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eleven - ‘Healthy’ networks? NHS professionals in the child protection front line
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
This chapter concludes our examination of the operation of provider networks in child protection. Its aim is to illuminate the experience of collaboration on the part of the main health professional groups engaged in child protection work at the front-line level. Studies of interprofessional and multiagency cooperation have tended to stress notions of ‘reciprocity’ and ‘consensus’ and have typically under-emphasised the factors that may operate to impair effective collaboration. One reason for this relative inattention to conflict is the way in which the network is conceptualised. Approached metaphorically, the idea of ‘networks’ suggests an interconnected web of well-established relationships, ”… a smoothly interlocking system of reciprocal roles” (Whittington, 1983, p 268). The focus of analysis is thus typically on the composition or structure of this relationship system. Attention to the dynamics of interprofessional networking, however, rather than to their formal structure, is also important and may reveal a number of underlying conflicts or tensions. As much as the conditions of reciprocity, the areas of tension may be instructive in explicating the day-to-day operation of a particular network.
To understand these dynamics we have argued the relevance of Benson's (1975, 1983) model of the ‘interorganisational’ network as a mini ‘political economy’ (a series of mutual resource dependencies) operating within a wider political economy (the relevant policy sub-sector/sector). Within networks, effective collaboration will hinge on the degree of equilibrium obtained across four dimensions (ideological consensus, domain consensus, positive evaluation and work coordination). Factors both internal and external to the network, however, may operate to disturb this equilibrium on any or all of its key dimensions. These may be the result of sub-structural elements (wider organisational/professional imperatives) affecting the internal balance of power and authority. Or they may be external, resulting from the links of member groups/organisations to power relations within the wider policy sector or society more generally. For Benson, three possible states of disequilibrium may follow:
• forced coordination (high on work cooperation, but low on domain or ideological consensus and positive evaluation);
• consensual inefficiency (low levels of work coordination, but strong on domain and ideological consensus and positive evaluation);
• evaluative imbalance (high on work cooperation and strong on domain and ideological consensus, but low on mutual positive evaluation).
one - Models and metaphors: the theoretical framework
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
The idea of policy networks assumed growing importance in the public policy literature of the 1990s. Defined as “(more or less) stable patterns of social relations between interdependent actors, which take shape around policy problems and/or policy programmes” (Kikert et al, 1997, p 6), the concept emerged originally in the US in the early 1950s as a critique of pluralistic explanations of political decision making. Pluralist theory posits a (more or less unlimited) number of groups competing (with more or less equal degrees of influence) for the attention of a largely disinterested state. Network analysis in contrast argues that a small number of groups enjoy a privileged relationship with the state at the expense of other interests. The approach was given particular form in the concept of ‘iron triangles’: a metaphor for the symbiotic relationship seen to exist between policy makers, government agencies and selected interest group(s) within a particular area of policy making (Peters, 1986).
As well as being distinct from pluralist analysis, network theory also differed from the other main model of interest group representation: corporatism. Unlike pluralism, in which all pressure groups are seen to have a roughly equal ability to influence the policy process, corporatist theory highlights the privileged role of certain, selected groups. Because of their key role in society, these groups have a ‘representational monopoly’ (Schmitter, 1979) that is recognised, licensed or created by the state. In the UK, for example, corporatism described the relationship between the state and the organised representatives of ‘capital’ and ‘labour’ that characterised the development of economic and industrial policy in the 1960s and early 1970s (Cawson, 1986). Despite obvious similarities to their own approach, policy network theorists such as Marsh and Rhodes (Marsh and Rhodes, 1992; Rhodes, 1997; Marsh, 1998) argue that the corporatist model may only be applicable in certain contexts. Policy making is more complex than the corporatists suggest. Rather than taking a ‘monolithic’ view of policy making, which sees all areas of government policy dominated by the same powerful groups, Marsh and Rhodes argue that it is important to “disaggregate policy analysis” (Marsh and Rhodes, 1992, p 4) and examine the particular forms of interest group representation that characterise specific policy areas.
five - Power and politics in the NHS
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
Before examining the role of NHS managers and professionals in child protection networks, it is important to gain an understanding of the evolving politics of the NHS. As a near monopoly provider of health care in the UK, the NHS is the principal, though not the sole, ‘field of action’ for the health policy network. In this network, according to Wistow (1992), the medical profession has played a significant and enduring role. However, the stability of the policy community has been subject to challenge in recent years as Conservative and then Labour governments have attempted to gain greater control over the direction of NHS policies and in doing so have redefined relationships between the state and the professions. As the Benson model indicates (1975, 1983), this shift in external power relations has affected the balance of power within the policy community as well as relationships between elements within the medical profession.
