1. What does Partnership Working Mean?
Session 2 -
What does Partnership Working Mean?
Facilitator notes
Welcome people back to the training session
Check people have signed in
Introduce facilitators to the group
Inform the group of fire and safety issues (found in the PHRC folder) as appropriate
Introduce the topic to be covered today
Give out presentation handout (give the notes handout at the end of the session)

2. Ground Rules
Listen to others and value the diversity of opinions in the group
Be constructive
Value the differences; there are no rights or wrongs, no good or bad
Be open and honest, keep to the agreed time, especially start and finish
Mobile phones!
- (extracted from, Working with Groups. General Improvement Skills. Modernisation Agency)
Facilitator Notes
Read through the slide - remind the group of the ground rules (they are the same ones as was introduced on the first session so participants have seen them before and previously agreed to them)

3. Recap on Previous Session
Facilitators Notes
Go through over view of previous session – see below as a reminder to you what the content was:
Explore the concept of health and different models of health
Discuss the history of public health
Identify what are health inequalities and discuss the influence of public health policy within the ‘New Public Health’
Explain how public health attempts to tackle health inequalities
Explore how public health can be implemented into professional practice
Any questions about this previous session?

4. Objectives of Session To understand what partnership is
To understand the importance of partnership working
To understand the theory of partnership
To identify barriers and opportunities of partnership working
Facilitator Notes
Read through the objectives on the slide

5. WHY DEVELOP PARTNERSHIP WORKING
Living and working conditions
Unemployment
Work environment
Water & sanitation
Education
Health care services
Agriculture and food production
Housing
Age, sex and constitutional factors
WHY DEVELOP PARTNERSHIP WORKING
“Joined up problems require joined up solutions” (New Labour statement) 2.

6. Health Policy Drivers – For Partnership Working
Health of the Nation (1992)
The NHS Modern and Dependable (1997) – “The demolition of the Berlin Wall”
Jakarta Declaration (WHO 1997)
Tackling Health Inequalities ; A Program For Action (2003)
Wanless (2001)
Choosing Health (2004)
Our Health, Our Care, Our Say (2006)
Notes for Facilitator and handouts
Read through the slide (notes below are provided on handouts)
The Health of the Nation (DoH 1992) - 1st attempt at a national strategy for health requiring the participation of a wide range of agencies at local and national level. Criticised for focusing on the disease not underlying causes.
Jakarta Declaration (WHO 1997) - identified the current change as that of releasing the potential for health promotion in different sectors and at all levels of society. Breaking down barriers between sectors and creating partnerships for health was seen as essential.
The NHS Modern and Dependable (1997) – initiated the reliance on partnership working but many other New Labour documents followed suit and partnership working was one of the governments major goals. “The demolition of the Berlin Wall -… So that patients get swift access to care and treatment” relates to a statement by Frank Dobson relating new joint working for health care as “integrated care” as part of governmental policy around restructuring service delivery.
Tackling Health Inequalities ; A program for action, DoH (2003) - “Delivering change will require active partnership at local, regional and national level”. This was illustrated with the development of ‘Local Strategic Partnerships’.
Wanless (2001) - in his review of health services described how for real changes to be made in the health of the nation a joint commitment between all sectors was required and therefore recommended an increase investment in all public health services was required to deliver an improved health of the nation and reduce health inequalities.
Choosing Health (DoH 2004) - The importance of partnership working is identified within Choosing Health who describes partnership working of one of the DoH 3 key principles in delivering Choosing Health and to improve healthy choices the involvement of many partners is required. The principles of partnership was chosen following a public consultation in which many respondents commentated on the need for more effective working together. By working together a ‘seamless service’ was proposed to be developed to the obvious benefit of the service user.
Our Health, Our Care, Our Say (2006) – “We are also increasing the opportunities for partnership between local authority, the NHS and the 3rd sector to support new approaches to care, and to tackle the inequalities in provision, and in outcomes, that persist in many areas. Some 70% of PCT boundaries are now coterminous with local authorities, offering real opportunities to strengthen partnership in many areas”

7. (Trevor Hopkins, Gateshead PCT)
“A lot of people who work in partnership continue to act as individual organisations and deliver pieces of work separately but they have meetings and call it partnership working…What we’re moving to...is more of what we call a virtual way of working, where you don’t see the organisational boundaries at all.”
(Trevor Hopkins, Gateshead PCT)
Facilitator notes
Read the quote out to the participants and then ask anybody if they have any questions or comments

8. Why do we work in partnership? What makes partnership work?
Group Work
Why do we work in partnership?
What makes partnership work?
Facilitator Notes
Divide participants into groups
Ask them to make two lists
Exercise should take twenty minutes
Ask for feedback
Ensure that the lists include the following
Why?
Pool resources, avoid duplication, maximise impact, more skills and knowledge, more innovation, more involvement by communities, increased efficiency, more negotiating power, more equitable services
What?
Clear purpose, shared vision, trust, respect, good communication, respect for partners – acknowledgement of role in partnership, good communication – clear and consistent, ensuring an effective means of making decisions and accountability, joint working, eliminating boundaries, commitment at senior level, decision making by consensus, effective meetings, balance of cost-benefit and responsibility between partners, identifying the necessary skill mix, understanding of organisational cultures and mechanisms, achievable outcomes and timescales, regular evaluation, shared budgets

