From partition to partnership Managing collaboration within a curative framework for NHS care

摘要

Purpose - Seeks to review policy and practice in the English National Health Service (NHS) to show the extent to which medically framed notions of cure act in opposition to attempts to enforce a duty of partnership in the delivery of health and social care. Design/methodology/approach - A review of national policy and the relevant academic literature, spanning two decades, was used to examine the development of inter-organisational relations at the boundaries of health and social care in England. Findings - The paper finds that, despite an espoused willingness on the part of national and local stakeholders to remove long-established disciplinary and organisational partitions between sectors, the failure to secure a shift from medically to socially constructed notions of health continues to impede more integrated care. Furthermore, policies emphasising patient through-put, speed of treatment, episodic intervention and the primacy of hospitals are shown to encourage and empower health professionals to withdraw from cross-boundary working in line with the isolating tendencies of bio-medically framed notions of cure. Originality/value - The paper draws together evidence from policy, research and theoretical literature to identify the underlying causes of collaborative failure, highlighting the manner in which associated processes of public service reform can serve to reinforce long-established institutional barriers to inter-organisational working, both now and in the future.