Health improvement: countervailing pillars of partnership and profession

Abstract

The Scottish Parliament has recently formed Community Health Partnerships (CHPs), in which health and social care providers come together within a unified organisational framework. This paper aims to assess the extent to which employees identify with their profession and whether professional identity poses a significant barrier to multi-disciplinary, inter-organisational partnership. The study adopted a mixed methodology approach. A survey of all CHP staff was conducted, four months after the CHP was created and obtained a 31 per cent response rate. Additionally, to obtain an in-depth understanding of the partnership, 26 interviews were conducted with senior and middle level managers and professional representatives. A strong professional identity in the health and social care context was evident while the partnership vision, in contrast, lacked clarity. Therefore under these circumstances individuals' sense of occupation has been heightened due to perceived attempts to erode their professional identity, and modifications to their sense of "self" have not been challenged by a strong partnership ethos. Managers face a deep-rooted cultural based challenge where individuals strongly identify with their profession rather than the ethos of the partnership, which impedes full integration. Managers have a "balancing act" of addressing structural and processual change within the integration agenda, without losing sight of the outcomes in terms of service delivery and improving health and wellbeing. This paper examines the implications of a new major health policy change that aims to integrate health and social care. In addition, the study unravels the complex issue of professional identity in this context.