Partnership Working in the British Nhs Essay Example

Partnership Working in the British Nhs Essay Example Partnership Working in the British Nhs Essay Partnership Working in the British Nhs Essay A review by Dr. Ignatius Gwanmesia on how inter-professional partnership working impacts on service delivery (NHS) (2007) Introduction In a utopian scenario, inter-professionalism should reciprocate efficiency in service delivery for service users. However in practice, inherent constraints left unresolved can construe to hinder rather enhance the safeguarding of clients welfare. Service users are experts on their own needs, Smale et al (1993), and they expect and judge the quality of health and social care services they receive in terms of whether they â€Å"help them achieve the outcome they aspire to, and whether these services are delivered in ways which empower rather than disempower them. † Davies et al (2005, 195). Realising these expectations is a factor not only of the user-staff ideologies and value bases but of the model (medical or social) and theories developed by service users Oliver, (1996, p. 31-33). While service users expect staff in joined up working to assist them to address both their medical and social needs, due to multifaceted constraints, partnership working is not readily able to deliver since it can be â€Å"tense and conflictual; a place of strife where members compete for territory and vie for recognition. Davies et al (2005, p. 158). Experience show that holistically the result can be compromised service delivery. To critically evaluate how inter-professional partnership impacts on service delivery, this discourse will start with an attempt to resolve the polarisation in its conceptualisation. The background will trace the evolution of the ideology from a theoretical, policy and practice perspective. The body of the discourse will first analyse those factors that impact on effective partnership; power relationship, empowerment, communication, power relationship and value differentials. Next, will be a critical examination on how the social, legal and political structures in Britain have been instrumental in realising the vision of the ‘Third way’. Next, different codes of practices will be examined to ascertain their effectiveness as instruments for ensuring practice standards. Then using ‘process’ and ‘outcome’ as evaluation criteria, Dowling, (2004, p. 309), the advantages and disadvantages of partnership will be compared. The conclusion will be an objective synthesis of those relevant dialogues developed within the discourse. Finally, the bibliography will alphabetically credit all the references employed within the essay. Definition Inter-professional partnership as developed in New Labour’s quasi-market partnership ideology is devoid of singularity in its conceptualisation. The concept is so highly polarised, Hutchison and Campbell, (1998); Ling, (2000) that different writers use or interchange different terminologies to infer similar ideology; multi-organisational partnership, (Lownders and Skelcher, (1998); collaborative governance, Huxham, (2000); inter-agency collaboration, Hudson et al, (1999); networks, (Kirkpatrick) and inter-organisational relationship and networks, Hage and Alter, (1997). With such visible variance, it is not surprising that Glendinning et al, (2002, p. 3) describes partnership in government circulars and policy pronouncements as, â€Å"largely a rhetorical invocation of a vague ideal. † In consonance, Balloch and Taylor, (2001. p. 6) state that partnership† lays claim to no single definition or model. † Despite this lack of singularity or consensus in its conceptualisation, Tennyson (1998) provides what I consider the most stipulative and appropriate definition for this discourse; a cross-sector alliance in which individuals, groups or organisations agree to work together to fulfil an obligation or undertake a specific task; share the risk as well as the benefits; and review the relationship regularly, revising their agreement as necessary† Tennyson, R. (1998, p. 7) However, from a more political perspective and seeking to clarify and be specific about its objective, the Audit Commission defines partnership as; A joint workin g arrangement where partners are otherwise independent bodies cooperating to achieve a common goal; this may involve the creation of new organisational structures or processes to plan and implement a joint programme as well as sharing relevant information, risks and rewards. † While White and Grove, (2000) perceive, â€Å"respect, reciprocity, realism and risk-taking† as partnership’s four most vital elements†, the Department of Health’s documents focuses on the notion of â€Å"inter-agency working, coordination and a seamless service† DOH, (1998a, 1998b, 1999b, 2000) Background As hitherto developed in the government’s White Paper: Modern Local Government: In touch with the people; local councils and their professionals constituted the primary deciders of the nature and degree of services provided to services user; with the interest of the former being paramount,. DETR (1998, para 1. 10 and 1. 