Health and Social Care Partnership: An Analysis of Mr. Ian's Case

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Improving Working in Partnership across the Health and Social
Care Sector: the case study of Mr Ian
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Table of Contents
Executive summary.........................................................................................................................3
Introduction......................................................................................................................................4
Section A.........................................................................................................................................5
Section B..........................................................................................................................................9
Section C........................................................................................................................................12
Conclusion.....................................................................................................................................16
Reference List................................................................................................................................17
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Executive summary
The report consists of the notion and analysis of “partnership working” in the healthcare sector.
At the beginning of the report, the philosophy of empowerment, autonomy and informed choice
has been considered. Mr. Ian's case was considered in the report as it consists of various
examples related to partnership working. It has been understood that the patient did not receive
appropriate and timely services due to the reluctance of teams. The unified, coordinated and
coalition models have been considered as it forms the basis of partnership working.
Additionally, the 'Data Protection Act 1998", "Mental Capacity Act 2005" and "Mental Health
Act 2007" has been chosen to analyse its application in the care setting. Due to variations in
professional background and working practices, the health outcomes of care users are affected.
Staff training, team meetings and effective communication practices can mitigate communication
gap, insufficient resources and other barriers.
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Introduction
In the healthcare industry, patients are considered as "partners", and the current trend can help in
involving the service users in the care planning process. Previously, only professionals used to
contribute and make decisions for the patients; however, nowadays, the importance of
partnership working has been understood by organisations. Hence, patient involvement is
considered paramount. The study is focused on exploring the concept and practices in
“partnership working”. The scenario of Mr. Ian shall be considered. Philosophies of
collaborative working shall be discussed in this report. Models shall be considered as well, and
the degree to which, appropriate models have been used in Mr. Ian's case shall be evaluated.
Importance of application of legislation shall be outlined. The barriers faced by organisations,
healthcare professionals patients while implementing and using the partnership approach shall be
discussed as well. Lastly, a few strategies to mitigate the issues of “partnership working” will be
discussed.
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Section A
1.1Explain the philosophy of working in partnership in Health and Social Care
Partnership based working in healthcare works upon certain philosophies because the partnership
approach is a two-way process, and it requires service providers to resolve all forms of barriers
(Glasby, 2017). The philosophies of partnership mainly include autonomy, empowerment and
allowing patients to make informed choices. There is a range of philosophies, however, in this
case, three philosophies shall be explained, and a case study of Mr. Ian shall be considered.
Autonomy- In healthcare, the philosophy of autonomy can allow care users to make their
decisions. The patients and their family members can be given a choice to secure their own
needs. Partnership working allows service providers to allow patients to get involved during the
practice. The care users, as well as the patients, can naturally feel independent when the care
plans would be designed. Particularly in the case of person-centred care, it is necessary for
healthcare providers to acknowledge the importance of patients (Entwistlee et al., 2018). It is
vital to reach common ground so that the decisions of patients and service users do not
contradict. One of the important priorities of healthcare organisations should be the patient’s
independence, and therefore, professionals are liable to consult the patient before taking
decisions. Interventions and medical treatments occur at a faster rate when patients are involved
in the process. For example, advance directives are used in some cases, and patient’s will are
documented as well. In case of severe services like CPR, analgesia or antibiotics, the patient has
complete autonomy to exercise his/her, right.
Empowerment- The service providers need to understand the philosophy of empowerment as it
can help the patients feel that they are in control of their decisions. Empowered patients tend to
develop self-awareness, and they can feel that they are equal partners (Castro et al., 2016).
Partnership approach also allows the service providers to feel satisfied after delivering accurate
services. The overall treatment compliance improves, and consequently, patients are likely to
trust the service providers. Contrarily, empowering patients has its pitfalls, and the philosophy is
quite debatable. Often patients tend to interfere with the decisions of the care providers. Here, the
“empowered” patients tend to misuse their authority. A patient portal can be a good engagement
tool to make patients empowered as transparency levels can be increased. One of the vital
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components of empowerment is information. An education and the informed patient can be
considered as an empowered patient. In this manner, the patient can play an active role in the
treatment process. They should have access to their medical records. The client-doctor
relationship would also improve when patients would feel empowered.