In addition, the devolution of service planning to the local level increases the potential for a more plural process and raises the prospect of local issue networks. In Benson's terms, these may involve the participation of both ‘demand’ or ‘support’ groups. The greater number of constituencies to be served may encourage more overt forms of political activity, including between professional interests, as they ‘jostle’ for position. This chapter will explore these changes in so far as they may impact ultimately on the operationalisation of child protection policies. It will also examine the governability of the NHS and, in association with this, the changing relationship between the state and the professions. The ability of governments to implement health policy will be discussed in relation to changing centre–local relations and, in particular, the compliance of key professional groups. The role of the health professions will be explored, as will the place of the ‘silent citizen’ in NHS politics. While concluding that the medical profession, and increasingly general practice, still exerts considerable influence within the health policy community, it appears that the state has succeeded in exerting greater control over the profession as a whole. The state–medical profession dynamic is, however, only one consideration in local provider networks. The interagency and interprofessional politics within networks are contextualised by the firm regulatory steer of the centre.
seven - A system within a system: the role of the Area Child Protection Committee
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
The Area Child Protection Committee (ACPC) is a joint forum comprising representatives of a wide range of agencies and professional groups working together in child protection. Its central role is to underpin interagency collaboration by developing, monitoring and reviewing local policies and procedures. Functioning as a middle layer between the broad frameworks of central government policy and the specific protocols of local level practice, the ACPC has been described as a ‘system within a system’: “… the co-ordinating body of the local child protection system … operating within the external ‘system’ of government child protection policy” (Sanders, 1999, p 264). As such it can be seen as a central mechanism for delivering the mandated coordination of local child protection networks.
As we have argued, the achievement of ideological/domain consensus, effective work coordination and mutual positive evaluation between participants are important prerequisites of effective interagency cooperation. We have seen in earlier chapters how these ‘superstructural’ attributes can be affected by different organisational imperatives surrounding network participants (sub-structural factors). Threats to collaboration on the above dimensions may arise from tensions deriving from any or all of four central aspects of those agencies’ wider objectives: fulfilment of central service delivery requirements; maximisation of public support/legitimacy for the service agenda; achievement of orderly and reliable patterns of key resources; and defence of operational paradigms (the ‘technological–ideological commitment’ to certain ways of working). As Benson argues: “Consensus between agencies on matters of domain and ideology can … only occur within limits set by their market positions” (1975, p 237). Within a multiagency forum like the ACPC, the wider interests of participating organisations may constrain not only the representatives’ ability to make certain decisions (especially if they carry financial implications) within the ACPC, but may also affect the implementation of any ACPC decisions at operational level.
The following section will describe the composition of the ACPC, exploring in particular the extent and nature of participation by health managers and professionals. After examining changing government expectations surrounding ACPC operation, the chapter will assess the extent to which it is able effectively to operate as a mechanism for mandated coordination within the local child protection process.
Index
- Carol Lupton, Nancy North, Parves Khan
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Acknowledgements
- Carol Lupton, Nancy North, Parves Khan
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Contents
- Carol Lupton, Nancy North, Parves Khan
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four - Accountability, agencies and professions
- Carol Lupton, Nancy North, Parves Khan
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Introduction
In the preceding chapters we have favoured Benson's ‘interorganisational’ approach as potentially the most helpful in explaining relationships within child protection networks (1975, 1983). We argue that his insistence that these relationships, theorised in four interrelated dimensions (domain consensus, ideological consensus, positive evaluation and work coordination), are not context-free but are rooted in ‘sub-structural’ influences, fits well with empirical evidence concerning provider networks in child protection. Benson's theory, however, is relatively silent on the role of the state in orchestrating policy implementation or in defining the parameters of acceptable practice surrounding interorganisational cooperation. In the case of child protection provider networks, the state's ‘presence’ relates most obviously to the dimension of work coordination (via regulatory and performance frameworks) although this is also mediated by the attributes of the three other dimensions. Benson's particular contribution, the identification of sub-structural factors (external power/interests and/or the motivations of ‘parent’ organisations) as determinants of the superstructural level, is germane to this chapter's focus on accountability. We suggest that the differing ability of provider agencies and professionals to resist the state's regulatory capacity (in both democratic and managerial forms) is important in understanding their engagement in child protection processes and that this can be explained with reference to substructural elements.
Network theory as proposed by Rhodes and Marsh (1992; Marsh, 1998) is of limited help since it focuses on ‘meso’ or ‘apex’ level relationships. The participation of professional groups in the core policy community assumes their members’ support for the decisions they make. This arrangement, however, is insufficient to explain the failures or success of policy implementation, as regulation by explicit rules and guidelines also shapes policy at the level of practice. However, these mechanisms cannot be taken for granted. They are both fallible and at times contradictory, as agencies and professionals have different interests and obligations. In the case of professionals these obligations may variously be to the employer (for example, a trust), agency (NHS or local authority), profession or society. As there are clear differences in the susceptibility of different professions to the regulatory state, it is important to explore the complexities of accountability, its functionality to the modern state and the reasons why different accountability frameworks operate for different professional groups.
nine - Sleeping partners: GPs and child protection
- Carol Lupton, Nancy North, Parves Khan
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Introduction
General practitioners’ (GPs’) contribution to child protection is viewed as critical but the record of their performance is patchy. Research exploring the reasons for this suggests a number of factors are brought to bear, ranging from workload pressures and the inconvenient timing of meetings to some more fundamental concerns about GPs’ perceived marginality of their role and issues relating to confidentiality. These rationalisations are worth exploring at greater depth, since they may also reflect the more fundamental dynamics of how GPs conceptualise their core role, and of the wider political agenda for general practice within the NHS.
