Inter-Organizational Strategies for NHS Improvement

The assignment proposes that strategies for improving the National Health Service (NHS) should be developed at an inter-organizational level between boroughs. This collaborative approach involves teams from different aspects of healthcare working together within or across organizations to achieve goals like joint funding, resource sharing, and standardized rules of engagement. The aim is to improve accessibility and ensure that the most vulnerable patients receive the necessary care.

Working in
Partnership
(Modifications)

Contents
Section 1: Foreword………………………………………………………………...… 2
Section 2: Executive Summary…………………………………………………...….3
Section 3: Introduction……………………………………………………………...….3
Section 4: Philosophies and concepts of working in partnership in health
and social care…….……………………………………………………………………….4
Section 5: Partnership relationships within health and social care…………...6
Section 6: Models of partnerships working across the health and social care
sector...………………………………………………………………………………….…...7
Section 7: Legislation and organisational practices and policies for
partnership in health and social care…………………………………..…..…..….…..8
Section 8: Differences in working practices across the health and social care
sector…………………………………………………………………………….…………10
Section 9: Outcomes of partnership working for use of service professionals
and organisations……………………………………..…………………….……..……11
Section 10: Barriers to partnership working in health and social care…..…12
Section 11: Strategies to improve outcomes for partnership working in
health and social care services……………………………………………………..…13
Conclusion…………………………………………………………………….………...15
Proposals………………………………………………………………………………...15
References………………………………………………………………………………16

Section 1
Foreword
During the contemporary generation several cabinet receiving a lot of
attention from the media and the public. Stafford Hospital is among one of those
and was developed by Mid-Staffordshire National Health Service Hospital
Trust, and the bin of Victoria Climbié who was tortured by her guardians was
completely decayed. Many patients died at Stafford Hospital, those cases like
that of Victoria Climbié, indicates that many organisations involved were badly
run. This resulted in drawbacks among the partnership between specialist,
agencies , organisations because it leads to the death of 1,200 patients who
endlessly died between 2005-09 in the Mid-Staffs NHS Foundation Trust.
During the year 2013 Francis Report mentioned about the drawbacks in
the Mid Staffordshire NHS Foundation Trust highlighting unprofessional and
unacceptable practices and is based on evidence of over 250 witnesses.
The main mission of the report by David Game College, London, in
January 2016 was to review about the rules and regulations of partnership and
even to mention the problems of lack of collective working.
Section 2
Executive Summary
During the month of January 2016 the information about ‘Working in
Partnership’ was addressed by David Game College in London. Outlining the
subject of collective working every individual, team, organization must
showcase the openness and shyness in regard to their behavior towards the
incident occurred at Mid Staffordshire NHS Foundation Trust where the
patients were not just kept at risk but even there life was in danger of causing
death.
Section 3
Introduction
This report focuses on the information regarding the system and perception of
working under partnership within health and social care environment and is
related to Mid-Staffordshire NHS Foundation Trust. It highlights the strengths
and weaknesses among partnership relationship and its equally important for
both the staff and patients to understand and apply those thoughtful
fundamentals to deliver efficient and effective care.
Working in a partnership can cause the threat to life or death and moreover the
lack of collectivity can create the serious matters like the tragic death of Peter