11). During the Conservatives years, fragmentation of service delivery among a variety of agencies resulted in, â€Å"poor performance of many local authority services; and lack of citizen engagement. † Geddes, (1998, p. 8); Martin et al, (1999); Audit Commission, (1998). As a remedial measure, the ideology of partnership in social work and social policy was initiated by New Labour as part of its, â€Å"democratic renewal and modernising agenda to champion new and different forms of decision-masking in public services with a shift from democratic towards partnership and participatory decision making†. Glendinning, (2002, p. 97). In the words of the Labour Prime Minister; â€Å"It is in partnership with others that local governments future lies† Blair, (1998, p. 13). Labour’s objective was essentially to â€Å"build councils which are in touch with their local people and get the best from them. DETR, (1998, p. 6) as agents of the local authority through the social services and related services, social workers inadvertently became proactive professionals in propagating the doctrine and practice of partnership. Labour’s rational in the partnership ideology in welfare delivery was initially conceived and sustained on the argument that rather than decentralisation Increasingly accountability would give the citizen a feeling of Their vision was a service that provided a seamless care, reduce waste and control spiralling cost, increased user’s choice and made services responsive. Although services responded and users choice extended; this state-driven and market-led approach was plagued with; service fragmentation, separate health and governmental budgets, problematic access to information; limited skilled workers; competition rather than collaboration was the norm. Geddes, (1998, p. 18); Martin et al, (1999). Based on the theory that what works is what counts, on gaining power in 1997, New Labour adopted partnership working; kept what worked-â€Å"contracts and primary care shift development and made partnership working central to its ‘Third Way’, Hudson, (1999) The vision was of person-centred; user’s-led; user-controlled service, with competition but collaboration; with a one-stop point for information in multi-format; teams being multi-disciplinary; and workers being multi-skilled. The drive towards strongly mandated official policy requiring interprofessional cooperation especially in child protection â€Å"has developed, partly in response to professional precept and partly in response to a series of Inquiry Criticism of poorly coordinated work in this field† Birchall and Hallett,(1995, p. 241) The Laming report (2003, para 17. 112) into the circumstances surrounding the `death of Victoria Climbie, was significantly responsible for the Children Act 2004 requiring working across traditional service boundaries mandatory in health and social care welfare service delivery. Quinney, (2006, p. ). Similarly, the outcome of the Black report in 1980 and the Acheson report in 1998 into inequality in health were reasons for Labour to intensify the campaign against value difference that resulted in social exclusion. Labour’s answers was summed up in the catch phrase â€Å"joined up problems require joined up solution. † Sullivan and Skelcher (2002) D eterminants of Effective Inter-Professional Partnership. Partnership working can be theorised on power-relationship in which a competent communicator with vision; the ability to empower and team-build, coherently directs members to achieve a common objective. Appropriately and democratically applied, power will empower and protect the vulnerable, enabling the perspectives of even the less capable, less articulate to be accommodated and acted upon. However autocratic or despotic power can lead to oppression and discrimination as typical in professionalism and credentialism where professionals like doctors may adopt a dogmatic rather than pragmatic approach in partnership working. The implication is that in welfare delivery staff need to be reflective so as not to revictimise clients through power misuse or abuse. Empowerment The Issue of Choice. Empowerment was indispensable â€Å"since the government’s commitment to a market system requires potential consumers to have enough information to make informed decisions about their requirements†, Payne, (1995, p. 175). Markets only succeed in advancing competition if there are alternatives to choose from, and choice is only possible if the service user knows about possible alternatives. The government’s Direct Payment to enable users to pay for their own service provision appropriately serves this purpose. However there is reservation as to the comprehensiveness of this measure since the payment is mean-tested. In partnership working the empowerment of clients either directly or indirectly through advocacy to actively participate in their own welfare delivery has primarily been fostered by sociological approaches such as the system or role theories. According to Payne, (1995, p. 178) such theories emphasise the importance of the social origin of many of the problems clients faced, they are not so incline to emphasise clients personal incapabilities, and therefore lead to an assumption of greater equality between the welfare client and staff. An identified constraint in empowering clients especially by social workers is that â€Å"social workers often in reality deal with people’s increasing dependence and this seems inconsistent with empowerment† Stevenson and Parsloe, (1993, p. 22) Where inequality between the welfare client and staff exist on the ground of value or power differentials, there is supposition that service delivery to the former maybe compromised. As will be seen later, empowerment is inextricably linked to effective leadership. Value differentials. The reality about value differences in partnership working is that it is reflective of a British society characterised by an enormous range of ethnic and cultural differences. Consequently, it becomes imperative to accommodate value differences as an asset within the context of valuing diversity rather than perceive it primarily as a liability. Within this context, where a traditional equal opportunities approach in partnership may focus narrowly on those form of discrimination which are illegal, Harrison et al, (2006, p. ) argues that by contrast in welfare delivery partnership, â€Å"a