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

1. Health and Social Care
Partnerships:
Can they really work?
Jim McManus, CPsychol, CSci, AFBPsS, FFPH, MCIPD
Director of Public Health
Hertfordshire County Council/NHS Hertfordshire

2. Sometimes it feels like another planet

3. Five partnership meetings this week

4. What do you mean the partnership plan was
due today?

5. Context – change and transformation
 Financial challenges
 Traditional barriers and approaches have
delivered some gains
 others have remained elusive and barriers
often seem embedded between agencies.
 The perennial problem - some partnerships
building a “third culture” which competes
with the existing cultures.
 Partnerships are a given because they seem
to be a necessity

6. The cynics view of partnerships
 A loose confederation of warring tribes
 A group of people all united, but against what nobody
really knows
 A group of people whose hands are so deeply in each
others budgets they can’t get out again
 A set of people who have come together to discuss
governance while people die around them
 Take minutes and waste hours

7. Content
 learning from experience,
 filtered through research evidence on
culture and partnerships
 identify some critical success factors where
partnerships work or do not.
 Informed by behavioural sciences

8. The NHS structure from April 2013 – a very DH
centrist view
Parliament
Funding
Accountability Department
of Health
NHS
Commissioning
Board
CQC
+ HealthWatch England
Monitor
Providers
Patients and Public
Local
Health Watch
Local Authorities + PH
Clinical
Commissioning
Groups
Local
partnership Contract
Accountability for results
Licensing
“Health &
Wellbeing Boards”
Commissioning
Support Services

9. Environmental Health
& Regulatory Services NHS
Police, Fire,
Community Safety Third Sector and
Community Bodies
Public Health
England
Specialist Public Health Agencies with Major Public Health Roles
NHS Public Health
(moving into HCC)
County Council
District Councils

10. 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 and
governance factors (Kodner, 2006)
 Co-ordination across systems is big on most country
agendas 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?

11. Research in the commercial sector
 Salience of Value
 Salience of strategic benefit (money, market
share, customer)
 Structures and governance fits strategic benefit
 (Rondinelli and London, 2003;Waddell & Brown,
1997)
 Private sector – Intellectual Property Issues
 Public Sector – Inter-professional issues

12. 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

13. A small
sample….

14. Summary
 A problem in many nations
 Understand what you want to
achieve
 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 the
universe so get on with it –
partnerships are a necessity in
some areas of public life
Dr Thomson hadn’t
Quite undertstood the
Telemedicine project

15. So how do we make it happen?
 A public health
perspective
 population,
 outcome,
 salience,
 Intervention
 System capabilities
 Lifecourse of the human
person
 Lifecourse of the
partnership

16. Admit your limits of knowledge and
competence – it’s liberating!

17. Contributors to overall health outcomes are
in multiple agency control
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health
5%
Health
Behaviours
30%
Education
10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to
care 10%
Quality of
care 10%
Clinical Care
20%
Environmental
Quality 5%
Built
Environment
5%
Built
Environment
10%
Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.
Used in US to rank counties by health status
While this is from a US context it does have significant resonance with UK Evidence, though I would
want to increase the contribution of housing to health outcomes from a UK perspective.

18. Partnerships don’t think often enough
about timeframes of yield
Years
0 1 5 10 15
Planning
Education
Vitamin
Supplements
Air Pollution
Decent
Homes
Jobs
Primary
Care
20
CVD
Events
Self Care
Vitamin D and TB
Rickets
CVD Events
Acute Bronchitis Admissions
Respiratory
Mental Health overcrowding educational attainment
Life Expectancy
Healthier space use Changing culture of activity
Life ExpectancyMental Health

19. The Lifecourse impact of health, little evidence most partnerships think of this

20. Degrees of Partnership
Cheminais, 2008
 Coexistence – clarity as to who does what and with whom.
 Co-operation – pooling the collective knowledge, skills and
achievements available.
 Co-ordination – partners planning together; sharing some roles
and responsibilities, resources and risk-taking; avoiding overlap.
 Collaboration – longer-term commitments with organizational
changes bringing shared leadership, control, resources and risk-
taking. Partners from different agencies agree to work together
on strategies or projects, each contributing to achieving shared
goals.
 Co-ownership –different agencies commit themselves to
achieving a common vision, making significant changes in what
they do and how they do it.

21. Blast from the past
 2003, republished 2011
 Innovative partnerships
 Blend of private and public
sector insights
 Where this has been used
 http://thepartneringinitiative.org/w/resources/toolbook-series/th

22. From the
Partnering
Toolbook

23. Critical success factors

24. Critical Success Factors – the people
 Psychological Contract
 Within and between
agencies and
individuals
 Clarity of outcomes
 Clarity of processes
 Clear advantage to each
agency
 Control and governance fit
for purpose

25. 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

26. A helpful friend for improvement
 Tools for service
improvement
 Available from
internet
 http://www.goalqpc.com/

27. Case
Finding
and
targeting
using
locally
designed
guidelines
and
protocols
Intervention Components linking NHS with sports for inactive people
Health Psychology for intervention design, public health for programme design and leadership, primary care for case finding, screening and referral, sports sector for delivery and
also for screening
Clinical Engagement and Support across programme
Public Health, Clinical and Sport Leadership across programme
Behavioural Change Training for Sport and Primary Care Staff
Evaluation including pre and post intervention measures
Call in and
Screen
using
Health
Checks
(multiple
settings)
Regular
goal
checks
and
positive
feedback
One to one
and group
support
with Sport
prescribed.
Individual
“feeling
good,
feeling fit”
plans made
Ongoing
motivation
from NHS
and from
Sports staff
to stay on
programme

28. Thank you
Jim.mcmanus@hertfordshire.gov.uk
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