This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information
Transcultural communication and health care practice:
Multi-disciplinary/multi-agency partnerships across cultures: a health perspective
Authors: Dr Uduak Archibong, Gerry Armitage, Julie Cameron, Raghu Raghavan, Jean Teare
In its 1997 White paper the New NHS, Modern, Dependable, the government sets out clearly what is described as a 'through way' of running the NHS - a system based on partnership, which is set down as one of the six guiding principles of the new service. Underpinning this is a range of policies and proposals which require closer inter agency relationships than in the past, including
- the introduction of a legislative "duty of partnership",
- the production of joint National Priorities Guidance covering both the NHS and the social services,
- the development of Joint Investment Plans between health and local authorities, and
- proposals to remove legal and organisational constraints to collaboration.
(Department of Health, 1997)
The partnership between the NHS family and social services has attracted a lot of attention. Traditionally this relationship has been at a strategic authority-wide level between health authorities and social services authorities, but the NHS reforms now require a more localised collaborative focus. The recent formation of District Care Trusts is an illustration of the Government's commitment to localised collaborative arrangements. However some concerns have been expressed regarding the health - social services relationships. These include:
- whether social service representatives, can adequately represent local authority interests (e.g. housing)
- how dual, personal accountability to local authority and health service will work when in place
- the sheer complexity of current partnership structures and initiatives
- the perceived issue of differing cultures between social service and health service
(Hudson and Hardy 2000)
The complexity of the NHS - Local authority partnership is illustrated in the case of Victoria Climbié, an eight-year-old West African child who died from child abuse in North London in 2000. Victoria had been seen by professionals from diverse disciplines and institutions, including health service, education, social service, housing, children's charity and the church. A public inquiry into the death of Victoria found that inter-agency collaboration was 'ineffective', there was a potential for confusion of roles and the case highlighted a need for a closer working relationships between all stakeholders. These findings support the recent Department of Health (2000b) assertion that the NHS and social services do not always work effectively together as partners in care, so denying patients access to seamless services that are tailored to their needs.
Joined up working is a contemporary imperative in the public sector, yet differences in positions between partner organisations can imperil a successful outcome (Bryant 2002). Often the dynamics of a partnership are dysfunctional because of real or perceived goal divergence or incompatibility between organisations or groups (Schruijer 1999). There are organisational, professional and personal factors, which may foster or limit multi-disciplinary and multi-agency working practices (Sicotte, D'Amour and Moreault 2002). Maintaining and managing collaboration is a delicate act of balancing conflicting demands while maintaining diversity.
The cultural competence of collaborative practices between social and health service professionals and users and carers from minority groups has more often than not been honoured in the breach than compliance. This module aims to ascertain how this continues to be the case and provide helpful pointers to health and social care professionals. From this backdrop, the module focuses on the integration of multidisciplinary and multi-agency collaborative working towards the development and delivery of social and health care services to minority groups.
It is paramount for professionals to ensure that in the course of their work to service users and others in the dynamic of service provision, that this process is anchored on current knowledge and assiduously researched ideas on best practices in the provision of appropriate and effective social and health care. The professional's ability to ascertain where to obtain these details and how to effectively use them, interpret and co-opt them to ensure informed practice enables a judgement to be made with regard to relevance to their day-to-day work. This module is designed to help the professional do the foregoing. It also enables the professional to gain access to helpful resource material, and read these in an informed and critical way, so that sound decision about their relevance to practice can be made.
Structure of the module
The module is made up of two overlapping sections:
Section one defines terms and legislation relating to users and carers involvement in social and health care development and delivery. It describes perceptions of family and paid carers and roles and responsibilities. It explains the role of the family in social and health care provision using examples from children's nursing.
Section two defines and sets the parameters for collaborative working, partnership and community involvement aspects of the module. It provides relevant literature to underpin these concepts and ways of working.
Some of the main features of the module include use of practical activities and memos aimed at helping the readers to grasp the key points considered in each subsection.
Aim and learning outcomes
The Aim of the module is to increase sensitivity to cultural differences and encourage understanding of multidisciplinary / multi-agency partnerships across cultures.
On completion of the module the reader will be able to:
- identify and discuss needs of users and carers across cultures and communities as part of effective service delivery
- appraise partnership-working practices; their dimensions and their suitability in promoting cultural diversity in care delivery
- xplore and debate the nature and types of collaborative working practices for social and health service planning in a diverse community
- discuss and analyse cultural influences on modes of advocacy and empowerment, recognising threats and opportunities in working; with and for minority groups