diversity approach regards any form of discrimination whether illegal or not as a barrier to human potential and therefore a problem (oppression) to be addressed. Within setups where social workers have to liaise or collaborate with professionals like medics, issues of image become very apparent. In consonance, Lymbery, (1998) has identified a number of inter-organisational and inter-professional pr oblems with social workers attached to a GP practice based on varying systems of accountability and remuneration. There is social consensus that doctors perceive themselves as occupying a higher professional hierarchy compared to social workers. Analysts are unanimous that contrary to the founding ideology of partnership, this hierarchical relationship â€Å"may be antithetical to the very concept of a team† While not limited to GPs, there is plausible rationale to argue that in partnerships, â€Å"professionals who historically worked in a highly individualised and non-collaborative culture (North et al, (1999); Callaghan et al,(2000) may find effective accommodation of the ideology of partnership problematic. Additionally, in partnership, participants are like ambassadors of their respective agencies, each with different operational; policies which do not allow for comprehensive partnership in practice. Hodgson, (1997); West and Poulton, (1997). At a more inter-professional level, observation by Dalley, (1989) that historical mistrust which constituted a barrier to effectiveness, is a typology of the relationship between social care workers and relevant health sectors. While professional codes of practice and boundaries may be contributory factors, Glendinnning et al, (2002, p. 69) suggest that in a social worker-National Health Service partnership, professionals of the former are perceived by those of the latter as, â€Å"being too slow in responding, unnecessary bureaucratic and overtly concerned with ‘irrelevant’ issues† this was a major point of debate in almost all my group exercises on partnership. The consensual perception is that while professionals like doctors are too narrowly bound by the medical model; facing events or incidences requiring an immediate and short-lived intervention, social workers are like community-liaison mangers constituting part of a homogeneous team involved in a continuous live-enhancing process. In the latter, enhancing independence, anti-discriminatory practice and combating social exclusion are of the essence. In fact is plausible to suggest that to a certain extent, social workers are those left to pick up the pieces after the doctors have left. From the preceding analysis it is apparent that social workers in partnership are more theoretically informed since they need to retrospect, self-evaluate in view to projecting (providing an informed service to improve the future). At client and leadership levels, critical accommodation and respect of value difference will safeguard against either intentional or inadvertent oppression or discrimination; resulting in effective teamship and improved outcomes. Leadership. Rather than elites or autocrats, â€Å"partnership leaders are people who have a vision, they make things happen, at the same time they strengthen and support their followers, inspiring them to trust the leader† Cook, (1996. P12) Effective leaders have mastered the rudiments of reflective power management to communicate empowerment rather than disempowerment and oppression. While some people are said to be born leaders, Dolan and Holt, (2005, p. 97) argue for the need for formal training in leadership skills in the health and social care environment where priorities and pace can change dramatically over a short period with a potential for chaos. This will provide the leader with; Vision- the ability to see a way forward to the desired outcome which may be as simple a prioritising and organising social work intervention so that all demands are met. While welfare delivery may entail complex, multi-faceted and problematic logistics, a good leader is able â€Å"to fin d creative ways of achieving expected targets while keeping the activity acceptable to staff delivering care† DOH, (1991). Vision in partnership leadership means taking external directives since the leader has to work with others beyond their usual work environment. Empowerment- In a heterogeneous partnership where partners have and defend maybe conflicting values, the leader’s ability to work on an individual basis in disseminating knowledge and information will unite and empower the team, resulting in commitment. While empowerment in partnership maybe perceived as lack of managerial control, Dolan and Holt (2005, p. 98) argue that the leader must set and communicate boundaries on what is acceptable standard and behaviour. While this control measure may seem to conflict with the very principle of empowerment, Senoir, (1999, p16) points out that this ensures for stability, respect and security within the decision-making framework. Personally I think unregulated empowerment can be counter productive since not every view is constructive. Team-building. The ability to build and sustain teamship with partnership working is fundamental to being an effective leader since leadership must draw people together, create common goals and encourage a sense of collaboration In giving directions and support to team members, Dean (1995) caution that leaders should recognise their own limitations. In partnership leadership where vision, empowerment and team-build are matched with an equal ability for effective communication, welfare delivery will reciprocate these competences. Effective Communication. Effective communications in partnership constitute the primary medium by which health and social care