Partnership Boards Research Articles

The integration journey in Wales – moving below the waterline. Fitting with the conference theme of ‘Change management implementation' this presentation will explore the journey so far in Wales in creating structural, legislative and system change. 

In 2014 the ground-breaking Social Services and Wellbeing Wales Act set out a new vision for social care which was built on the principles of prevention, service user voice and control, co-production and integration. This was further supported by the vision set out in a Healthier Wales; our 10 year plan for Health and Social Care.
 This legislation placed a legal duty on Local Authorities and Local Health Boards to ‘co-operate’ in meeting the care and support needs of their population. It saw the creation of seven Regional Partnership Boards (RPBs) which brought together Health, Social Care, Housing and Third Sector partners with service providers, service users and unpaid carers to strategically plan care and support in their area. 
 Six years on RPBs have made some notable progress including integrated needs analysis and planning arrangements and the development of integrated service delivery models. However more work is needed to embed integration into our heath and social care system. 
 RPBs are increasingly being viewed as an iceberg, with partnership working so far being progressed ‘above the waterline’ with the small group of people and organisations committed to the integration journey. This presentation will set the ambition in Wales for moving ’below the waterline’ and engaging with wider stakeholders and partner organisations to mainstream integration.
 RPBs are made up of a wide range of stakeholders including service users and unpaid carers. They have all contributed to the integration journey so far and in 2022 these stakeholders have been working closely with Welsh Government officials to review and strengthen current structural arrangements.
 Recent work has included the co-production of an engagement charter to support the effective engagement of services users, carers and third sector organisations in the work of Regional Partnership Boards as true partners.
 
 Work has also been completed to fully align the strategic work of RPBs with Local Primary Care Cluster arrangements in order to ensure strategy and locality based delivery inform and complement each other. 
 Evidence to understand and shape the journey so far has also been provided by Audit Wales, a KPMG review of pooled budget arrangements across Wales and evaluations of the Integrated Care Fund and the Transformation Fund. These two evaluations provided the learning to shape the five year Regional Integration Fund (RIF) launched by Welsh Government in April 2022. The £144.6m a year RIF will seek to create sustainable system change through the integration of health and social care services so that by the end of the five year programme, we will have established and mainstreamed six new national models of integrated care. 
 This presentation will highlight the progress made in Wales in relation to creating structural, legislative and system change but will also raise the question of how to secure the necessary behavioural change to mainstream the integration of health and social care. It will focus on the importance of having the right balance and alignment between systems, structures and people, resources to lever change and the need for a new style of leadership. 

The ownership elephant is becoming a mammoth: a policy focus on ownership is needed to transform Aotearoa New Zealand's health system.

Explicit government policy about ownership of health services is an important yet missing element in Aotearoa New Zealand's health system. Policy has not systematically addressed ownership as a health system policy tool since the late 1930s. It is timely to revisit ownership amid health system reform and increasing reliance on private provision (for-profit companies), notably for primary and community care, and also as an integral part of digitalisation. Simultaneously, policy should recognise the importance and potential of both the third sector (NGOs, Pasifika, community-owned services), Māori ownership and direct government provision of services to address health equity. Iwi-led developments over recent decades, along with the establishment of the Te Aka Whai Ora (Māori Health Authority), and Iwi Māori Partnership Boards provide opportunities for emerging Indigenous models of health service ownership, more consistent with Te Tiriti o Waitangi and mātauranga Māori. Four ownership types relevant to health service provision and equity are briefly explored: private for-profit, NGOs and community, government and Māori. These ownership domains operate differently in practice and over time, influencing service design, utilisation and health outcomes. Overall, the New Zealand state should take a deliberate strategic view of ownership as a policy instrument, in particular because of its relevance to health equity.

Integrated Health and Social Care in England: Ten Years On.