Connelly (known as ‘Baby P’) and the Victoria Climbie was failed by social
services in four boroghs.
Working in partnership is demonstrated in various ways in this report,
exemplifying how professional agencies, service users, carers and service
provide can achieve the best result. Additionally,among all the other parties if
the information is forwarded by the single soul than is results in transparency,
openness along with co-operation making a health organisation successful and
trustworthy for the people they care for.
Section 4
Philosophies and concepts of working in
partnership in health and social care
Partnership is done between different persons from various other organisation and
they equally decide to start their business with the sharing of resources and efforts.
The various needs of communities are required to be fulfilled like those of health,
legal structure, social factors, housing, food etc. which are overcome by those of the
partnership business organisation.
Philosophies of the associations consider ethics and decision-making promoting
equal access to services, but does not always happen. Philosophical theories
provides an innovative manner of solving the complex issues related to beliefs.
Principles such as: justice, dignity, respect and beneficence provides a structure of
understanding the difficulties arising in health and social care.
 Authority: the way in which the persons are treated and the decisions are
taken fairly with a well assigned reasons (Rawals, 1971). Proper authority ,
health improvement as well as fair treatment are the basic aspects of
understanding the health of the public. This was not experienced in case
regarding Stafford Hospital where proper care was not ensured. And in the
case of Victoria Climbie the one who got tortured by her guardians, was
admitted inside the hospital and was not treated or cured well by the staff
inside the hospital which resulted in her death.
 Dignity and respect: concerns compassion for another. Treating patients
and clients with dignity. Respect must be shown at all times when providing
services for patients and clients. Honouring patient’s autonomy can be
considered as a form of respect is the example of the miss-happening
occurred at Mid-Staffordshire hospital.
 Beneficence: is concerned with promoting good healthcare environment and
safety and security of others. It creates the thoughtful ground of respect and
morale practices. Rather, ensuring about the health of the patients, the staff
abused and disrespected them at Stafford Hospital.
Under this report it has been showcased that the various thoughtful principles and
other practices are largely neglected at Stafford Hospital. As well as in regard to
Victoria Climbie, she was let down by four local authorities.
Both scenarios show when services are not joined up it can result in poor outcomes.
Partnership working are below the standards in many hospitals per example the Mid-
Staffs and Winterbourne Hospital. Moreover, in Winterbourne View hospital the staff

including doctors were very careless and lazy and due to their laziness it resulted in
death of the patients and even it resulted in more critical condition of the patients
inside the hospital. Empowerment, informed choices, autonomy and independence
are discussed below.
 Empowerment ensures the support towards the people by providing them
proper guidance and information and enables them to make decision
accordingly. To empower people in care settings staff needs take into account
the rights, preferences, needs, likes and dislikes of various individuals by
considering their situations and difficulties when planning his or her care.
Patients at Mid-Staffs were denied choices about decisions which affected
their health and well-being and this can be achieved by improving the sense
of development as well as confidence within a person to take up a stand
against the wrong occurring.
 Informed choices having the opportunity to make choices is something most
of us are concerned. However, for many people who needs support, being
presented with choices may be confusing. In order to provide the support to
an individual related to health care the professionals should convey the
complete information about each and every aspect to the individuals so that
they could select the best out of all. While in Stafford hospital the relevant
informations were not provided to the
 Self determination ensures the self growth of the person by having the
complete control of a person on himself. The person can increase the sense
of self efficiency in completing the task in about a day as a routine aspect.
The self determined person may experience a kind of threat sometimes in
case of any hospitals where the staff has to take the personal care of the
particular person, during that time a person should make sure that the
particular individual is completely fine and does not require any particular
thing as well as their preference must be kept forward every time. Because
many times we have studied in newspapers about the ill treatment provided to
the patients inside the hospital which resulted in causing death of the patients.
Moreover, many patients at Stafford hospital were left in urine and faeces
soaked bede and denied food and water. Some were so dehydrated that they
resorted to drinking water out of flower vases.
 Freedom means the opportunity to take decisions regarding important
aspects of an individual life. It refers to characteristics namely self-autonomy,
ability and control. Independence means the opposite of dependence. Those
patients within the care of Mid-Staffordshire NHS Foundation Trust lacked
freedom and in some case their lives. Being dependant on carers resulted on
the death of patient Gillian Astbury, 66year old lady resulted in lapsing under
coma because of the irresponsible behaviour of the nurses working under the
hospital.
When people are able to choose they are empowered, and this helps with the self-
esteem making them feel positive about themselves. Care workers should uphold
two fundamental principles- privacy and dignity. Maintaining a person’s dignity and
privacy is very much part of the person-centred care. However, at The Mid-
Staffordshire NHS Foundation Trust there was a huge lack of care and dignity
among the staff. Moreover, the old patients were left dirty and without proper flow
and patients were deprived of dignity and respect in so much that it caused the death
of those patients.

