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 is beneficial). Partnership is even viewed by some as a “radical new localism in public policy, reversing a longstanding hegemony of government centralism”. McDonagh (1995) agrees that partnership plays an important role in bridging community and government. Others argue that the partnership approach seems to be capable of redressing problems of public administration and mobilising civil society by means which work collectively and share experiences and knowledge.
There are a number of pointers to successful partnerships. They operate most effectively when built on “explicit and structured planning, nurturing and maintenance.” They are most likely to succeed in circumstances where an open discussion of potential difficulties are aired. They function best when partners offer contrasting contributions to an agreed common goal. An example of a successful partnership structure is within Northern Ireland where various organisations involved with partnership working were set up as a result of the EU Special Support Programme for Peace and Reconciliation. One of the projects established was a business park site in the deprived area of Creggan. This was developed by the community working together with a number of statutory agencies including Derry City Council.
Many theoretical problems with partnerships have been identified. Although partnership implies a shared agenda with a degree of common interest, they do not always share a common consciousness. Consisting of a variety of actors with differing perceptions, partnerships inevitably create tensions and conflicts among them. This is particularly true within partnership settings composed of a wide range of partners with different backgrounds. Therefore, rather than existing within an environment of harmony (what Booth (1998) terms “the presumption of altruism and rationality”), a contrasting view sees the existence of competitiveness as inevitable. Walsh et al (1998) assert that partnership is seen as “oscillating between positions of conflict and consensus, inequality and parity”. In contrast, Mackintosh (1992) argues that, although each partner tries to work for its own agenda, the partnership process can be a “mutual struggle for transformation”.
There have also been criticisms levelled at the decision-making process, in which the government states that partnership provides a means of listening to the public, whilst the community sees partnership as a way for the government to bypass and legitimise the decision making process. In this way, partnership is seen as a device used by the State for ‘buck-passing’ its role, de-radicalising community protest, privatising poverty and ‘trading-off’ between partnership and participation. Partnership is viewed by some as merely a consultation process for statutory agencies to identify community needs and solutions rather than a co-decision of policy making and implementation. The community actor becomes a mere voice rather than just a social partner.
Partnership requires equality amongst all actors as common stakeholders, with wide and balanced representation. But the rhetoric of partnership frequently masks unequal relationships among partners – an imbalance of power between the collaborating bodies. The statutory agencies hold most of the power and resources. In contrast, community groups lack resources and expertise, with less experience of decision-making. The community sector has to satisfy the State, develop and deliver a range of services that the State wants, report on and monitor them and ensure that they meet high quality standards. A community representative has commented on this imbalance:
Are we in the business of driving social change or are we the agents of social control? Do we act as the litmus test for the government policy highlighting its failures and campaigning for change or do we act as a buffer for the government, struggling to carry out policy and alleviating its worst excesses, thereby limiting opposition at community level.
As well as theoretical problems with partnerships, there are some practical difficulties. Partnerships are based on two fundamental assumptions. Firstly, that sufficient harmony exists between groups to allow collaboration to occur. Secondly, that the decision-making process can be readily controlled. Unfortunately, these do no always hold true. Douglas (1998) states that the reporting of the experiences of partnership working has tended to be restricted largely to positive, ‘anecdotal’ stories. They do not discuss the problems that were faced by those involved in the partnership work. For example, in a review of progress within the first year of the Labour government, Klein (1998) noted that: “collaboration and co-operation are easier to invoke than to achieve”. Optimism about partnership working may be well intended but can be seen as simplistic. Faith in partnerships is based mainly on a feeling that it must be good to work together. Alternatively, there may be an awareness of great difficulties within the existing system, but an attitude that these can be overcome. Skills and expertise in developing and maintaining partnerships are essential, particularly in relation to leadership and the management of change. However, there is evidence that such skills are often lacking. In addition, many authors have drawn attention to the fact that there is a lack of evidence on the evaluation of partnership working. There is a difficulty in identifying and selecting firm indicators and then applying them to the work of specific partnerships
Another problem with partnerships is that they can be time consuming and expensive to keep going. There may be communication difficulties with confusion over roles. Interdisciplinary differences and inter-professional rivalries are often evident as well as tensions between professionals, lay groups and communities. Disputes often arise between statutory agency and community partners e.g. over the priority of target areas and the allocation of scant resources. Other authors have highlighted the difficulty of selecting community representatives. In the case of the District Partnership Derry Council Area, one of 26 District Partnership Boards for the allocation of the EU Peace Fund, representatives were nominated through the Northern Ireland Council for Voluntary Action, the central office of community/voluntary organisations located in Belfast. This meant that the decision making process was centralised and likely to be influenced by strong and active groups. According to Mackie, we have moved from a situation a decade ago where the involvement of the community was rare, to one where it is largely obligatory. Communities have been put under increasing pressure to get involved. This can put a strain on the time of community activists and the community itself. “I participated last week” has become a common refrain as communities are consulted on a wide variety of topics.
