Symposium 4 Partnership working to promote healthy, active ageing
Symposium lead:
Susan Lambert, Head of Centre for Health Economics and Policy Studies, School of Health Science, Swansea University, Swansea, Wales, United Kingdom S.E.Lambert@swansea.ac.uk
Symposium chair:
Professor Joy Merrell, Professor of Public Health Nursing, School of Health Science, Swansea University, Wales, United Kingdom
Symposia focus:
This symposium will explore the challenges facing project coordinators who are pivotal to the success of three initiatives supporting the health and well being of older people in different care sectors: intermediate care, a hospital discharge scheme and a national programme of community projects developed to improve physical and emotional health. All three papers used mixed methods. Each paper takes an issue that explores the complexity of the coordinator’s role in achieving effective partnerships with the statutory, voluntary and private sectors. Partnership working with these stakeholders, as well as people from local communities, is central to the delivery of support for older people. Whilst there is much literature which broadly explores the benefits and challenges of partnership working, there has been less focus on the processes and hidden work involved in promoting effective partnerships in practice. Policy initiatives in England and Wales have been developed to promote active ageing and enhanced quality of life of older people. National Services Frameworks for Older People anticipate increased access to responsive, person-centred mainstream and voluntary sector provision (DoH 2001, 2006, WAG 2006). Intermediate care, timely hospital discharge services and healthy ageing initiatives are central to promoting independent living for older people. The skills required to develop effective service delivery in these core areas of health and health care will be identified and the solutions to challenges and barriers to success will be explored. The symposium will contribute to the development of knowledge and policy and practice in health and health care by exploring:
- The processes and hidden work in achieve partnership working in practice.
- The challenges and benefits of working collaboratively with volunteers and statutory partners, as part of a menu of interventions in the care of older people. Word Count: 295
Abstract 1: Ambiguity and Complexity in Partnership Working: The Case of Age Concern’s Bridging the Gap Programme
Joy Merrell, Professor of Public Health Nursing. Gaynor Mabbett, Head of Centre for Public Health and Primary Care. Melanie Jones, Tutor in Sociology. School of Health Science Swansea University, Wales, UK
Background
Partnership working is viewed as a means to solve complex problems which can not be solved by one agency alone (WAG 2002), and especially for vulnerable groups including older people recently discharged from hospital. Intermediate care services are seen as preventing avoidable hospital admissions (WAG 2003). Through the provision of multi-agency support, the “Bridging the Gap” project seeks to facilitate sustainable discharge from hospital for older people who have low level needs.
Aim To:
- Provide a detailed account of the relationships between volunteer and paid workers
- Identify the benefits and challenges of partnership working.
Methods
A case study, stakeholder evaluation was conducted involving focus groups with a purposive sample of volunteer and paid workers (n=17), interviews with managers, partners and referrers (n=11) and secondary analysis of client satisfaction questionnaires (n=84). Data were collected between Nov 2005- March 2006. Data were analysed using SPSS and thematic analysis.
Results
Findings indicated that avoidable hospital readmissions were reduced. The co-ordinator’s role was pivotal in facilitating partnership working. Ambiguity surrounding roles and boundaries, the pace of change and lack of support for the co-ordinator posed threats to partnership working. Volunteers and paid workers (including district nurses) reported benefits in terms of learning new skills, knowledge and ways of working. Volunteers also reported benefits from widening their social networks.
Discussion
There are a number of threats to effective partnership working between paid workers from different disciplines; volunteer and paid workers; and statutory and voluntary services. Drawing on theories of ambiguity (e.g. Billis 1989) understanding of these threats will be enhanced. Resources to facilitate partnership working will be explored and strategies for overcoming the threats presented.
Conclusion
Evidence from this project contributes to knowledge on partnership working at the micro-level to inform future planning and provision of intermediate care services for older people.
References
Billis D. (1989) A theory of the voluntary sector; implications for policy and practice. Centre for Voluntary organisations Working paper No. 5., London: London School of Economics.
Welsh Assembly Government (2002) Building Strong Bridges. Strengthening partnership working between the Voluntary Sector and the NHS in Wales. Cardiff: Welsh Assembly Government.
