural forces (institutions). These forms were therefore extended to include a further mode of ‘the network’.
Jon Glasby, Helen Dickinson

New Public Management

Abstract
NPM is a management paradigm that emerged from the late 1970s onwards and gained international attention. NPM varies from country to country in its implementation and commentators such as Ferlie et al. (1996) have suggested that it is not one paradigm, but a cluster of several. What these paradigms share, though, is a belief that big government is an unhelpful way of organizing the design and delivery of public services. NPM is critical of bureaucracy, suggesting that it is an inflexible way of organizing that has a tendency to be too hierarchical. Hierarchies are often associated with top-down decision-making process, which are thought to be too distant from the expectations of citizens and service users.
Jon Glasby, Helen Dickinson

NHS Commissioning Board (NHS England)

Abstract
When Gordon Brown was about to become Prime Minister after Tony Blair stepped down, rumours circulated that he would look to do something dramatic in a number of different policy areas in his ‘first 100 days’ in charge. Within health care, an idea that seemed to be seriously being considered was to delegate greater responsibility for the NHS to an ‘independent board’, much more arms-length from government (thus, removing the NHS from day-to-day political interference). As commentators at the time suggested (Glasby et al., 2007, p. 2):
While Nye Bevan said that the sound of a dropped bedpan in Tredegar should reverberate around the Palace of Westminster, he surely would not have wanted to distribute bedpans, empty them and clean them out all by himself.
Jon Glasby, Helen Dickinson

O

Older People

Abstract
In the United Kingdom, a series of technological and demographic changes has meant a significant increase in the numbers of people aged 65 and above (and a particular increase in the number of people aged 85 and above- sometimes referred to as ‘the oldest old’). As he government has suggested (HM Government, 2009, p. 38):
By 2026, population estimates show there will be double the number of people aged over 85 that there are now, and the number of people aged over 100 will quadruple … We can see these changes in our own families:
  • A girl born in 1920 could expect to live to around 60.
  • Her daughter born in 1950 could expect to live to around 70.
  • Her granddaughter born in 1980 could expect to live to her mid-70s.
  • Her great-granddaughter born in 2008 could expect to live to her early 80s.
Jon Glasby, Helen Dickinson

P

Partnership Working

Abstract
Whenever the issue of inter-agency collaboration is debated, the first sticking point is always language. Even reading the other entries in this book so far (see, for example, the entry on teamworking for one set of definitions), it will be clear that there is a wide range of terms, often used imprecisely and inter-changeably (and with different authors using the same terms to mean slightly different things). To cite but a few examples, different accounts talk about concepts such as collaboration, inter-agency working, integration, inter-disciplinary working, inter-professional working, multi-disciplinary working, seamless care, strategic collaboration, transdisciplinary working, whole systems working and so on. Indeed, Leathard (1994, p. 5) alone identifies 52 different terms, describing this as a ‘terminological quagmire’. While most authors comment on this ‘definitional chaos’ (Ling, 2000, p. 83), they can sometimes make it worse by reviewing previous definitions and then coming up with their own. Rather than add to this complexity, the current entry seeks to draw out key themes in the broader partnership literature and signpost below to further sources.
Jon Glasby, Helen Dickinson

Personalization

Abstract
From the late 2000s onwards, adult social care reforms have increasingly been described in terms of a personalization agenda. Summarized in the government’s Putting People First concordat (HM Government, 2007, p. 2), this agenda was clear that:
Ensuring older people, people with chronic conditions, disabled people and people with mental health problems have the best possible quality of life and the equality of independent living is fundamental to a socially just society. For many, social care is the support which helps to make this a reality and may either be the only non-family intervention or one element of a wider support package. The time has now come to build on best practice and replace paternalistic, reactive care of variable quality with a mainstream system focussed on prevention, early intervention, enablement, and high quality personally tailored services. In the future, we want people to have maximum choice, control and power over the support services they receive.
Jon Glasby, Helen Dickinson