negotiations take place. This is more so in interaction with vulnerable and maybe disempowered clients who may not be articulate or assertive enough to exercise their right to proactively participate in decisions affecting their lives. Similarly, competence in communication is required under the current market-based care provision system where care mangers have to work with a myriad of agencies in negotiating care provisions. Within leadership, it can be argued that where communication is good and ideas are welcomed, teamship is enhanced. However, at a client level where effective assessment is a function of reciprocal communication competence, Davies et al (2005, p. 191) argue that clients are disempowered since it is not easy to participate on a basis of equality with powerful professionals, when people have spent a considerable period without control over decisions which affect their lives and unable to exercise much autonomy. Similarly, Giddens (2000, p. 286) points out that the sense of identity and values shared by professionals in hospitals, GP surgeries disempower vulnerable clients who become forced to accept compromised services. Holistically, this suggests that client’s welfare in social care deliver partnership is more of a commodity than a right. Issues in Partnership Working. Partnership working and Empowerment in practice As a self-professed enabler, Blair, (1998, p. 3), Tony Blair embarked on his partnership policy by setting up the Social Exclusion Unit (SEU) to help â€Å"improve Government’s action to reduce social exclusion by producing joined up solutions to joined up problem† SEU, (March, 2000) In line with his â€Å"democratic renewal and modernising agenda to champion new and different forms of decision-making in public services with a shift from democratic towards partnership and participatory decision making†. Glendinning, (2002, p. 7), Blair made empowerm ent the focus of his partnership policy. Some important principles of this agenda included; the importance of partnership and participation; the closer relationship between health and social care; and the mixed economy of care reflecting choice and market forces. The National Service Framework (NSF), Single Assessment Programme (SAP), Assessment Framework for Children ad Families were initiated to enable and facilitate the realisation of the partnership objectives. Similarly, professional codes of practice were set out to regulate welfare practice; (UKCC. NMC, GSCC, and BASW) were set out to inform, guide, regulate, discipline, protect and negotiate. Brechin et al (2000). The concern with a surplus of legal instruments and professional codes is that one gets lost in the resulting maze. Moreover they are specific rather than universally applicable. Responding to clients needs meant he establishment of Primary Care Trust (PCT) which made services available at the point of needs to clients. Similarly the creation of Health Action Zones created new ways of working in and with communities and across professional boundaries to address inequalities in health. Quinney, (2006, p. 78). The conflict with these initiatives is that agendum for accessing services is set by staff, creating instant inequality. Even where legal mandate like the Direct Payment Acts is supposed to give clients the control over the type and degree of service received, the decision-making process is vertical with client being given what the staff deem appropriate rather than horizontal where provisions are need-led. Labour’s quest to improve quality standards in partnership working is exemplified by the multi-faceted joined up working between the Department of Health with; â€Å"the Strategic Health Authority, the Commission for Social care Inspection (CSCI); NHS Modernisation Agency and the Social Care Institute for Excellence to identify and spread best practice. Quinney, (2006, p. 61). Similarly, the National Institute for Health and Clinical Excellence (NICE); Social Care Institute for Excellence (SCIE); Commission for Health Care Audit and Inspection and General Social Care Council, Quinney, (2006, p. 2) provide national guidance on the promotion of good health and the prevention and treatment of ill health. Specific to social work and nursing respectively the GSCC and NMC ensure that welfare deliveries by their staff are consistent; legally and ethically complaint. The main criticism of these initiatives is that practice may become too restrictive and dogmatic at the expense of ref lexive practice. Values and ethics in partnership working. Codes of Practice) Generally, legal instruments like the NHS Community Care Act 1990 and Children Acts provide directives to welfare staff. However, within social work and the nursing professions where the vulnerability of clients and the potential for power abuse is acute, the General Social Care Council (GSCC) (2002); and the Nursing and Midwifery Council (NMC)(2004) set out professional standard and informs the public, other professions and employers of the standard of professional conduct that they can expect of staff. In keeping with the partnership working ideologies, empowerment is central in these codes, emphasising respect of uniqueness or diversity, the confidentiality of patients data except shared solely on a need-to know basis, Baker, (19954, p. 74); anti-discrimination, anti-oppression, mutual respect and right to informed choice; partnership collaboration, openness and transparency; fairness and equity in practice. The problem with codes of practices is that different agencies have different codes, with the potential for conflict in logistics in care-planning and service delivery. For example in situation of domestic violence involving children, the police may view it as a criminal issues