Repeated calls for improved joint working between agencies and professionals providing social care have had limited success. Following a brief review of possible reasons for this, it is argued that joint working cannot truly succeed unless it does so at street level at the professional/user interface. Yet this level has received little attention. Taking the example of a mechanism created to ease communications and negotiate transitions between a range of services for the elderly, the paper demonstrates that there exists an important but neglected role for brokers or mediators (so-called ‘reticulists’) who display an awareness of the political realities and power dimension of organisational life and who operate on the margins and in the interstices of services. Of the lessons to be learned from this initiative in joint working the most important is that a direct transplant is likely to suffer rejection. The mechanism reported on is a product of its environment—a ‘bottom-up’ response to a perceived problem—and tailored accordingly.
Recent years have witnessed a growing concern in the NHS to devise and implement policies which explicitly recognise that certain client groups and services should receive a higher priority. The paper points to problems arising from the formulation and implementation of the Scottish health priorities documents, drawing where appropriate on related developments in England. Three areas are highlighted for analysis: the policy ambiguity inherent in the documents; problems of collaboration in implementing the policies; and problems posed by central-local relations. The paper concludes that there is a need for a more sophisticated response to the present fiscal squeeze than simply defending the status quo and suggests that the squeeze could provide the necessary stimulus for change.
Local government (LG) is ideally placed to influence the determinants of public health (PH) and reduce inequalities, but opportunities are routinely missed.
Aims and objectives
The aim of the Local Authority Champions of Research (LACoR) study was to explore ways to embed a culture of evidence use in LG.
Five linked work packages were undertaken using mixed methods. In this paper, we report data from semi-structured interviews with UK local authority (LA) staff (n=14).
Findings show a changing culture of LG: embedded researchers can enhance connectivity and interaction, build linkages, use levers of influence, and learn alongside LG navigators. Understanding the diverse microcultures of evidence use in LG is critical. Research champions can help to navigate the social, financial, political and regulatory context of LG and academia, influencing change dynamically as opportunities emerge.
Changing organisational subcultures is ambitious and unpredictable given the complexities of, and variability in, local contexts. Cumulative changes appear possible by recognising existing assets, using relational approaches to respond to LG priorities. In-house capacity remains underestimated and underutilised in efforts to embed evidence use in LG decision making. Co-located embedded researchers can use contextually specific knowledge and relationships to enhance evidence use in LG in collaboration with system navigators.
There is a need for academics to adapt their approach, to take account of the context of LG to achieve meaningful health and social impacts with LG and test the contribution of embedded approaches to wider system change.
Partnership working has been a central feature of New Labour's approach to the delivery of health and social policy since 1997. A number of partnership-based initiatives have centred on reducing health inequalities and improving health. This article reports on the findings from a systematic review of the impact of partnership working on public health, and considers whether these partnerships have delivered better health outcomes for local/target populations. It finds that there is little evidence that partnerships have produced better health outcomes for local/target populations or reduced health inequalities.
Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.