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'Top-Down' Partnerships in Public Health Have Little Impact  
'Top-Down' Partnerships in Public Health Have Little Impact
Partnerships in public health have little demonstrable positive impact on addressing issues such as obesity or alcohol abuse, according to a new report. Although partnerships are popular as a way of tackling cross-cutting issues, the Durham University study shows there is little evidence to suggest partnerships have any impact on outcomes, and can merely be 'expensive talking shops'.

The findings suggest the constant political and organisational changes are damaging partnership working, and that the coalition government's proposals for significant changes in the NHS and public health pose significant risks, particularly the abolition of Primary Care Trusts.

The research, which included a systematic review of the literature as well as interviews and focus groups with decision-makers and frontline staff, shows partnerships were often seen by the people working within them as problematic, bureaucratic and over-engineered.

The authors of the report suggest there is much to learn from the way frontline practitioners organise themselves to make things happen, without a formal framework.  Partnerships that did work well were those that were set up from the 'bottom up' rather than 'top down', closer to the end users rather than management-led.

Those partnerships were based around delivering on the needs of the service users and constructed from practical necessity, and include frontline workers from the voluntary sector, local authorities and Primary Care Trusts coming together to find joined up solutions to service users' needs and help deliver a more seamless service.

The report, which looked at partnerships tackling obesity, alcohol abuse, teenage pregnancy and smoking, comes at a time of tough public spending and policy changes but with a government's desire to reduce bureaucracy and make partnerships more effective.  Existing health partnerships are due to be replaced by Health and Well-Being Boards from 2012 although early adopters are being established with immediate effect.

In formal partnerships, the findings suggest time investment at the beginning by all involved to make sure everyone understands each other's jargon, culture and objectives is vital.

Lead author of the report, Professor David Hunter Director of Durham University's Centre for Public Policy and Health, said: "A big barrier is the constant political churn which leads to staff turnover or people changing jobs, and in turn to the loss of trusting relationships which is vital for partnerships to work.

"There is also a tendency for each organisation to work in silos, trying to meet its own objectives and targets as their first loyalty is to their own senior management, not to the partnership.

"The findings show that partnerships tend to be very expensive talking shops with people from different organisations, like the NHS and local authorities, talking to each other without fully understanding each other's cultures, language or objectives.  This leads to bureaucracy, inefficiencies and no clear focus on outcomes.  Yet, the government love the idea of partnerships but are they partnerships for the sake of partnerships or do they actually make an impact?  Our results show a re-think is needed."

Responsibility for public health currently sits with the NHS but is due to be moved back to local authorities, where it was located up to 1974.  Professor Hunter, who has observed and commented on fourteen NHS reviews over the years, says this move could be a 'poisoned chalice at a time when local authority budgets are being cut'.

He commented: "On the surface, this seems like a good idea.  The NHS has become  primarily  a 'sickness service' designed to repair those that fall ill and doing little to promote good health whereas local authorities are more focused on health improvement and wellbeing  and in many ways are the natural home for public health.  However, this move comes at a time when local authorities' budgets are being slashed.  It is vital that money for health improvement is safeguarded."

Professor David Hunter is advising the World Health Organisation on its new public health strategy for Europe and was previously an adviser to the Marmot Commission on health inequalities in England. 

Professor Hunter is also a non executive director of the National Institute for Health and Clinical Excellence (NICE) with particular responsibility for public health.  He is author of The Health Debate, a critical review of current health policy in the UK.

This project was funded by the National Institute for Health Research Service Delivery and Organisation programme.

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