Some commentators have argued that some partnerships have tended to become too large, inflexible and cumbersome. The sheer complexity of partnerships can cause difficulties: “If greater knowledge persuades us to see problems as multi-faceted, then we are pushed into more complex kinds of co-ordination mechanisms”. Progress on partnerships has also been challenged by organisational change within the NHS and reconfigurations in local government. In addition, major budget pressures in health and social services have undermined the development of partnerships. Due to financial restrictions, partnerships have to identify and prioritise community needs. Reaching a consensus as to which groups will be funded is very difficult because every group has its own needs and each believes that their need is the greater.
It can be seen that partnerships, driven by the Labour government, form a significant element of recent policy developments in the health field. New partnerships have developed between statutory agencies and the community in pursuing the betterment of improved health and socio-economic life. However, most community groups feel that partnership is not equal; the state holds the resources and decisions, and is stronger than any partners. Furthermore, partnerships are sometimes undertaken with insufficiently clear rationales, foundations or supportive evaluation. As we have seen above, meaningful partnerships are achievable. However, for partnerships to be successful, they must be based on trust and encourage participation, so that joint purpose and common values can be established. They must also be covered by clear guidelines on openness, communication, defining expectations and accountability.
Reflection
Reflection goes beyond just gaining knowledge to explore the foundations of that knowledge, strengthen understanding and increase awareness of the values and attitudes that influence it. In reflecting on the experience of this debate, I need to begin by saying that it was extremely difficult to decide which topic to choose as both were extremely interesting. Eventually, I decided to join the group containing individuals who I had not worked with before to enrich my experience of the module. I believe that I made a good choice. Partnership working is a key component of the new public health agenda and so a debate of this kind is invaluable.
Our group comprised a good mix of people with a wealth of experience in partnership working. The group proved highly motivated. Everyone worked well together to reach a consensus as to what partnership working meant; there were no dominant individuals who could hijack the debate and this was a strength of the group.
The group met up on four occasions and also communicated via email. At first, everyone collected as much information as possible on partnership working. We later divided the topic into more specific areas. Everyone pulled their own weight and the project was completed in a spirit of camaraderie. I definitely improved my information gathering skills. Only late did we decide who would argue which side of the debate and this was a good choice as we achieved most when the entire group was working together. We decided on a TV debate format to present the debate. This was thought to be the best way of getting the information across. A few of us liked the idea of a court room after a previous positive experience of this style working in the sociology module but a consensus emerged that a TV debate would be best. One criticism of the project, perhaps, was that there should have been more competition between the two groups. The debate should also have included a section where the audience voted for one group or the other.
The group was faced by some practical problems. Some group members were absent through leave and bereavement. In addition, we all felt constrained by the relatively short time scale. Coming from geographically remote areas, meeting outside timetabled sessions was not possible. If there had been more time, we might have been more systematic in picking up emerging key themes. Initially, we had little sense of how much information we needed to input into the debate. I believe that much of the information that we collected was not needed in the final debate. The most challenging part of the debate was the presentation where I had to play a character who does not believe in partnership working.
