Managing Partnerships for Improving Health & Wellbeing Learning from a “brave new world” Jane Mackinnon, Moira Fischbacher & Judy Pate Department of Management

Community Health Partnerships in Scotland Inter-agency partnerships for health improvement NHS-led in partnership with Local Authority “It is intended that CHPs will create better results for the communities they serve by being aligned with local authority counterparts and by playing an effective role in planning and delivering local services.” Partnerships for Care (2003).

The Glasgow City Integrated Model 5 Community Health & Care Partnerships (CHCPs): Single integrated management structure for local community health and social work services Retains clear lines of accountability for statutory functions, resources and employment issues to ‘parents’

The ‘Parents’… NHS COMMUNITY SERVICES SOCIAL WORK SERVICES GLASGOW CITY COUNCIL INTEGRATED COMMUNITY HEALTH & CARE PARTNERSHIPS

Working across boundaries Political drive for partnerships & integration but… What are the realities of managing this process? Managing change is difficult enough within one organisation… Different starting points… Different organisational processes etc… The experience of East Glasgow CHCP?

Setting the scene for East Glasgow Deep rooted social & health inequalities e.g.: Over 41% of population live in the most deprived neighbourhoods in Scotland Only 68% of 15 year old boys survive to 65(12% below Scottish average) 33% children in workless households (80% above Scottish average) Hospital admissions for heart disease 38% above Scottish average ( )

East Glasgow CHCP – the organisation Approximately 1500 CHCP staff: Around 300 professionals are ‘Independent Contractors’ to NHS (GPs, Pharmacists, Optomotrists & Dentists) Around 1250 directly employed in the CHCP by the ‘parent’ organisations (NHS & Social Work) Different pay & conditions of employment! NHS – nurses, health care assistants, physiotherapists, psychologists, health visitors Social Work – team leaders, social workers, social care workers, social care assistants

e.g. The ‘matrix’ of CHCP management Head of service: NHS Operations Manager: NHS Team Leader: Social Work Nurse Social Worker Nurse Assistant Operations Manager: Social Work Team Leader: NHS Social Worker Nurse Social Care Assistant

The theoretical base Measures of success Nature & Development of Trust Health outcomes (e.g. Mitchell & Shortell, 2000; Roussos & Fawcett, 2000) Partnership process & outcomes (e.g. Hudson et al, 2000; Dowling et al, 2004) Partnership Theory Partnership, professional (e.g. Huxham & Beech, 2003; Glendinning, 2003) Professional, personal, institutional… (e.g. Mishra and Morrisey, 1990; Jones et al, 1997) Collaborative Advantage, collaborative inertia, prerequisites (e.g. Hudson & Hardy, 2002; Huxham & Vangen, 2005) Identity theory

The research - ‘Phase I’ Funded by Glasgow Centre for Population Health Staff survey (response rate 31%, N=389) Interviews with Managers and Professional representatives (36) ‘Case studies’ in four service areas: Represent variety of stages of ‘integration’ Interviews with health and social care staff (73)

Developing the CHCP Staff resilient and highly committed to service users NHS and social work – common values but very different organisations & cultures Lack of capacity across ‘boundaries’ = frustration

Trust High among day-to-day colleagues Trust in management ‘undecided’ – role of team leaders crucial to ‘build bridges’ More disconnected more anxious and undervalued Areas of uncertainties lead to anxiety and ‘mistrust’, e.g. consultation and feedback loop; changing roles?

Professional Identity Universally strong sense of professional identity, particularly in more ‘integrated’ services - strengthens where perceived ‘threat’ Teams of health & social work staff in same office (co-location) largely positive but… Level of ‘integration’ causing concern – e.g. ‘Care Management’, blurring professional boundaries? Impact of management matrix & changing professional structures

Managing the challenges across boundaries… Working to build and maintain trust: Managing fears of a ‘takeover’ Communicating positive and negative elements of organisational change Developing staff capacity for change Creating a sense of interdependence Co-location or ‘integration’ – who, why and how far? Perceived ‘erosion’ of professional identity could create a barrier to integration

Managing the challenges across boundaries… Developing coordination & consistency across boundaries Can the CHCP tackle organisational barriers – practical & cultural? Need to shift the focus of integration from structures to the patient/service user Measuring success (Hudson & Hardy; Dowling et el) – and what are CHCP staff looking for (patients, service level, organisation)?

And finally… Thanks to East Glasgow CHCP for their open response to the research. The full report is available from For any more details please contact Jane on: Tel: (+)44 – (0)