Physical Disability

Abstract
One of the key user groups for local authorities is people of working age with physical disabilities. Although some Councils organize their services as part of more generic community care teams (e.g. bringing together physical disability and services for older people), many have separate teams specializing in support for people of working age. In the NHS, the approach is different again, with policy and practice increasingly focusing on people with long-term conditions (who are often older people, although this also includes people of working age).
Jon Glasby, Helen Dickinson

Power

Abstract
The issue of power is a prominent one within studies of organizations and the inter-agency literature is no exception to this rule. Many accounts of inter-agency working allude to the notion that differential power relations have posed difficulties in collaborative working practices in a number of different ways. However, any attempt to debate these issues first requires an understanding of the concept of power itself (and this has been understood in different ways).
Jon Glasby, Helen Dickinson

Primary Care

Abstract
While there is considerable local variation, the primary care team usually consists of a range of different workers, including GPs, practice nurses, district nurses, health visitors, practice managers, dministrative staff and, potentially, a series of attached staff (such as nurse practitioners, community psychiatric nurses, physiotherapists, counsellors and so on). Although this includes a number of different disciplines and professions, a lead role has often been played by GPs (whose origins as a profession date back many hundreds of years). Ironically, although GPs are seen as the lynch pin of a crucial public service, they have typically been private businesses, operating like a small legal or accountancy firm and selling their services to the NHS. When the health service was first created in 1948, GPs fought hard to retain their independent status, and they continue to operate on a different contractual basis to other health and social care professions (with relatively little policy makers or managers can do to influence their behaviour except for incentivizing them — often financially).
Jon Glasby, Helen Dickinson

Public Health

Abstract
In a classic quote, public health was defined by C.E. Winslow (1920, p. 23, quoted in Baggott, 2010, p. 4) as:
The science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventative treatment of disease, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance or improvement of health.
Jon Glasby, Helen Dickinson

R

Regulation and Inspection

Abstract
One of the challenges often traditionally cited in respect to interagency working is that of the processes of regulation and inspection (Glendinning et al., 2005). At an organizational level, these are essentially the processes by which we can be sure that health and social care providers are conforming with appropriate standards and delivering care in the appropriate way (and this is the focus of this entry). Of course, individual health and social care professions also have to register with the relevant professional regulator (such as the General Medical Council for doctors) — and this can cause additional friction if individual professional bodies require their practitioners to practise in slightly different ways, have different approaches to continuing professional development and/or have slightly different professional codes of conduct. However, the way in which individuals practise is also influenced by the broader organizational context and the wider system within which they work — and the regulators of health and social care services have a key role to lay in helping to shape this.
Jon Glasby, Helen Dickinson

S

Safeguarding

Abstract
Safeguarding essentially involves protecting a particular group from abuse and neglect and ensuring that they receive safe and effective care. We probably most often encounter safeguarding in the context of children’s services, although this is equally applicable to adult and older people’s services and are important wherever we have vulnerable individuals and groups. Safeguarding is more than simply the protection of an individual from abuse; it is about the well-being and socio-economic inclusiveness of these individuals. In recent years we have seen a large degree of policy and practice interest in the field of safeguarding since the passing of the Human Rights Act (1998) and a series of high-profile abuse cases in both adult and children’s services.
Jon Glasby, Helen Dickinson

Social Care

Abstract
Although social care lacks an official definition, its key roles are often to provide practical support with activities of daily living for people who cannot do these tasks for themselves and to protect and promote the well-being of children and young people. As the Social Work Taskforce (2009, p. 5) states:
When people are made vulnerable — by poverty, bereavement, addiction, isolation, mental distress, disability, neglect, abuse, or other circumstances — what happens next matters hugely. If outcomes are poor, if dependency becomes ingrained or harm goes unchecked, individuals, families, communities and the economy can pay a heavy price. Good social workers can and do make a huge difference in these difficult situations.
Jon Glasby, Helen Dickinson