Making informed choices- The term “informed consent” is crucial in medical practice because
it is linked directly to ethical compliance. The patients can be protected from “unwanted”
medical treatments, and they can be involved in the planning process (Slade, 2017). The
thorough usage of informed consent also involves communication. The consent is usually taken
in a signature form, and it should be noted that client’s signature implies that mutual consent
from the service provider and the care user has been considered. After identifying the basic rules,
medical treatment can be preceded.
In Mr. Ian’s case, it has been seen that the teams who were in charge of his care have used none
of the philosophies. For example, the care workers assessed Mr. Ian, and they suggested that he
posses the mental capacity and he is also capable of making health-related decisions. However,
due to his unethical behaviour, he has been transferred to the “Local Authority Long Term Team
(LTT)”. Hence, it can be concluded that without taking Mr. Ian’s consent, he has been
transferred from one team to another. The philosophy of informed consent has been violated.
1.2 Evaluate partnership relationships within health and social care services
Partnership association is based upon dissimilar levels, and here the three levels shall be
discussed. These comprise “service user level”, “professional level” and “organisational level”.
In the case of the service user, relationship exists between three primary entities, and it includes
the care users, health agencies and the experts. Here, the primary link of partnership is the
service user (Torchia et al., 2015). The organisation and other professionals should be concerned
about respecting the wishes of the service users. Following that, at the professional level, the
professionals in the healthcare field are responsible for making partnership and delivering
services (Gradinger et al., 2015). In Mr. Ian’s case, the professionals that delivered services by
working in partnership are care workers, occupational therapists and the social care staffs.
Thereafter, at the third level, the organisations need to work in collaboration for providing
support to a “common service user” as in this case, Mr. Ian. Therefore, in his case, the diverse
organisations concerned were the “Local Authority Long Term Team (LTT)”, “Mental Health
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Review and Reablement team”, “Risk Enablement Panel (REP)”, Care Agency and the “Single
Point of Access (SPOA) team”.
In the UK, various legislations also support partnership/collaborative working. For instance, the
Darzi Report, “Our Health, Our care our say 2006”, “Mental Capacity Act 2005” and the
“Putting people first” supports collaboration between service users, healthcare experts and
healthcare organisations. As per the Mental Capacity Act, often service users possess the
capability to make own decisions, and it is the responsibility of the healthcare experts to assess
the capacity of the individual first (Brown et al., 2015). Consequently, it promotes partnership
working in a positive sense. In this approach, the involvement of service users can be promoted,
and people can be valued more. The professional staffs are accountable for implementing the
guidelines of the White Paper at the local level. This, in turn, allows professionals to accomplish
social inclusion. Additionally, the Darzi Report states that it is vital to lift up the eminence of
care, and service users possess the right to choose the location of care (Archer and Bowden,
2019). Additionally, service users can make preference regarding the hospital doctor and
professionals need to honour the preference of the patient.
After analysing the “Mental Capacity Act” and the Darzi Report, it can be suggested that the
guidelines here are aimed at promoting partnership working. For instance, at the service user
level, the “Mental Capacity Act” will allow patients to make informed choices and professionals
are liable to put the patient at the central point of decision-making. Moreover, the Darzi Report
also states that care users have the authority to choose the doctor and place of care, which in turn
shall allow increasing satisfaction levels of the patients.
In Mr. Ian’s scenario, it can be stated that partnership working failed to accomplish its objectives
because he has been subjected to a constant shift from one team to another. When the local
authority failed to access his needs properly, it shifted his case to the “Mental Health Review”.
However, both the organisations failed to sustain a collaborative relationship. Thereafter the LTT
decided to shift his case to REP; however, even the REP denied taking his responsibility. His
case was shifted thereafter to the occupational therapist and the care social worker. Since both
these experts possess dissimilar professional backgrounds, they were unsuccessful to engage Mr.