In conclusion, I feel that this experience has been very positive and it has been an effective learning process. The project taught me to be tolerant of other peoples’ ideas and views. I tried to keep an open mind and not let my own preconceptions get in the way. I have learnt about the benefits of working together. The debate was also important in drawing together the different parts of the MPH course. Although we did not purposefully input bits from the other MPH modules, these fell naturally into place. The project definitely gave me a chance to apply the skills that I had picked up from other parts of the MPH. In addition, we were encouraged to be creative in this module and I believe that this was reflected in our final performance. Finally, doing the module gave me a sense of versatility, well-roundedness and confidence in my abilities. I feel ready to practice public health and to persuade others of the importance of partnership working – thank you!
References
Collins English Dictionary & Thesaurus 2000.
Day, P. 1999, ‘Informing policy and promoting active communities in the information society’, network/Proj/ws99/day-pp.html, last accessed 21/5/03.
Otaka, K. 2001, ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Department of Health 1998. The New NHS: modern, dependable, London: The Stationary Office.
Department of Health 1999. Saving Lives: Our Healthier Nation, London: The Stationary Office.
King’s Fund 2002. Partnerships Under Pressure: A Commentary on Progress in Partnership-working between the NHS and local government, King’s Fund, London.
Department of Health 1998. The New NHS: modern, dependable, London: The Stationary Office.
Health Act 1999. Chapter 8, London: The Stationary Office.
Local Government Act 2000. Chapter 22, London: The Stationary Office.
‘Partnership working’, http://www.nelh.nhs.uk/nsf/inprimarycare files/nsf partnershipworking, last accessed 20/5/03.
Otaka, K. 2001, ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Walsh, J. 1998, Local Partnerships for Social Inclusion? Oak Tree Press, Dublin.
McDonagh, R. 1995, A Partnership Approach to Regeneration, Making Belfast Work, Belfast.
Otaka, K. 2001. ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Partnerships for Health: a Review. HEBS Working Paper Number 3.
Otaka, K. 2001, ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Booth, T. 1988, Developing Policy Research, Gower, Aldershot.
Markwell, S. 1998, ‘Exploration of conflict theory as it relates to healthy alliances’ in Alliances in Health Promotion; Theory and Practice, ed. A. Scriven, Macmillan, London
Walsh, J. 1998, Local Partnerships for Social Inclusion? Oak Tree Press, Dublin.
Mackintosh, M. 1992, ‘Partnership: issues of policy and negotiation’, Local Economy, vol. 7(3), pp. 210-224.
Otaka, K. 2001, ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Rosemount Resource Centre 2001, Building for a Bright Future.
Douglas, R. 1998, ‘A framework for healthy alliances’ in Alliances in Health Promotion;Theory and Practice, ed. A. Scriven, Macmillan, London.
Klein, R. ‘Clinical depression.’ The Guardian, 29 Apr., p.6 .
Speller, V. 1998. ‘Future developments of healthy alliances’ in Alliances in Health Promotion; Theory and Practice, ed. A Scriven, Macmillan, London.
Francisco, V., Paine, A. & Fawcett S. 1993, ‘A methodology for monitoring and evaluating community health coalitions’, Health Education Research, Vol. 8 (3), pp. 403-416.
Higginbottom, G. & Simpson C. 1996, ‘ Developing alliances for health: principles and practice’, Health Visitor, Vol. 69 (3), pp. 108-109.
Gray, B. 1985, ‘Conditions favouring inter-sectoral collaboration’, Human Relations, Vol. 38 (10), pp. 911-936.
Saks, M. 1996. Professions and the Public Interest: Medical Power, Altruism and Alternative Medicine, Routledge, London.
Otaka, K. 2001, ‘Partnership: a new mechanism of local governance?’, , last accessed 20/5/03.
Mackie, D., ‘Dancing while standing still’, , last accessed 21/5/03.
Standish, G., Perry C. & Palk, N. 1994, ‘Scoring doubles.’ Health Service Journal, 15 Sept., pp. 26-27.
Hudson, B. 1995, ‘Joint commissioning: organisational revolution or misplaced enthusiasm?’, Policy and Politics, Vol. 23 (3), pp. 233-249.