Social Enterprise

Abstract
Social enterprise is a type of organization that is defined not by its need to create profit but by its ethos and social aims. Social enterprises are broadly defined as ‘business[es] with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners’ (Department of Trade and Industry, 2002, p. 13). A social enterprise is, first and foremost, a business that is engaged in some form of trading, but this trade is primarily to support a social purpose. Social enterprises are like businesses in that they aim to generate surpluses, but unlike private businesses, these surpluses are then re-invested into the local community or the social problem that the organization was set up to address.
Jon Glasby, Helen Dickinson

Social Model

Abstract
Historically, services for people with a physical disability have tended to be strongly influenced by a medical model (which sees disability as an individual, biological issue). Over time, however, this view has been increasingly challenged by groups of disabled campaigners (often described as part of an ‘independent living movement’) who have rejected this definition and developed a social model of disability. In this view of the world, someone may have an ‘impairment’ (an individual, biological condition) — but the disability that can result is a consequence of the discrimination that people with impairments face in this society. As an example, someone able to stand freely (who might be seen as ‘able-bodied’ in our current society) would actually be ‘disabled’ in a built environment designed for people in wheelchairs — they would have a bad back and would constantly hit their heads on low doorways. Equally, someone trying to help a person in a wheelchair who cannot reach a light switch could invest large sums of money in research to find ways of ‘curing’ the person — or they could simply move the light switch. Social rather than the medical, the latter intervention is much cheaper and easier — and indeed would work for everyone in a wheelchair rather than just a single individual.
Jon Glasby, Helen Dickinson

T

Teamwork

Abstract
Contemporary health and social care communities are confronted by complex, cross-cutting issues, but are still constrained by the structural, procedural and cultural barriers that are associated with a welfare system largely designed along functional lines. Against this background, effective teamwork has often been seen as one of the potential ways that we might overcome some of these challenges and provide more seamless services. Just like leadership and partnership, teamwork has also become somewhat of a buzzword in recent years and has been critiqued as being something of a management fad. Yet, when people do not work together effectively as a team, then very real and detrimental outcomes can occur. Although the term might be overused, it is so widely applied precisely because it refers to something significant. However, it does mean that we need to make an important distinction: just because we call something a team does not mean that it necessarily is — teams need investment.
Jon Glasby, Helen Dickinson

Theory

Abstract
Dickinson (2008) argues that the field of inter-agency working is under-theorized and relies mainly on descriptive accounts of what individuals and groups have done and how they have worked together in practice. Theories are essentially short-hands for understanding and explaining particular situations and making predictions about what might happen and why. They are analytical tools that abstract to a macro-level to help people understand contexts and predict their actions. Yet, despite accounts of inter-agency working often being under-theorized, this does not mean that there is not a wealth of different theoretical models that might be drawn upon.
Jon Glasby, Helen Dickinson

Trust

Abstract
As we have argued throughout other entries in this book, much of the literature on health and social care partnerships has a tendency to be quite descriptive in nature, recording how different individuals and organizations interact with one another. In these descriptive accounts of inter-agency working one of the factors that is often identified as being important is that of trust. As an example of this Cameron and Lart (2003, p. 13) state that ‘key ingredients to successful joint working are trust and respect. To be successful, organizations and the personnel working within them must trust and respect the work of partner agencies and/or partner professionals.’ The old saying that ‘trust is hard to build but easy to destroy’ rings out as a warning message in many of these accounts.
Jon Glasby, Helen Dickinson

V

Values

Abstract
Pendleton and King (2002, p. 1325) define values as ‘deeply held views that act as guiding principles for individuals and organisations.’ Values are often hidden, or rather invisible, but they can be crucial in either facilitating close inter-agency working or else prove to be a barrier in attempts at joint working. Waine et al. (2005, p. 11) describe values as ‘taken-for-granted meanings’. Where individuals and agencies have worked together for a significant length of time, these will be understood and partners will be able to predict and trust the actions of their collaborators. Where the values of partners are not understood, this can lead to distrust and uncertainty. Much of the discussion that is presented here links to the concept of culture, which is, in part at least, informed by values (and readers who are interested in the concept of values may wish to also read the culture entry to gain a more rounded view).
Jon Glasby, Helen Dickinson
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