The government's idea of meaningful partnerships between statutory agencies and the local community to address public health issues is an unachievable fantasy?

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The government’s idea of meaningful partnerships between statutory agencies and the local community to address public health issues is an unachievable fantasy?

The approach of statutory bodies attempting to address the health needs of local communities has often been the development of partnerships - formal or informal arrangements to work together to some joint purpose. The definition of meaningful is ‘serious and important’, so these partnerships should not be superficial in nature. Statutory agencies are organisations required or authorised by law. The question therefore asks about partnerships between governmental agencies and communities. The idea of community itself is contested, however, with different types of community being described such as ‘geographical communities’, ‘communities of interest’ and ‘virtual communities’. This essay will focus on geographical communities – individuals who live in a shared locality e.g. neighbourhood, village, town etc.

The last few years have seen a cultural shift from traditional models of service provision to working together in different ways. Driving this change has been an increasing recognition of citizens’ rights to higher quality services. The partnership model has long been at the heart of EU public policy. Within the UK, partnership arrangements have been strongly influenced by the Labour government’s idea of the ‘Third Way’. This is defined by a synthesis of ‘real opportunity’ and ‘responsibility’. Citizens are no longer purely the recipients of public services. Instead, they are partners with ‘shared responsibility’. The Labour government has grasped partnership working as a key to resolving problems within the service system and with the quality of public services. Partnership working is now central to government policy. The 1997 White Paper The New NHS: modern, dependable (1997) discussed partnerships both within the NHS and between the NHS and other groups. Saving Lives: Our Healthier Nation (1999) highlighted the potential of local partnerships. Partnership working has been driven forward using incentives and sanctions to achieve change: the government has removed legal obstacles to joint working between health and social services and made special grants available to foster partnership working. For example, The New NHS: Modern, dependable (1997) imposed a ‘statutory responsibility’ on Health Authorities to involve partners from a range of sectors in the development of ‘Health Improvement and Modernisation Plans’. The Health Act (1999) imposed a duty of partnership between health bodies and councils. The Local Government Act (2000) called for partnerships between the council, public, voluntary, community and private sectors to improve the economic, social and environmental well-being of their areas.

Health action zones are a prime example of partnership in action, with involvement from the NHS, local authorities, community groups and the voluntary and business sectors. They have been set up in areas with the worst health status in the UK, so that poor health can be more clearly addressed. They have taken forward challenging work programmes which address both health care issues and the determinants of health such as housing, environment, employment and income, as well as focusing on specific client groups such as older people, children, people with mental health problems and minorities. Other examples of partnerships between statutory agencies and communities include Local Strategic Partnerships, the Healthy Schools Scheme, Healthy Living Centres and Sure-start.

There are many recognised benefits of partnership working. Partnership allows groups to get together at the same table to discuss common issues rather than apart from one another; this improve inter-sectoral communication. Partnership is designed to provide a space for dialogue amongst partners with different perceptions, thereby developing a more collective way of working for local development. Partnership arrangements allow tensions and conflicts to appear in public space. In this way, partnership enables statutory agencies to listen to community needs, exchange information, tap into an important resource – local experience and knowledge, get feedback on the impact of their policies, thereby reflecting these voices into their decision making. Thus, the biggest advantage of partnership from the statutory perspective is listening to the community voice. Partnership also provides an opportunity for statutory agencies to share a sense of locality. An executive staff member on a Partnership Board in Northern Ireland has written:

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We get to know the people within the community, build the trust with those. Because of regular contacts, it would be different from just giving funding and not seeing the groups again.

In turn, partnership provides opportunities for community representatives to have regular access to a number of key agencies.  Partnership offers greater opportunities for socio-economic development, particularly for less profitable, but socially beneficial projects.

Partnership is seen as a mechanism to ensure that government responsibilities in public health are consistent (where needed), coordinated (where complementary activities are required) and collaborative (where pooling of expertise and resources ...

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