the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Case Study - "We won’t ever backbite'
'We won’t ever backbite': overcoming conflict in joint work with people with learning disabilities
This partnership is about introducing a joint assessment and care planning procedure for people with learning disabilities living in XX borough.
There were four parties:
1. the service users
2. a specialist team of social workers working with people with learning disabilities
3. a specialist health team, of physiotherapists, occupational therapists, speech & language therapists, clinical psychologists, a community nurse
4. a group of people known as the Challenging Needs Service, who do behavioural psychology with people with learning disabilities.
There were serious conflicts between all the professional groups
People in this case:
June, a specialist worker in the Community Trust:
Linda, a manager in the Mental Health Trust:
Shelley, managing a team in the Community Trust
Miles, the Social Services Team Manager:
Mary, the Joint Commissioner, who came into the scene later. The others have all
commented on the changes she introduced.
The Service Users' Group give their views on how they are involved in policy and planning ,
as well as some comments on their experience of services.
Dawn, the Facilitator for the Users' Group explains her role.
Read or download a PDF of all the stories in this case study.
researchers' Commentary
Strong hostility and negative emotions
This story is about a partnership between health and social care organisations working with people with learning difficulties. The relationship between professionals was initially very hostile with strong negative emotions of one party to another. Indeed, one person wrote up on the office whiteboard, "I ache with hate" after a joint meeting, and left it there in the office. Inter-group relations between health and social care appeared to have followed the pattern that Schein identified in his work with groups of boys: each side had stereotyped the other, and from their experience of the other side, had looked for or selected 'evidence' that reinforced their existing negative view.
Strategies of the new leader
A new person came into this scenario as Joint Commissioner, working to both health and social services, at a senior level. Her approach enabled all parties to work together in a different way. She had a clear message: users come first. What is striking about this case is that all parties were agreed on the clarity of her leadership. Even Linda, who is concerned about 'working jointly for jointly' sake' has a grudging respect for the authority of the Joint Commissioner.
The joint commissioner’s strategies for overcoming conflict and hostility have included:
Clarity within complexity
From an external perspective, the complexity of the partnership structure is striking [see diagram for a simplified structural version]. It is almost impenetrable for outsiders. It involved a social services department, an acute and a community trust, working in different ways across several boroughs. Any user would find this confusing. The Joint Commissioner was outstandingly clear: she provided a point of reference to enable people to handle the complexity. That point of reference was the users. She reduced the complex multi-partner context and history of hostility to simple rules. She moved away from blaming, and was not interested in this history, while not accepting' bad behaviour'.
Widening the circle: 'this isn’t tokenism'
The Joint Commissioner 'widened the circle' and set up a Forum attended by representatives of the new User Group and a wide range of others. She ignored the history, but made sure that everyone knew the policy imperatives for the future, linking to the 'big issues' such as users have maximum autonomy in their lives. Users with learning disabilities were involved in policy, not just consulted as consumers. The Users' Group talked about the JIP (Joint Investment Plan) , and knew it related to how to spend the money for the whole year. One worker said: 'We consulted with the Users' Group about the Primary Care Trust (PCT). It is the first time I thought, This isn’t tokenism. They were actively engaged, whatever their ability.' The voluntary sector was also involved in creative ways, for example, a cycle group could link with physiotherapists to design special bicycles : 'Our world has expanded beyond statutory services - it's incredibly liberating,' said one worker.
Generic and specialist – managing the paradox
Partnership does not mean doing away with specialist knowledge. Each group had particular skills and experience to contribute which was acknowledged.
Equal partners?
The Joint Commissioner also raised the issue of equality within the partnership. 'Are you an equal partner if you bring nothing to the table?' Is it only money that brings influence in joint decision-making? A recent study of partnerships in the Strathclyde area found that powerful organisations needed to collaborate with vulnerable ones because the smaller organisations had something that the former could not provide.
Taking learning from the partnership back to participating groups
There has been a real opportunity to take learning from the Partnership Forum back to the groups who make up the partnership. Cameron and Cranfield refer to this in their three circles of partnership: the action, the process of the partnership, and taking learning back. The idea of making mainstream services appropriate for adults with learning disabilities is one that is gradually gaining ground.
Read or download a PDF of all the stories in this case study.