as opposed to the social worker who will rather approach it as a social problem requiring social support. Also, conversely to clients, staffs are much well-briefed about the details of the processes of welfare delivery. Evaluating partnership working. (Advantages and disadvantages) The problem with evaluating partnership issues is that the concept is a social construct; Balloch and Taylor, (2001. p. 6) and lacks a bench mark for its own evaluation. While opinions about the usefulness of partnership is highly polarised, when evaluating outcome, process-wise, Labour’s diligence in organising partnership training, initiating relevant legal instruments and structures including the increasing moves to empower clients are reasons-enough for qualified compliments. Holistically, effective partnership as in the commissioning of services in a complex and multiple-needs situation is ideal in focusing the energies and resources of different agencies on a common problem. Well-managed, Harrison et al (2003, p. ) points out that this would enable a coherent and holistic approach to complex, cross-agency problems. Within a social climate of diminishing finance and resources, partnership as in the Single Regeneration Budget (SRB) may provide access to financial support. Similarly sharing of scarce resources can be easily negotiated. The one-stop pooled-budgets system has not only reduced bureaucracy but has extended the Care Management p rinciples across a wider field to enable the purchase of a wider range of care packages. â€Å"People said they wanted to take more control of their own health and well-being† DOH (2006, p. 3). In community care services, the supposed empowering answer was Direct Payment; â€Å"a way of people who need support to have more control over the services they receive† DOH, (2006, p. 16). The vertical rather than horizontal decision-making process involve in this arrangement is dogmatic not pragmatic as befits democratic decision-making in democratic partnership. Moreover how does one actually define needs? PCT have brought services closer to the point of needs, although agendum on surgery timetable and means of service delivery maybe beyond client’s control. Similarly, the risk of taking responsibility is shared. However, while service users may be empowered, comprehensive participation is problematic since most clients may not be competent-enough to benefit from empowerment. Despite the advantages of partnership working, criticisms of its outcome are increasing. In a staff-user partnership working, professionals like doctors who historically worked in a highly individualised and non-collaborative culture (North et al, (1999) may find comprehensive accommodation of the ideology of partnership problematic. Whether using the ‘process’ of partnership or its ‘outcome’ to evaluate its effectiveness, opinions about user’s satisfaction is highly polarised. At the root of this is the fact that in a multi-ethnic and complex British society, welfare clients and staff hold, respect and defend different conflicting values that constraint comprehensive partnership collaboration. Moreover, there are doubts as to whether clients are comprehensively aware of their role or entitlement in the partnership framework. Similarly, while the superfluity of legal instruments, practice codes and local community partnership strategies could be excused for the government’s enthusiasm to justify its mandatory partnership working for agencies in welfare delivery, the Audit Commission (1999) report expressed concern in the enormous growth of partnership work. It reported that; â€Å"In some areas so many of these structures have been set up that the water are again muddled, and it becomes unclear how overlapping partnership and strategies actuality fit. Audit Commission, (1999, p. 57) Within the quasi-market social care partnership, where professionals like doctors have become share-holders, the need to minimise cost means that services users are either intentionally or inadvertently not informed about the availability of relevant services. In 1999, â€Å"doctors admitted that cancer patients are not told of all the treatment available because there is not enough money to pay for the drugs required † Kirby et al. , (2000, p. 62) Similarly, the tendency to fast-tract the discharge of patients from hospitals to free up beds may be informed by capitalist ideologies whereby, the Care-Management system is helps in managing the crisis of capitalism through targeting, and rationing in healthcare. Moreover any welfare arrangement system based on a market ideology may not necessarily create a user-led partnership working Critical appraisal of factors affecting partnership working. As hitherto established, defining partnership with specificity is inherently problematic. Balloch and Taylor, (2001. p. 6). The analogous fact that due to a myriad of constraints, â€Å"making partnership work effectively is one of the toughest challenges facing public sector managers† Audit Commission, (1998, p. 5); BCC, (2001a, p. 13); Labour party, (2000, p. 14), compels me to question whether the pursuance of partnership is a case of the ‘indefinable’ pursuing the ‘unachievable’? Glendinning et al (2002, p. 2), whether in social work or policy practice. Because partnerships involved distinct statutory services, each constrained by their respective policies; codes of practice and financial limitations, effective integration in partnership is prevalently relative rather than comprehensive. In fact it would not be farfetched to infer that the seeds of its ineffectiveness are embedded in its very concept. Furthermore, where effective collaboration is of the essence, there is bound to be contestation and conflict resulting from the social