Introduction:As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010–2020 based on reviews by regulators, parliamentary committees and the national audit office.Overview of Policy:Integrated care became a priority through the work of the Future Forum, a group of leading stakeholders established due to concerns about greater competition in public health care. This led to a public statement of shared commitment to integrated care by national health and social care bodies. Early mechanisms included a pooled fund to achieve nationally set objectives, the creation of local authority led partnership boards, and high profile innovation programmes. Later in the 2010’s, new health led partnerships became more dominant vehicles to achieve integrated care at regional level.Impact of Policy:Despite progress within a few local areas, and reduction in delayed discharges from hospital the overall picture from national reviews was that expected improvements were not achieved. Emergency admissions to hospital continued to grow, patients within primary care reported being less involved in their care, and health inequalities worsened. The initial response to COVID-19 was health-centric contributing to outbreaks in care homes and inadequate supplies of protective personal equipment. The ability of leaders to look beyond their organisations’ interests was reported as vital for local progress. National government performance frameworks discouraged system based working and chronic underfunding of social care led to major capacity and workforce challenges.Conclusion:The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. Even with considerable investment and intent progress should be expected to be slow and difficult. Layering of numerous policy initiatives provides confusion and can distract from the important work of relationship building. And ultimately, integrated care cannot by itself address major inadequacies in the underlying resources and structural inequalities.

Structuring the Interstitial Space of Global Financing Partnerships for Sustainable Development: A Network Analysis

ABSTRACT In this article, we theorise global financing partnerships as a ‘space between fields’ that is generated and structured by the relationships between the actors mobilised into partnership boards from different fields. We investigate the structuring of the space of partnerships through a formal network analysis of a new dataset of 188 board members of 10 global financing partnerships across climate change, education, health and nutrition. Individual board members are analysed with reference to their home organisation and sector, the boards on which they serve, and salient issue areas. Centrality and ERGM analyses reveal that, in contrast to the policy narrative of inclusive and egalitarian partnering, donors (from states, international organisations and private sector) are systematically privileged in the structuring of this partnership space. We identify network mechanisms through which systematic biases in partnership relations perpetuate existing hierarchies, and introduce the concept of ‘relational practices’ that could counter these mechanisms. Combining a theorisation of partnerships as spaces between fields with network concepts provides a distinct theoretical basis for elucidating the structuring of partnership spaces at the macro-level, through the analysis of individuals’ connections at the micro-level and inter-organisational ties at the meso-level.

Improving mental health through the regeneration of deprived neighbourhoods: a prospective controlled quasi-experimental study

BackgroundPolicy makers often target deprived neighbourhoods for regeneration with the expectation that population health will improve, since housing and neighbourhoods of low quality, as well as the social and economic determinants of poor health, are concentrated in the most deprived areas. Our aim was to examine the effects of Communities First, a Welsh Assembly Government community-led programme of neighbourhood regeneration targeted at the 100 most deprived electoral wards in Wales on mental health. MethodsInformation on Communities First regeneration activities in 35 intervention lower super output areas (LSOAs) (n=4197) and 75 control LSOAs (6695) were linked to data from the eCATALyST study, a prospective cohort study, in 2001 (before regeneration) and 2008 (after regeneration) within the Secure Anonymised Information Linkage (SAIL) databank. Communities First was delivered through multiagency partnership boards in all 22 local authorities. Boards worked with residents to identify and secure funding for regeneration activities. The primary outcome was the change in Mental Health Inventory (MHI) score (a population-based measure of anxiety and depressive symptoms) between 2001 and 2008 recorded in eCATALyST. We examined the changes in mental health in intervention LSOAs compared with control LSOAs using propensity score matching (1:1 ratio) to balance the level of socioeconomic disadvantage across groups. Sensitivity analysis examined the impact of length of residence in an intervention area and six types of regeneration activity. Findings1500 regeneration projects were funded from 2001 to 2008. Before regeneration, mental health was worse in the intervention than in the control group (mean MHI score 66·6, SD 22·3 vs 71·0, SD 20·8). After propensity score matching, regeneration was associated with an improvement in the mental health of intervention compared with control group residents (β=1·54, 95% CI 0·50–2·59), suggesting that inequalities in mental health narrowed. We found evidence of a dose–response association between length of residence and improvements in mental health (ptrend=0·05). We could not attribute improvements to any one type of regeneration activity. InterpretationTargeted regeneration directed by the residents of deprived urban communities can help reduce inequalities in mental health. FundingThis study was funded by a grant from the National Institute for Social Care and Health Research (RFS-12-05) and undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (MR/KO232331/1) and the Farr Institute of Health Informatics Research.