Section 5
Partnership relationships within health and social
care
By throwing lights on the collaboration at various stages the report evaluates the
partnership relationships within health and social care services.
 Duties at user level – ensures about various association who has different
needs and requires different support systems.
Each of the following groups needs to be considered:
 Persons below 18 years - safe working with children and young
people certain policies and procedures must be ensured.
 Elderly: the elder or old age people should be well treated.
 Youth's in care: now-a-days youths are basically fallen ill due to
junk foods and are basically trapped with food poisoning.
 Disable people: include those persons who are disabled which
includes- deaf, blind etc.
 Illiterate people: include those persons which comes from small
places or poor background and are generally lacking knowledge
about every things.
 Mentally ill people:include those people who are mentally
disturbed or are basically psycho.
 Sufferers: includes people who are majorly ill.
 Soldiers, asylum seekers: includes those persons who are not
living with their families and are acting as political persons or
soldiers.
The patients like Victoria Climbie the one tortured by her guardians and lately
murdered by them inside the hospital because of the carelessness of the staff inside
the hospital.
 Inter-professional stage – it means the stage at which the professional
person from different level with that of different mindsets and different idea
comes together to work as a group and leads to the achievement of the
objectives of the organisation (Collier and Goode, 2015). Health care
specialists such as GP’s, nurses, therapists, social workers, educationists and
support workers are grouped together to work for an organization goal. The
service users like elders, refugees, mentally ill persons, disabled persons etc.
should be taken care professionally by arranging staff according to the
requirement of the particular patient which results in development of health of
the patient.
 Organisational and policy level –this is concerned about the health, housing
and social care. For example the Citizens Advice Bureau provides a very
important social care service for people who may be struggling with money or
legal advice. The Salvation Army provides night shelters, while day care is
offered by voluntary organisations such as Age UK. MIND and SANE
supports those with mental health issues (Hetheringdon and Rashed 2013
p328)

The error was detected at each and every level in ensuring the actions and
the expectation of the public was a big failure of the NATIONAL HEALTH
SERVICE system.
 Critical partnership – it ensures the collective working among the local
authorities and health services. It is the responsibility of each and every local
authority working under partnership with other public agencies, the voluntary
sector, service users and contracted services to concern about the welfare of
the accessible adults. Throughout UK, councils of social service departments
are main agencies involved in safeguarding and protecting persons from
abuse. Underlining the Francis case ( 2013) the concerns are not raised by
the local medical community regards the Mid-Staffordshire Foundation NHS
Trust until it was too late.
Under this section it has evaluated that among different partnership relations at
every different level their exists the responsiveness among the staff on an
organisation to ensures the health and safety of the patients with the hospital and to
also deal with them with the complete dignity and sense of due respect.
Section 6
Models of partnerships working across the health
and social care sector
In this section of the report examine models of partnership working by focusing on
the various models and how they operate in the health care environment.
 Unified model – which provides a single incorporate method of health and
social delivery of health or social care services and structural integration. In
this system A unified system with a single employers and a respective budget
offers considerable promising, removing the potential of blaming other for
failures. There are various advantages to this model(Hetherington and
Rashed 2013). Some of them are reduced delay in discharges and in the
training period new investment in middle group and domiciliary care
specialist, the improvement of intergrated teams for example community
mental health group for senior citizens, progress of relocation from long-stay
hospital.
 Co-ordinated model – which shows that the coordination's between the
management and employee in the organization for running successful
organization and best services provide to the customer in the perceptive of
safety and security. .
 Coalition model – this concerns that every people have different and
separate work regarding to the speciality in the work they have expert and
experience. Then provide better services to the patient in the hospitality
industry. The disadvantage of the of this model is that to working each other,
then the service is weaken the service.
 Hybrid model – combines other models of partnership across the health and
social care sector. It shows how different departments operate in the NHS.