Welsh Assembly Government (2003) The Review of Health and Social Care in Wales. The Report of the Project Team advised by Derek Wanless. Cardiff: Welsh Assembly Government
Abstrct 2: Providing person centred care through partnership working in intermediate care
Valerie Thomas, Tutor in Health Policy, School of Health Science, Swansea University, Swansea, Wales, United Kingdom
Background
Intermediate care (IC) is a concept which is familiar to many people working in health and social care in the UK but the term is used to describe services as diverse as social services reablement teams, residential rehabilitation units and hospital based nursing units. All services should focus on maximising independence and cross professional working. Aim The aim is to explore the perceptions of staff working in and referring to community based IC teams.
Methods
The paper draws on results from a Doctoral study (data collection from mid 2006 to mid 2007).
Methods included 2 focus groups (n=6,n=10)and observations with IC teams (n=6), face to face interviews with referrers (n=17)and an evaluation of the outcome measures. Data were coded and analysed within and across data sets to identify themes.
Results
Promoting partnership working has resulted in a level of understanding, trust and reflexivity between team members which translates into a person-centred approach, putting the person at the centre of every activity (McAllin and Bamford 2007). The service manager/coordinator has facilitated the development of a model of working which transcends disciplinary boundaries, provides a sense of a central purpose and a clear idea of the focus of the work.
Discussion
This paper explores the challenges of inter professional working when measuring the effectiveness of services.
Challenges facing managers / coordinators include: the heterogeneity of services that are labelled IC and the complexity of the objectives that IC seeks to achieve.
Conclusion
Managers need to understand the systems and structures within which they are required to manage (Jasper 2002). This paper explores the hidden work that takes place to facilitate partnership working within this complex model of care.
References
Abstract 3: Jasper M. (2002) Nursing roles and nursing leadership in the New NHS-changing hats, same heads Journal of Nursing Management 10(2):63-64
McAllin A. & Bamford A. (2007) Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated? Journal of Nursing Management 15(4):386-391
Promoting healthy ageing: coordinating the work of volunteer health mentors and meeting the requirements of statutory partners Susan Lambert, Head of Centre for Health Economics and Policy Studies, Janice Lewis, Tutor in Public Health, Joy Merrell, Professor of Public Health Nursing, Cathy Taylor, Tutor in Primary Care, School of Health Science, Swansea University. Gillian Granville, Independent Health Consultant, London, United Kingdom
Background
The lay health promotion model is a cornerstone of public health policy (Department of Health, 2004, 2006). The Ageing Well programme offers health-related activities led by and for people aged 50 years or more, to encourage good health and reduce illness and disability in ways that challenge traditional service provision by professionals. The lay health model underpins the recruitment of health mentors or health trainers who work in communities to support behavioural change.
Aim
To evaluate Age Concern’s Ageing Well programme in England and Wales Methods The paper explores how coordinators in Ageing Well cope with the challenges of working with volunteers and statutory sector partners to deliver the active ageing agenda.
Methods included focus groups with project coordinators (n=31), telephone interviews with volunteer mentors (n=102), individual interviews with clients (n=31) and a documentary review. Data were analysed using thematic analysis.
Results
Coordinators were pivotal to the success of projects. Challenges to be overcome included: gaining recognition from statutory health partners of the contribution of the lay health model to active ageing and prevention work; achieving sustainability of projects when funders wanted to support new work and, thirdly, the recruitment and retention of volunteers.
Discussion
The complexities of working in a multisectoral environment are identified. Lack of large scale studies, particularly in the UK, made it difficult to convince commissioners of the success of projects. The key contribution of volunteer mentors is in interpreting health information in a way that understands the values and beliefs of the older person, which supports behavioural change.
Conclusions
There is scope for the programme to work more closely with local health partners and volunteers to increase the number of projects. The study shows that involving lay people from their communities to reach their peers with health messages can be successful.
References
Department of Health (2004) Choosing Health: Making healthy choices easier, London: Department of Health. Department of Health (2006) Our health, our care, our say: a new direction for community health services. London: Department of Health.