The Chiefs of Community Policing in Rural Sierra Leone

ABSTRACTThis paper argues that when police reform in Sierra Leone was instituted to consolidate a state system after the country's civil war ended in 2002, it reproduced a hybrid order instead that is embodied by Sierra Leone's primary local leaders: paramount and lesser chiefs. In this sense, policing has a distinctly political quality to it because those who enforce order also define what order is and determine access to resources. The hybrid authority of Sierra Leone's chiefs emanates from multiple state-based and localised sources simultaneously and comes into play as policing takes place and police reform moves forward. This argument is substantiated by an ethnographic exploration of how and with what implications community policing has been introduced in Peyima, a small town in Kono District, and focuses on one of its primary institutional expressions, Local Policing Partnership Boards.

Commissioning health care for offenders

This article sets out the background to offender health care in the UK and explains how the commissioning of services in England is changing. The roles and responsibilities of NHS England and clinical commissioning groups are explained with reference to prison health care, and other secure accommodation and community offender health. Identified risks such as poor attendance at partnership boards, and lack of capability and capacity in clinical commissioning groups may lead to less attention being given to local system delivery and less engagement with key partners. Nurse managers, working in commissioning and provider settings, need to understand the changes to achieve greater partnership working and ensure that the quality of care across pathways is maintained for offenders.

Inclusion or outcomes? Tensions in the involvement of people with learning disabilities in strategic planning

Social inclusion is a key principle that underpins the provision of services for people with learning disabilities in England. Learning Disability Partnership Boards, which are responsible for local strategic planning of learning disability services, hold a particular role in promoting inclusion since they are required both to operate inclusively and to achieve inclusive outcomes. This study sought to explore the extent to which these ambitions for inclusion were being achieved. It consisted of three phases: a scoping exercise to elicit the views of key stakeholders; a postal survey of Partnership Boards (response rate 51%); and semi-structured interviews with Partnership Boards members in six local authorities. Findings suggest that Partnership Boards are struggling to fulfil their dual role, with tensions emerging between the desire to operate in fully inclusive ways and the ability to affect strategic change within local services.

Ten years of partnership

PurposeLearning Disability Partnership Boards (LDPBs) were established throughout England in 2001. This study aims to explore how people with learning disabilities have been involved on LDPBs and the opportunities given for them to take part in civic activities.Design/methodology/approachThe author conducted systematic observations in five different LDPBs operating in South East England and, using purposive sampling, interviewed 55 members of these boards.FindingsRepresentatives who had learning disabilities were able to contribute in four different ways. These were as a co‐chair of the main meetings; member responsible for a specific activity or role; contributor to meetings and discussions; and as a presenter.Originality/valueThe study illustrates that, although people with learning disabilities are involved in the work of LDPBs, their opportunities to influence outcomes are not fully recognised by others. Normal meeting conventions can prove difficult. Alternative arrangements can enable people with learning disabilities to contribute more to meetings and have more influence on outcomes.

The learning disability health self‐assessment: three years on

The self‐assessment was designed to create an environment where people from partnership boards and other interested groups could work systematically alongside health and social care professionals to improve the health of people with learning disabilities in their community. The process has now been used in all ten English regions, making it possible to identify ‐ both within and across regions ‐ innovative good practice, and also system and service deficits having an impact on the health of people with a learning disability. An additional benefit comes from repeating the process annually, thus allowing comparative analysis of progress, and identification of the factors that have helped to achieve that progress. The self‐assessment has strengthened commissioning and offered a foundation and rationale for service development. It has led to better local and regional governance, accountability and systematic reporting, and ‐ most important ‐ has been a catalyst for greater and more meaningful involvement and inclusion in the health economy of people with a learning disability and their families and carers.

Valuing People: family matters ten years on

It is ten years since Valuing People promised a ‘new deal’ for family carers and included specific objectives for involving families in local partnership boards, providing better support for them in their caring role and investing in family leadership nationally, regionally and locally. Over the last decade there have been many advances towards meeting these objectives. However, we cannot afford to be complacent, and must continue investing in families and people with learning disabilities to ensure that the gains of the past decade are not lost.