They all adhere to a person-centred approach. With this model problems
existed at the Mid Staffordshire Hospital regards to patient safety, poor and
inhumane care and neglect.
Many models of cooperation operate in health and social care. It is patent
that there distinct advantages and disadvantages in applying this models in health
and social care. When models of business concern work well it has a many
beneficial impact on service users. However, according to the various failures in
adhering to a basic model have compromised the lives of numerous services users.
Section 7
Legislation and organisational practices and
policies for partnership in health and social care
It is legislation and organisational practices and policies for collaborative working in
the health and social care sector. Various acts are discuss below:-
 Social care Act 2012 – is a major piece of the legislation shaped and
controlled the partnership working in the health and social care provision.
Within it there is a legal requirement that people are involved in the decisions
about their care. Many implications of this Act are still being worked thought.
(Collier and Goode 2015).
The Health and social care 2012 introduces a number of key changes to the
NHS in England. These changes came into being on 1 April 2013. The
changes include: Doctors will have more say in what services are provided.
Private and voluntary services will have a greater role to play. Patients will
have a stronger voice. There will a new focus on public health to reduce ill
health. Accountability locally and nationally will be stronger and there will be
reduced tiers of management. (Hetherington and Rashed 2013)
 Care standards act of 2000- it is another act that has established standards
for working in service provisioning in the health and social care industry.
Before the introduction of the act, the Healthcare commission, the commission
for social care inspections, and the mental health commission were the
organisations that maintained the service quality.
 Equality and human rights commission – it was formed on 1 October 2007,
it protects employees right and deals with giving equal opportunity to every
employee, racial equality as well as disability rights. It governs equality
legislation on gender, race, health, age, religion, transgender and enforces
compliance of human rights Act 1998. It encourages change in society and
bring justice in nation. It takes legal actions on behalf of victims. Race
Relations Act.1976.
 Data Protection Act 1998 – this law protects individual and the way
information about them is used. It relates to people living in the UK. All
recorded information about the individual is subject to the Data Protection Act.
(Collier and Goodie 2015)

 Children Act 2004 – This Act gave local authorities the duty of care to
ensure that children in need are identified and their needs met by the
arrangements established between statutory and voluntary services. Local
authorities can seek help of any other authority, including health authorities. In
the case of Victoria Climbie she could have been saved if the organizations
involved in her care had noted the signs of abuse. Previous to her death she
was seen by the police, the social department of four local authorities, the
National Health Service (NHS), the National Society for the Prevention of
Cruelty to Children (NSPCC). All failed.
The different legislation outlined above seeks to improve the lives of people who are
vulnerable. Within the UK there are numerous pieces of legislation and acts that are
intended to put a stop to discrimination, promote diversity and ensure equality.
Policies are a closed up line with current legislation,according to the government
rules and regulation of the country, nationally at governmental level and also locally
by organisations. Policy makers can determinative important decisions that affect
people’s lives every day.
It is important that there is a legislation to protect, guide, reinforce and support
service users and healthcare professionals. When a policy is in place it gives
guidelines to health and social care workers to proceed appropriately when a
situation arises. All are the rules and regulation provide by the government to the
human right to protect, guide reinforce and support the service healthcare
professionals. When a policy is in place it gives guidelines to the health and social
care employee to processed when a situation arises.
Many of the above mentioned acts where breached at the Mid Staffordshire NHS
Foundation Trust, customer's or patients were not receiving satisfaction from the
organization in terms of treatment.. The present report examine many of the factors
that affects a systemic failure at the hospital. This included compromised all of the
hospital staff disability in working, in terms of providing services to the patients and
customer satisfaction towards . .
Section 8
Differences in working practices across the health
and social care sector
There are different types of differences in the health and social care partnership
organization such as the type of the organization practices. However, this section
explains the differences in work practices.
 Clinical Commissioning Groups (CCGs) the commission was initiated in
April 2013 and are seemed as an ‘important concern of the Government’s
reforms to the health and social care system (www.kingsfund.org.uk). They
are overseen by the by NHS England, and consequently are accountable
to the Health Secretary Jeremy Hunt. LOOK AT PPT. PRESENTATION

