School of Medicine & Health Partnership Working and the Implications for Governance David Hunter

School of Medicine & Health Background Partnerships are viewed as the method of policy delivery across the policy spectrum and as a priori ‘a good thing’ Research on public health partnerships is limited - focused on processes and structures rather than outcomes

School of Medicine & Health Study Aims to clarify factors promoting effective partnership working for health improvement and tackling health inequalities (context-focused) to assess the extent to which partnership governance and incentive arrangements are commensurate with the complexities of the partnership problem (process-focused) to assess how far local partnerships contribute to better outcomes for individuals and populations using tracer interventions in selected topic areas to make such an assessment (outcomes-focused)

School of Medicine & Health Methods Stage 1 Systematic literature review of partnerships in public health Stage 2 9 case study sites selected according to the strength of partnership working – high, medium, low – with 3 sites in each category. There were 3 phases to stage 2: (1) first round semi-structured interviews with 53 senior managers in the selected PCTs and lead elected members in the local authorities in each site; (2) follow up telephone interviews after 8 to 12 months with 8 out of the 9 DsPH in the study sites; and (3) 4 tracer issues identified from 4 of the study sites involving semi-structured interviews with 32 frontline practitioners and 4 focus groups with service users in 3 of the locations to establish how far partnerships impacted on their work and outcomes

School of Medicine & Health The Benefits of Partnership Working (1) Working in partnership was seen as providing a co- ordinated approach to tackling public health issues The major benefit to service users was giving them a more seamless service and acting as a signpost for other services they may need to access Different agency perspectives, it was believed, could lead to innovative solutions in tackling public health issues from policy formulation to practical everyday contexts, by sharing knowledge and expertise of partner agencies

School of Medicine & Health The Benefits of Partnership Working (2) Sharing information between agencies and having established information sharing protocols:  avoided duplication and encouraged a co-ordinated approach  ensured that service users did not always have to give the same information to all other services with which they came into contact in the public health and related arenas. But this remains work in progress – still instances of poor information sharing and lack of sharing protocols between agencies Goodwill between agencies was seen as the glue that holds partnerships together, particularly on the frontline ‘Local champions’ played a crucial role in partnerships Structures less important than relational factors, eg trust and goodwill

School of Medicine & Health Barriers to Partnership Working Different agency priorities are an issue and can negate, or limit the potential of, effective partnerships A lack of good information sharing protocols in place – not a seamless service for users –users being re-assessed  Partners not clear about their respective roles and responsibilities  Failure to ensure that targets are shared and owned by the partnership so that agencies do not disengage when their own targets and priorities become pressing A recognition that LAA targets are important for frontline practitioners and their own targets contribute to LAA targets A lack of ownership of LAA targets by frontline practitioners with some LAA targets being seen by some (from director level to frontline practitioners) as unattainable

School of Medicine & Health Key Messages for Partnerships (1) Policy and procedures need to be more streamlined with an emphasis on outcomes Partnerships deemed to be successful were those in which the policy processes were outcomes focused, with joint delivery mechanisms, clear lines of accountability, the full engagement of relevant partners, and careful monitoring Less successful partnerships were deemed to be deficient in respect of these key features Concerns over the apparent disconnect between frontline practitioners and senior management with frontline partnerships appearing to be more organic and holistic; this contrasted with senior management approaches where the emphasis was firmly on a target-setting approach to delivery on key themes

School of Medicine & Health Key Messages for Partnerships (2) Partnership working was seen as the preferred method of tackling public health issues and health inequalities by respondents Partnerships continue to be rather messy constructs with no clear causal relationship between what they do and what the partner organisations achieve by way of outcomes Tendency to over-engineer partnerships Complex systems and wicked issues suggest the need for a different approach to partnership working, one that is looser, more flexible and responsive to rapidly changing contexts Collaborative or integrative leadership to nurture joined-up working

School of Medicine & Health What Determines a Successful Partnership? Clear purpose, common aims, goals, objectives The right partners who can contribute and commit Ability to have an honest dialogue about each partner’s contribution Trust and relationships Leadership