Partnership boards’ performance

Latest information from journals

Participation and Local Urban Regeneration: The Case of the New Deal for Communities (NDC) in the UK

Dargan L. Participation and local urban regeneration: the case of the New Deal for Communities (NDC) in the UK, Regional Studies. The contention of this paper is that the policy discourses of ‘community’ and of ‘participation’ underpinning area-based regeneration programmes are overly simplistic, and their use in regeneration policy is, as a consequence, highly problematic. Based on an analysis of a regeneration partnership in the north of England, this paper will demonstrate that, while partnership members share the same levels of access in decision-making structures, the members of partnership boards have such different understandings of the purpose of participation and the role of residents in the regeneration process that it has created conflict serious enough to affect delivery of regeneration. Dargan L. La participation et la restauration urbaine locale: l'étude de cas du New Deal en faveur des communautés au R-U, Regional Studies. Cet article cherche à affirmer que les discours politiques sur les notions de ‘communauté’ et de ‘participation’ qui étayent les programmes de restauration territoriaux sont trop simplistes et, par conséquent, leur emploi dans la politique de restauration s'avère très problématique. A partir d'une analyse d'un partenariat de restauration dans le nord de l'Angleterre, cet article cherche à démontrer que, tandis que les membres du partenariat jouissent des mêmes niveaux d'accès aux structures dans la prise de décision, la compréhension des membres des commissions partenariales quant au but de la participation et au rôle des habitants dans le processus de restauration varie tellement qu'il en a résulté un conflit suffisamment important que la restauration s'avère touchée. New Labour New Deal for Communities (NDC) Restauration Participation Communauté Discours Dargan L. Beteiligung und lokale Stadtsanierung: der Fall des ‘New Deal for Communities (NDC)’-Programms in Großbritannien, Regional Studies. In diesem Beitrag wird die These aufgestellt, dass die von der Politik im Zusammenhang mit Gebietssanierungsprogrammen eingesetzten Diskurse der ‘Gemeinschaft’ und ‘Beteiligung’ übermäßig simplistisch sind, weshalb ihre Verwendung in der Sanierungspolitik äußerst problematisch ist. Ausgehend von der Analyse einer Sanierungspartnerschaft in Nordengland wird in diesem Artikel nachgewiesen, dass die einzelnen Partner zwar einen gleichberechtigten Zugang zu den Entscheidungsstrukturen haben, doch dass die Mitglieder in den Vorständen der Partnerschaft derart unterschiedliche Auffassungen über den Zweck der Beteiligung und die Rolle der Anwohner im Sanierungprozess haben, dass ernste Konflikte entstanden sind, die sich auf die Umsetzung der Sanierung auswirken. New Labour New Deal for Communities (NDC) Sanierung Beteiligung Gemeinschaft Diskurs Dargan L. Participación y regeneración urbana local: El caso del New Deal for Communities (NDC) en el Reino Unido, Regional Studies. En este artículo explicamos que los discursos políticos de ‘comunidad’ y de ‘participación’ que socavan los programas de regeneración de áreas son demasiados simplistas y por consiguiente es muy problemático que se usen para la política de regeneración. Basándonos en un análisis de una colaboración de regeneración en el norte de Inglaterra, en este artículo demostraremos que, si bien los miembros de sociedades comparten los mismos niveles de acceso en las estructuras de toma de decisiones, los miembros de las juntas directivas en sociedad tienen opiniones diferentes en cuanto a la finalidad de la participación y el papel de los residentes en el proceso de regeneración, lo que ha creado conflictos lo suficientemente graves como para afectar a la realización de la regeneración. Partido Laborista New Deal for Communities (NDC) Regeneración Participación Comunidad Discurso

Are partnership boards really valuing people?

Observations were conducted in three county councils to find out whether the government’s ambition to develop Learning Disability Partnership Boards (as expressed in the White Paper Valuing people) are being realized. All the partnerships practiced various inclusive activities in order to involve people with learning disabilities in public service strategies. However, there appeared to be limited opportunities for citizens to be involved in recommendations or decision‐making for their area. This concurs with other research elsewhere on the involvement of citizens in state provision, i.e. public participation in civic affairs remains in the control of public sector managers. The lack of opportunities for citizens to direct the allocation of resources and strategies at a local level, regardless of their ability to process information, emphasises the limits of New Labour’s citizen–public sector partnerships.

Northern Ireland’s District Policing Partnerships and the Participatory Ideals

The present article analyses the role of the District Policing Partnership Boards conceptualized by the Patten Report as a pivotal aspect of policing reform in Northern Ireland. It argues that, as originally envisaged, these Boards possessed a participatory capacity to transform rigid institutionalized relations of power between state and society. In outlining their potential the article aims to highlight the difference between traditional consultation mechanisms and more communicative‐based participatory policing. The article analyses the reasons why this more radical model was rejected and examines the impact of this on the operation of District Policing Partnerships. It concludes that the consultative mechanisms that emerged have so far contributed little to the structural transformation of police–society relations in Northern Ireland.