NHS Trust Development Authority (NHSTDA) – The NHS Trust Development
Authority (NHS TDA) will be responsible for overseeing the performance
management and governance of NHS Trusts, including clinical quality, and
managing their progress towards foundation trust status(Collier and Goodie 2015) .
 Monitor – the independent sector regulator for healthcare in England states
its “main duty is to protect and promote the interests of patients”. It advises
that it does this by ‘promoting the provision of services which is effective
and economic and which maintains or improves the quality of services’. This
did not occur to the Mid-Staffs Hospital as if collaborative working had
existed; patients would have received better care. WHAT DO YOU MEAN?
The differences of practice and policies can also be discouraging the
collaboration in a partnership. For example, there are health care organisations
which are working as voluntary and working as statutory organisation. The employee
practice methods, employee qualifications and the knowledge level can be different.
If there are international voluntary organisations, there will be other issues such as
language barriers as well. These differences can cause the health care organisations
to discourage the flow of information, informed decision making and other important
communications. And those can lead to poor collaboration and coordination in the
health care organisations in partnerships.
Section 9
Outcomes of partnership working for use of
services professionals and organisations
Outcomes of partnership working for using of
service, professionals and organizations
Different problems can occur when working in partnership in the health and
social care sector.
 Outcome for users of services: positive outcomes eg. Imporved service,
empowerment, authority, inform decision making. Negative outcome neglect,
abuse, harm, anger, miscommunication, information overload, conclusion,
frustration, duplication of service provision, disempowerment.
 Outcome for professionals: positive outcomes eg. Coherent approach, shared
principle, comprehensive service provision, common working practices,
integrated services. Negative outcomes eg. Communication breakdown,
disjointed service provision increased costs, loss of shared purpose.
 Barriers to partnership working: lack of understanding of roles and
responsibilities, negative attitudes, lack of communication, not sharing
information, different priorities, different attitudes and values.
 Strategic to improve: Communication, information sharing consultation,
negotiation, models of empowerment collective multi-agency.
 Failures to recognise different concepts of success leads to inappropriate
conclusions about the effectiveness of partnership. In the Mid Staffordshire

Foundation Trust the outcomes of partnership working for patients,
professional and Victoria climbie had negative consequences that impacted
people’s lives.
This part of the report has evaluated possible outcomes in collaborative
working suggesting that good staff support and management are fundamental to a
health organisation and are directly related to patient’s experience of care.
Section 10:
Barriers to partnership working in health and social
care
It is apparent from the report, thus far, that there are many barriers to
partnership working. Analyses of these barriers are illustrated below:
 Culture of working – The working culture in the NHS has come under
consuming scrutiny in recent years after a series of let down in hospital
trustsA culture of open message, active obligation and challenge will help
ensure that patient safety is put above all else. A real change in culture, a
refocusing and re-commitment of all who work in the NHS is required on
putting the patient basic. Health care professionals need a common patient
centred culture which produces at the very least the fundamental standards
of care to which we are all entitled, at the same time as celebrating and
supporting the provision of excellence in healthcare. According to the Francis
Report (2013) on the Mid Staffs the necessary culture will only flourish if
leaders reinforce it every day in every part of the service.
 Resources - Many reports on inadequate services in the NHS including the
Francis Report focus on a lack of funding. When insufficient money is made
available to the ever increasing demands on the NHS services can no longer
afford to deliver a good care. Individual trusts are struggling and increasingly
failing to meet the demands. Some of the failing to the Mid Staffordshire
Foundation Trust were in concern due to a focussing on reaching targets,
achieving financial balance in the various areas of the trust and seeking
foundation trust status at the cost of delivering acceptable standards of care.
A “lack of robustness” was known in budget-setting and cost improvement
delivery processes.
 Behaviour – Therefore the employees will face conundrums when making
professional decisions at the workplace and the quality control systems of the
organisation will be confused and impractical. Attitudes and values of the
organisations and workers is another barrier that can discourage partnership
work. There are employees who would not like to work with another