9. What makes partnership work- in summary
Values
Delivery mechanisms
Facilitator notes
Use this slide to summarise the previous group exercise that what we are talking about is values and delivery mechanisms in order for partnerships to work

10. COFFEE
Facilitator notes
Coffee break 20 minutes

11. Types of Partnership working
Partnerships
Multi-agency
Inter-sectoral
Inter- or multidisciplinary working
Teams
Facilitator Notes and handout notes
Go through with the participants the following information
There are many different terms that are used to describe the ways that people work together to promote health. Although these are often used interchangeably it is possible to distinguish between them:
Partnership – As previously discussed this refers to joint action between partners (national and local agencies and the public). It implies the equal sharing of power between partners and the setting out of mutual responsibilities
Multi-agency – refers to organisations that belong to the same sector such as health, social services, or education who are all statutory providers of public services
Intersectoral – goes beyond any one sector and may include public, private (business and commerce) and voluntary groups
Inter – or multidisciplinary working – is sometimes used to describe joint working of people with different roles or functions within the same organisations or across sectors.
Teams – usually have a common task and are made up of people chosen because they have relevant expertise. They may be multidisciplinary such as a primary health care team or a team who work in the same organization or they may be interagency such as an HIV team child protection team.

12. Potential Barriers to Partnership
Group work
Potential Barriers to Partnership
Think of some ideas on how to overcome these barriers
Facilitator notes
Divide the participants into groups and ask them to make two lists
This exercise should take twenty minutes
Ask for feedback
Ensure the lists include the following
Lack of commitment at a senior level, differences in outlook, professional rivalry / perceived imbalance in power, lack of appropriate skills, lack of shared/achievable goals, different organisational cultures, different geographical boundaries, confidentiality, funding/imbalance in the contributions to resourcing , loss of key staff, changing political agendas, clarification of roles, conflicts of ownership, unreal expectations, unrealistic time frames, poor information exchange within and outside the partnership

13. The Ladder of Participation
8. Child-initiated shared decisions with adults
7. Child-initiated and directed
6. Adult-initiated shared decisions with children
The Ladder of Participation
eg with children
Degrees of participation
5. Consulted and informed
Facilitator notes
AS the facilitator goes through the rungs of participation ask the participants their opinions, experiences and what they think are the barriers to always working at level 7/8
Go through the ladder having a discussion with the participants what each rung on the ladder means in practice with children (facilitators can if they wish exchange this example of working with children for another example)
Manipulation --- the aim is cure or educate the participants. The proposed plan is best and the job of participation is to achieve public support by public relations. Happens where adults for example use their service users or children, young people and parents/carers to support causes and pretend that the causes are inspired by young people.
Decoration --- children, young people and parents/carers are used to help or bolster a cause in a relatively indirect way, although adults do not pretend that the cause is inspired by young people.
Tokenism -- users appear to be given a voice, but in fact have little or no choice about what they do or how they participate. Can be called “Informing” And can be seen as a most important first step to legitimate participation. But frequently the emphasis is on a one way flow of information. No channel for feedback
Assigned but informed -- This is where users are assigned a specific role and informed about how and why they are being involved.
Consulted and informed--- happens when children, young people or parents/carers etc give advice on projects or programmes designed and run by adults. And they are informed about how their input will be used and the outcomes of the decisions made
Adult-initiated shared decisions with children --- Decision making shared decisions. Also known as Partnership where power is in fact redistributed through negotiation between children/volunteers and power holders. Planning and decision-making responsibilities are shared
User-initiated and directed – This step is when children, young people and parents/carers for example direct a project or programme. Adults for example are involved only in a supportive role
User-initiated, shared decisions with adults --- This happens when projects or programs are initiated by children, young people and families and decision-making is shared between users and adults. These projects empower service users while at the same time enabling them to access and learn from the life experience and expertise of adults
4. Assigned but informed
3. Tokenism
2. Decoration
Non-participation
1. Manipulation

14. Group Exercise
Decide on a piece of work someone in the group has been involved in.
What rung is it on?
Why did you decide it belonged there?
What are the barriers to moving it up the ladder?
Facilitator notes
Divide the participants into pairs/threes
Ask them to think of an example
Put answers on flip chart
Exercise should take 10 minutes
Ask for feedback

15. Group Exercise Think of a partnership you want to develop
Think about what partners you will need
Think about the values and delivery mechanisms you will need to develop in order to develop an effective partnership
Begin to develop an action plan - looking at the steps you would need to take to develop a partnership eg. engagement, planning the first meeting and the first outcomes you would wish to happen
Facilitator notes
Divide the participants into groups – larger groups if possible
Clarify there are four points to this group work and we want a few points for each
Exercise should take twenty minutes
Feedback may be limited to a couple of comments (due to time restraints)