New Public Management and Public Services for People With an Intellectual Disability: A Review of the Implementation of Valuing People in England

Abstract Public policy for people with an intellectual disability has been shaped since 1945 by universalistic ideas of human rights and social inclusion. These universalistic ideas are increasingly under challenge from consumerist ideas, which is reflected in public policy in the New Public Management (NPM). NPM involves a critique of poor coordination and quality in public services, and proposes the enhancement of consumer choice through a greater diversity of providers and market mechanisms to allow consumers to select between them, partnership arrangements to improve coordination, and target‐setting and monitoring by governments. NPM has been widely applied internationally in the reform of public services, and has been implemented for services for people with an intellectual disability in England, following the white paper Valuing People in 2002. There is limited research data on the outcome of this policy, but it indicates that: (1) enhanced choice to be achieved by person‐centered planning has probably affected only a minority of those eligible and has not changed access to public services; and (2) partnership boards have primarily existed to convey and manufacture consent for centrally determined policies. These problems match those identified in surveys of NPM in other sectors, but there is an additional concern that the consumerist ideas incorporated in Valuing People may be used by governments to replace, rather than supplement, policies to directly enhance access to public services through such measures as antidiscrimination laws. The review indicates a need to assess policies for people with an intellectual disability, in a wider social context and through international comparative research.

Community Policing in Freetown, Sierra Leone: Foreign Import or Local Solution?

Though community policing is widely promoted by donors and criticized by academics, there has been little research on its practice in Africa. This essay examines one of the main elements of community policing, namely community forums, in Freetown, Sierra Leone. They were examined from the point of view of the police, Partnership Board executives and local communities. The triangulation of response provided an evaluation of their strengths and weaknesses. Positively they have improved communication between police and communities and provided intelligence, investigation, intervention, arrest and dispute resolution. Negatively they are elite dominated and most of the activities, initiatives and even finance come from the community. Despite the difficulties, the Partnership Boards are universally valued and are not seen as unwelcome foreign imports.

Out of Area, Out of Sight: Review of Out‐of‐Area Placement Arrangements made by Social Services and Health for People with Learning Disabilities from the West Midlands

In 2004/2005 local partnership boards requested West Midlands South and Birmingham & The Black Country Strategic Health Authorities (SHAs) to review and report back on the circumstances of adults with a learning disability placed out of area. There are currently 623 known adults with learning disability living out of area at an annual cost to commissioning services of £35 million. In 1993 the Mansell Report predicted major problems and potential consequences relating to future planning of services for people with learning disabilities and complex needs. Twelve years on this has become a reality, as more people are living in highercost services away from their original district and families. There is no evidence from this review that out‐of‐area services are any worse or any better than local services. The review does not set out to make a direct comparison of out‐of‐area placements and services provided locally, nor does it reflect on the number of people being imported into the West Midlands. With lack of monitoring and reviewing of placements, many people have been left solely to the care of provider organisations. Commissioners of services are becoming reliant on the Commission for Social Care Inspection (CSCI) to raise any concerns with them. This review calls for specific action to be taken now to reverse this trend of increasing out‐of‐area placements and to make more cost‐effective local solutions.

Empowerment, self-advocacy and resilience

This article critiques the relationship between the aims of 'learning disability' policy and the realities of the self-advocacy movement. A previous study found that self-advocacy can be defined as the public recognition of the resilience of people with learning difficulties. In the current climate of Valuing People, partnership boards and 'user empowerment', understanding resilience is crucial to the support of authentic forms of self-advocacy. This article aims to address such a challenge. First, understandings of resilience in relation to self-empowerment and self-advocacy are briefly considered. Second, the current policy climate and service provision rhetoric are critically explored. Third, it is argued that we need to recognize how self-advocacy groups celebrate resilience through a variety of social and identity-shifting actions. How current policy responds to these aspects of resilience is questioned. It is concluded that the lived reality of self-advocacy needs to be foregrounded in any attempt to understand empowerment.

Learning Disability Partnership Boards: Making Participation Real?

This article considers the role and function of learning disability partnership boards. It focuses on how partnership boards have developed their skills in working in partnership with people with learning disabilities (self‐advocates) and uses examples from around England as well as observations from self‐advocates themselves.