Bridging the boundaries? : collaboration and community care, Sunderland 1990-1994
The independence of the health and social care agencies makes the coordinated delivery of inter-related and inter-dependent services very difficult. Collaboration in health and social care has been a goal of policy makers for many decades, but it has not been achieved to the degree or to the extent of the aspiration. This thesis examines collaboration in the context of the NHS and Community Care Act 1990, which marked a new stage in the development of community care policy and in collaborative working between health and social services. The thesis takes the form of a case study set in Sunderland during 1990-1994, from the passing of the Act to the first anniversary of the implementation of its community care elements. It considers firstly, collaboration at a strategic planning level between Sunderland Health Authority and the Local Authority Social Services Department in the development and implementation of community care policy; secondly, the evaluation of a collaborative project at an operational level, in the attachment of a social worker to a general medical practice; and thirdly, the evaluation of a project which tried to strengthen collaborative working within the health service, among district nurses, health visitors and general practitioners. The thesis sets these three pieces of work in a number of contexts: the political setting of the NHS and Community Care Act and the changes it introduced; the literature of collaboration; and a description of Sunderland and its need for health and social care. The case study showed how difficult it is for organisations to work together. Relationships between individuals tended to be more collaborative than relationships between corporate bodies, but it is important to see the relationship between those individuals in the context of relationships between organisations. The study also found that for the success of joint projects to be sustainable and generalisable, collaboration needs to be present at all levels of the organisations. The thesis also showed that there is as much need for collaboration within the health service as between the health and social services. The thesis used as a measure a framework of factors which promote collaboration, and found that many elements were lacking in Sunderland. However, in the real world it is necessary to settle for a notion of "pragmatic collaboration" in which joint working is possible even when full collaboration is absent.