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- Author or Editor: David J. Hunter x
- Public Health and Epidemiology x
The UK government’s reforms of the NHS and public health system require partnerships if they are to succeed. Those partnerships concerned with public health are especially important and are deemed to be a ’good thing’ which add, rather than consume, value. Yet the significant emphasis on partnership working to secure effective policy and service delivery exists despite the evidence testifying to how difficult it is to make partnerships work or achieve results.
Partnership working in public health presents the findings from a detailed study of public health partnerships in England. The lessons from the research are used to explore the government’s changes in public health now being implemented, most of which centre on new partnerships called Health and Wellbeing Boards that have been established to work differently from their predecessors.The book assesses their likely impact and the implications for the future of public health partnerships. Drawing on systems thinking, it argues that partnerships can only succeed if they work in quite different ways. The book will therefore appeal to the public health community and students of health policy.
Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change but health inequalities continue to widen. Such developments have profound implications for the future direction of public health policy and practice.
The public health system in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted and what the origins of dilemmas in public health practice are. The book will therefore appeal to public health professionals and students of health policy, potentially engaging them in political and social advocacy.
This chapter highlights the need for partnership working, which has been a long-standing objective of health and social policy. For many years, the National Health Service (NHS) and local authorities have been attempting to deal with ‘wicked issues’. Issues such as homelessness, disaffection of young people, and the ageing society that have complex multiple causes require joined-up approaches by the statutory and third sectors at national and local levels. In 2012, at the time when Public Health responsibilities were transferred from the NHS to local authorities, health and wellbeing boards (HWBs) were established in England. With few exceptions, HWBs punch below their weight and are not the powerful system leaders that were hoped for. Evidence of their value and impact is negligible, with poor-performance indicators, and the difficulties in overcoming deep-seated departmentalism and a silo approach prevalent in government and public services, leaving ‘wicked issues’ as deep-seated as ever.
It is impossible to understand the devastating impact of the COVID-19 virus across the UK involving significant loss of life, and the government’s much criticised response to it, without applying the lens of a sociopolitical perspective.
A substantial body of evidence exists to show that the virus has had a disproportionate impact on poor communities, and on care homes, reflecting widening health inequalities and the effects of deep public spending cuts since 2010.
This chapter explores many of the core cleavages in health policy, reflecting political and ethical tensions over the balance to be struck, and negotiated, across personal and collective responsibility, across public and private interests, and between the rights of the community and personal freedoms.
Adopting a sociopolitical perspective allows us to identify and explore a range of factors which, taken together, help explain where the government’s handling of COVID-19 has been found wanting.
Three particular policy failures, and the political choices leading up to them, are explored. These comprise the persistence of a command and control approach to handling the crisis, the policy of austerity introduced by the Coalition government in 2010, and the heavy reliance on outsourcing activities to the private sector and management consultants. An agenda for reform going forward is presented to conclude this chapter.
Chapter 6 describes the changing context for partnership working in public health following the UK coalition government’s plans for returning lead responsibility for public health in England to local government while also creating a new agency, Public Health England, to provide support and national system leadership. The changes, contained in the Health and Social Care Act 2012 and introduced in April 2013, reinforce the importance of partnership working while introducing new partnership forms that are yet to be tested and evaluated. The new health policy landscape is described and an interim assessment of progress provided.
In the light of the research presented and the public health changes underway in England, assesses the future prospects for public health partnerships which will become more complex and challenging. This chapter argues for a different approach which emphasizes the importance of relationships and suggests the need for less attention being given to structures and order. Partnerships in future need to be much more flexible and task oriented, engaging with those who can effect change on the frontline. The public health challenges facing society have few obvious or clear-cut solutions. Partnerships need to experiment and take risks to find out what works and why. If this requires being a little messy in how the work gets done then that may be desirable. The chapter offers some learning points for effective partnership working.
Partnership working is central to British public policy. Few challenges facing government can be tackled successfully without working across boundaries and in partnership. Public health issues are particularly complex in this respect and yet little is known about public health partnerships. The research reported in this book seeks to go some way to closing the knowledge gap employing the notion of a public health system to explore the issues raised. The book brings the discussion up-to-date by examining the evolving public health system in England and the major changes introduced in April 2013. These have introduced new partnership forms that remain to be tested. Our research offers useful insights and learning points.
This chapter discusses the various theories and concepts of partnership working and explores what partnership working is, the opportunities and barriers to working in partnership, and the various modes of governance underpinning partnerships. It argues that a networked approach to the governance of partnerships is needed based upon systems thinking to tackle the complex ‘wicked issues’ found in public health.
The chapter reports on the findings of 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.
This chapter presents the research findings, through qualitative research, derived from the views of senior practitioners and their perceptions of the effectiveness and efficacy of public health partnerships. Interviewees include: Directors of Public Health, Directors of Commissioning, Councillors, and other senior public health practitioners.