Ian in the management process.
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Partnership relationship can be advantageous at all three levels because it promotes functional
working, and it saves the time of the service users. It can be recommended that in partnership
working, organisations have the capacity to collaborate and improve service delivery. Contrarily,
it can be disadvantageous as observed in Mr. Ian’s case. Particularly, at the organisational and
professional level, this approach failed because professionals belonged to different backgrounds,
and they have trouble sharing their skills and expertise, which is the basic element of partnership
working.
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Section B
2.1 Analyse models of partnership working across the health and social care sector
Among the various models, the healthcare sector can utilise three basic models of partnership.
These involve the “unified model”, “coordinated model” and the “coalition model”.
Unified model- In this case, single management is responsible for handling and delivering
services. Under the management, training and staffing occurs and services are provided in an
integrated manner (Carman and Workman, 2017). One of the disadvantages of the unified model
is that it is a quite restricted model because it does not incorporate various service providers or
experts in the healthcare field and service delivery is restricted to few experts.
Coalition model- In this case, “federated partnership” takes place among the organisations. It
implies that operations are carried out separately; however, the management of the organisations
works in a coordinated manner (Duff and Buckingham, 2015).
Coordination model- Here, the management of the healthcare organisation forms a partnership
and aim to work in a synchronised manner; however, the services are provided distinctly. The
coordinated model might have certain disadvantages because experts belong to various
professional backgrounds, and it becomes challenging them to coordinate during service delivery
(Reeves et al., 2018). There might be confusion or perplexity, and consequently, the system
might fail to deliver services appropriately.
In Mr. Ian’s situation, it was observed that the coordinated model was utilised and various teams
such as the LTT, R & R Team and the REP has provided distinct care and services. However, the
teams lacked proper collaboration. The team members have not done the risk assessment of the
service user thoroughly and consequently; it resulted in his unfortunate death. Moreover, the
Review Team Manager was incapable of carrying out formal supervision upon the occupational
therapist and consequently, the situation became quite confusing for the service providers as
well. Confusion among the SPOA team and the Health IT system also increased, and there was a
delay in Mr. Ian’s transfer.
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It can be suggested that in order to collaborate effectively, it would have been appropriate to use
the unified model in the sitution of Mr. Ian. If the entire service delivery could have been done
under one management, then it would have saved Mr. Ian’s life. The delay that occurred in
service delivery could have been prevented.
2.2 Review current legislation and organisational practices and policies for partnership
working in health and social care
The government has enacted a range of organisational policies and legislation that promotes
partnership working. Few of the legislation mainly include the “Data Protection Act 1998”, the
“Mental Health Act 2007”, and “Mental Capacity Act 2005” among others.
“The Mental Health Act 1983” has been amended in 2007, safeguards the rights of the mentally
disabled people. Here the professionals and clinicians play a fundamental role in assessing the
needs of the mentally disabled people and the regulations outlined in the act is focussed upon
reducing conflict (Willis and Dalrymple, 2015). The patient’s family members have the right to
act on behalf of the individual and take health-related decisions. The “Data Protection Act 1998”
is another vital legislation of the government that has been enacted to protect personal data of
clients. As per the act, it is the duty of the organisations to store patient’s information in a
classified manner (Presser et al., 2015). Several other organisations collaboratively maintain
patient’s data in a confidential manner. Before sharing any personal information, it is the task of
the organisation to assess the need to share data with other organisations.
Additionally, in partnership working, the “Mental Capacity Act 2005” allow persons to make
decisions for patients who lack the aptitude to make decisions (British Medical Association,
2015). Usually, the patients suffer from memory loss or any other severe illness that affects their
mental capacity. Therefore, it can be stated that by following the mentioned legislation within the
organisation, partnership working can be promoted and patients will be able to exercise
improved care quality and services.
In Mr. Ian’s case, it would have been appropriate to use the “Mental Capacity Act”, and it would
have been crucial to gain the consent of his family members before shifting him from one team
to another. Due to failed collaboration among teams regarding legislation, Mr. Ian was subjected
to an unfortunate death.