constructiveness of the concept of teamwork in partnership; whether integrative; directive or elective. Freeman et al. , (2000). Irrespective of the lack of consensus and ambiguities, Glendinning, (2002, p. 100), associated with discourses and practice in partnership, the imperative for councils to re-engage with the communities they serve and the equal obligation to embrace the community governance agenda is ensured by a Prime Ministerial Ultimatum. Blair, (1998, p. 22) According to Glendinning, (2002, p. 100) â€Å"local government must modernised or perish. In New Labours â€Å"intermediate or network form of organisation†, Clarence and Painter, (1998); Exworthy et al, (1999) Powell, (1999a); Rhodes, (2000) the quasi-market-led ideology predispose its practice to conflict of interest as the quest to maximise profit does not necessarily create a service with service-users needs as the paramount determinant of practice. In the government’s Care management system where social workers serve as managers in negotiating care services, bureaucracy and budget management rather than clients interest was the primary beneficiary. Moreover where partnership is perceived as empowering service users and their backing agencies, sociologist argues that the prevalently bottom-up approach â€Å"cannot simply be imposed on, or parachuted into areas. † Powell and Exworthy, (2001). While the euphoria for conformity and embodiment may inadvertently compel agencies to apply the ideology irrespective, there is plausible reason to be concerned about the rights and autonomy of the voluntary and community organisations. At a micro level, and as evident in the Victoria Climbe child abuse saga, where professional discrimination diminish collaborative partnership between the medics and social workers, there is need to statutorily qualify the status of the latter if they are not to become invisible. In fact, with partnership being such a fluid ideology coupled with â€Å"the potential for ambiguity and misunderstanding, Harrison, R. et al. , (2003 p. 5) agencies’ interpretation and implementation of related objectives are unavoidably inconsistent and contextual. In practices, producing positive result in partnership is not the outcome of diligent professionalism or cones. Conclusion While there is consensus about the social constructiveness of the ideology of inter-professional partnership in the NHS, this discourse has established that effective partnership working is a synthesis of effective power management, democratic leadership; communication, empowerment and the valuing of value differences to achieve a common objective. Although Labour’s partnership processes are well-structured and managed, outcome are highly polarised. Similarly, while the benefits of New Labours’ ideology of partnership may be highly disputed, research evidence show that, â€Å"even if adherence to such principles does not itself guarantee effective, efficient and appropriate intervention in service delivery, ignoring them is likely to diminish the sharing of professional information and expertise, a wider scope for accessing resources and financial support, the sharing of risk and providing service users with a wider choice. Additionally, where efforts to demystify the ideology of partnership is not founded on theories established through systematic approaches and methodologies, intervention outcomes are bound to experience reciprocal consequences. Therefore for partnership to accomplish it founding objectives, achieving a stipulative definition should be accompanied in practice by the development of â€Å"mutual trust and respect based on a clear understanding of the different skills that different professionals have to offer. † Gledinning, (2002, p. 8) More so, while different legal instruments, codes of practices and ethics may seek to enforce partnership ideologies, it is acknowledging the reality that the heterogeneity of partners (values) in partnership renders comprehensive partnership, one of the toughest challenges facing public sector managers† Audit Commission, (1998, p. 5); BCC, (2001a, p. 13); Labour party, (2000, p. 14). In inter-professional partnership, a reflexive approach i n practice will go a long way to resolving and safeguarding against oppressive relationships. At a positive level, preceding analysis is indicative that effective partnership has resulted in â€Å"information sharing and reduced bureaucracy; improved inter-professional relationship. Pithouse and Butler, (1994); Stannard, (1996); Ross and Tissier, (1997); Tucker and Brown,, (1997). At a personal level, it constitutes an appropriate and effective venue through which the continuous process of upgrading the social work competence of working in an organisation is sustained. Bibliography. Audit Commission (1998) A fruitful partnership: Effectively partnership working. London: Audit Commission. Balloch, S. and Taylor, M. (eds) (2001a) Partnership working: Policy and Practice. Bristol: The Policy Press. 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Journal of Inter-professional Care, vol. 11, no2, p. 205-216 White, K. and Grove, M. (2000) Towards and understanding of Partnership, NCVCCO Outlook. Issue 7. Appendix One. Concept of Teamwork in Partnership. A directive philosophy is based on an assumption of hierarchy, where one professional occupies a position of leadership and is responsible for directing the other team members. An integrative philosophy places much greater importance on collaborative activities and on team membership, with the contribution of each professionals being equally valued. An elective philosophy is adopted by professionals who prefer to work autonomously and only involve other professionals if need be. This is more of a system of liaison