organisation or not like to follow shared values and standards. this can causes
attitudes problems and effects the partnership firms.
Identifying barriers can help to prevent a re occurrence of the events at Mid
Staffordshire NHS Foundation Trust were 1.200 patients unlawfully died.
New Horizons (2009), suggests that only re-structured partnerships across all the
public, private and third sector working with local community will deliver the
essential change to better the health and general well-being for respective individual,
families, carers and communities of all ages and backgrounds (Hetherington and
Rashed 2013).
Section 11:
Strategies to improve outcomes for partnership
working in health and social care services
There are numerous strategies that can be used to improve partnership working.
Many of the suggestions below have been considered in Francis’ Report (2013) and
Keogh’s Report. Some of the strategies involve making and commissioning
decisions that will affect the health, social care and housing services provided by
partnered organisations to service groups in different areas of the country.
Particularly to those deemed to be vulnerable (such as the elderly, children and
young adults, those with mental health issues, and those with disabilities).
Strategies
 Recruitment –. Human resource management must focuses on requirement
and selection of employee in the organization for decreasing the customer
and patient's complaint about the services provide by the organization.
Requirement of capable and knowledgable person who is experience in
this particular filed. HR department should have some changes in the
selection process such as follows structure form of requirement, interview of
candidates with including practical exercise for required position of the
organization.
 Whistle-blowing – Health care professionals can feel intimidated by the
hierarchy they are working within, which can prevent them from raising
concerns. Mid Staffordshire trust employed trainees during the period of time
that has been investigated, but these trainees did not raise concerns about
the substandard care. The strategy is to develop information about how to
raise concerns, and provide this to all new members. This information would
explain the roles and responsibilities of all individuals (such as medical
directors) and organisations (such as deaneries and the CQC) that have a
responsibility for quality and patient safety, and make recommendations on
steps to take when doctors have a concern.
 Transparency - Transparency means making accurate and useful information
about performance and outcomes available to staff, patients, the public and
regulators. Follows the equality act concepts for running a successful

organization in this competitive marketing environment. Organization must
focuses on the giving specific information to the employee and the patiets of
the organization without any type bureaucracy.
 Education and training - the management must be focuses on the
providing proper education and training to the staff members of the
hospital and giving feedback from the employee about the work on the
monthly basis. Analysis the employee problems and reconsideration to
the employee of the organization. . The RCP believes that doctors should
be trained to provide holistic care, to be professional, to understand concepts
such as risk management, and to be able to assess research evidence.
Holistic care includes taking responsibility for aspects such as compassion,
dignity, pain relief, hydration and nutrition. More (general) internal medicine
experience in different settings may help to deliver this.
 Give partnerships time to yield results:- It can take time to see the
outcomes from partnerships. This is partly because it takes time to
establish trust and joint methods of working, although this shouldn't be
used as an excuse for delay and inaction.
Various strategies have been recommended in the Francis Report (2013), 290
praise were made planned to change this culture and make certain that patients
come first.
Plan of action are formed at an inter-organizational level between boroughs,
enabling them to deliver a coordinated care. Strategic decisions are made up
involving teams from various backgrounds working within particular organisations or
cooperate between different business entity .
Working in partnership aims to enhanced accessibility by having joint funding,
divided resources and rules of working that will not examination the services users
who are most required.
Health care professional can helps in better partnership working by encourage
the three key rules: shared values, agreed gaols or outcomes for the individuals who
needs support and regular communication. (Collier and Goode, 2015).
Conclusion
This report has indicated that at Mid Staffordshire NHS Foundation Trust,customers
or patients were not Stanfield from and treatment. The report examine many
factors that incontestable a systemic failure at the hospital. This included the
poor working, lack of work understanding of the employee on the organization.
One of most critical factor of the failure is they should not follow the laws and
implementing them to organization. The wider system failed to detect the risks to
patients at the hospital and intervene quickly.
Proposals
My proposal is that strategies are formed at an inter-organizational level between
boroughs, enabling them to deliver a coordinated care preventing that the disaster at
the organization ever happens again in the NHS. Strategic decisions are made up
involving teams from different aspect working within specific organisations or join

forces between different organisations. . Working in partnership aims to enhanced
accessibility by having joint funding, divided resources and rules of working that will
not examination the services users who are most required.
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http://www.dignityincare.org.uk/Resources/Respecting_dignity/Autonomy/ (Accessed
on 20/04/2016)