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2.3 Explain how differences in working practices and policies affect collaborative working
In HSC, diverse professionals are involved in assessing the needs of the patients and preventing
the occurrences of illnesses (Mclnnes et al., 2015). In Mr. Ian’s case, social workers were
involved in identifying his needs. The R&R Team Manager decided to assign the responsibility
of Mr. Ian upon two healthcare staffs. The occupational therapist and the social care staffs,
however, failed to work using a collaborative approach because they have different working
practices. Consequently, the risk assessment process differed. It was difficult to work with Mr.
Ian according to the healthcare staffs because he often used to get drunk, and both the workers
faced troubled while managing his behaviour. It is apparent from the case that the occupational
therapist felt that handling Mr. Ian involved moderate risk while according to CSW, handling
Mr. Ian was potentially risky. Due to differences in training and different roles possessed by the
workers, it was evident that information sharing between the workers was done inappropriately.
The service user ultimately suffers when professionals are unable to work upon the principles of
collaborative working. Differences also exist because of the communication gap. As evident
from the case study, the CSW and the OT also lacked effective communication among each
other. The workers simply attempted to transfer their duties on the REP team so that Mr. Ian’s
case can be transferred to the LT team. It highlights a lack of sense of responsibility among the
workers. After receiving the case, the REP team was reluctant to tackle Mr. Ian’s case, and the
team did not challenge several practices like the capacity of service users, the safety of staffs or
the legal frameworks. The team was unclear about its own responsibilities. Confusion emerged
among the SPOA team, LT and the REP. The teams had limited information about Mr. Ian.
Coordination was lacking between the local authority and the mental health services, and
subsequently, no one was clear about the transfers of Mr. Ian. Apart from the teams, the police
were also accountable for detecting the progress of Mr. Ian’s health condition. The police would
occasionally visit Mr. Ian for occasional welfare checking. However, collaborative efforts would
have been more effective, and it would have saved his life. The professionals could have
followed the guidelines set in the “Care Standard Act 2000”, “Mental Health Act 1983” or the
“Mental Capacity Act 2005”. Hence, it can be concluded that variation in working practices
severely affects collaborative practices.
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Section C
3.1 Evaluate possible outcomes of partnership working for users of services, professionals
and organisations
Partnership working can have constructive as well as unconstructive outcomes depending upon
the execution of the services and collaborative efforts given by the teams. The usage of
philosophies like autonomy and patient empowerment can lead to positive outcomes and
subsequently, lack of coordination, miscommunication and reluctance from team members lead
to negative outcomes for the patients and the experts as well (Batalden et al., 2016).
Outcomes for service users- “Partnership working” allows service users to feel empowered
because they can be directly involved in their care planning process. Patient autonomy would
increase because the service users will have a say, as they will be treated as equal partners in the
care process (Bee et al., 2015). Contrarily, service users will also face harmful outcomes if they
are not concerned with the process. For instance, the patient might face confusion due to
information overload. Further, involving service users also implies that there is a possibility of
miscommunication. Patients might want to exercise their rights, and they can even interfere with
the care process.
Outcomes for professionals- Partnership working allows the professionals to offer services in a
coordinated manner. They further have the scope to organise tasks and then communicate among
each other regarding the needs of the clients (Greer et al., 2016). They can work using a
professional and collaborative approach. A patient might suffer from a multitude of diseases as
observed in case of Mr. Ian and therefore, various professionals such as the daily workers,
occupational therapists and physiotherapists had the scope of collaborating among each other and
improving his health outcomes. However, it has been found that the professionals were unable to
collaborate, and the overall outcomes were negative. There was wastage of time and
miscommunication among the service providers.
Outcomes for organisations- At the organisational level, it is apparent that organisations can
use shared principles and a comprehensive approach while delivering services. The relationship
between multiple organisations can be enhanced if organisations work on common grounds
(Porter and Kramer, 2019). Integrated services can be provided to the user, and subsequently,
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