While operating from a position of relative managerial autonomy, and therefore isolated from the regimes which increasingly govern the activities not only of the semi-professions but also hospital clinicians, GPs have been increasingly involved in service planning and exposed to the competing priorities of the health service. This chapter will argue that the low priority GPs currently accord to child protection work is an inevitable consequence of the profession's model of practice. It will also be argued that child protection's absence from current priorities for joint working between health and social care, and its resulting displacement to the periphery of health care ‘business’, have restricted the responsibility for child protection to a few, key personnel. In terms of Benson's model, there are insufficient ‘resources’ (money or authority) to attract the profession to participate in child protection networks as well as a number of ‘superstructural dissonances’ inhibiting collaboration.
The expectation and the record
The involvement of GPs in child protection processes is seen as essential, not only to the identification and referral of children but also to the process of determining an appropriate response to the situation. The Working together guidance (DoH et al, 1999) is quite firm in its conviction that GPs are centrally placed not only to identify children at risk of harm but to contribute to the child protection process at all stages. General practitioners are exhorted to provide relevant information to the child protection conference (CPC), whether or not they are able to attend personally. Despite the importance given to their role in a series of policy declarations (Home Office et al, 1991; DoH and Welsh Office, 1995; DoH, 1998b; DoH et al,1999) and by other front-line workers (Simpson et al, 1994; Lupton et al, 1999b) research has raised questions about how adequately it is being discharged.
ten - Health visitors and child protection
- Carol Lupton, Nancy North, Parves Khan
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The primary focus of health visitors’ work with families is health promotion. Like few other professional groups, health visitors provide a universal service which, coupled with their knowledge of children and families and their expertise in assessing and monitoring child health and development, means they have an important role to play in all stages of family support and child protection. (DoH et al, 1999, section 3.35)
Introduction
As with other front-line professionals in health care, health visitors are viewed – and see themselves – as having a seminal role in both the identification of child protection cases and the subsequent management of cases. It is a role which, on a number of criteria, they appear to fulfil satisfactorily (Simpson et al, 1994; Birchall with Hallett, 1995; Lupton et al, 1999b), but which has also been subjected to constraints and tensions. These are derived from the changing political economy of health and primary care and concerns about the future of health visiting. They also reflect debates within the profession about professional–client relationships in the context of a process that has been dominated by judicial considerations and the determination of culpability. Following an account of the performance of health visiting in child protection, this chapter will deliberate the reasons for health visitors’ commitment to child protection matters, whose record contrasts with that of their general practice colleagues. It will identify past and contemporary pressures faced by the profession in maintaining a multifaceted role. In doing so the chapter will explore current debates, which seek to resolve apparently dichotomous demands on the role, and will evaluate the profession's capacity to determine the future direction of the service and the allocation of scarce health visiting resources to child protection work.
An understanding of its history is helpful in contextualising current debates in the profession. Health visiting originated at a time when concerns about urban populations and the spread of disease encouraged the development of a public health movement. By the early 20th century, sanitary reforms had been completed and the state instead began to attend to individual and child health, an approach prompted by the poor physical condition of Boer War recruits. Advice and support for new mothers and the creation of child welfare services became the focus for health visitors’ involvement.
Working Together or Pulling Apart?
- The National Health Service and Child Protection Networks
- Carol Lupton, Nancy North, Parves Khan
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This book examines the contribution of the NHS to the multi-agency and inter-professional child protection process. It examines the roles played by health professionals within child protection and investigates the nature and operation of the central policy community and local provider networks.
Frontmatter
- Carol Lupton, Nancy North, Parves Khan
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two - Policy communities and provider networks in child protection
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
As identified in Chapter One, ‘policy networks’ are seen to play a key role in the policy-making process. The idea of networks, we have argued, may be particularly appropriate in a multiagency, interprofessional area such as child protection. The limitations of network theory for the analysis of child protection policy, however, have also been outlined. In particular, we suggested that the operation of networks in their wider contexts, their interaction with other networks and the relationship between policymaking and policy-delivery networks have been relatively neglected within the relevant literature. These limitations may be especially problematic in the field of child protection where, as we shall indicate below, the networks are highly susceptible to external pressures and are cross-sectoral and multilevel in nature. Moreover, although the possibility of internal conflict is theorised in certain types of network (those closer to the ‘issue network’ than to the ‘policy community’ end of the continuum), little attention has been paid to this dimension and its impact on policy outcomes. Again, we would suggest, the analysis of internal tension or conflict rather than cohesion and consensus may be particularly relevant to the politically sensitive area of child protection.
A complementary framework for understanding the operation of policy networks, we argue, is that developed by Benson (1975, 1983). This sees the policy arena as an interorganisational ‘political economy’ comprising many different networks. Collaboration (within or between networks) is characterised by tensions deriving from the unequal resources and authority of network members, underpinned by the operation of wider social relations/structures of power. Such an approach allows us to examine the internal and external power dynamics of policy networks, which may be particularly relevant where these networks are multiagency or interorganisational in nature. Unlike network analysis, which focuses on policy formation, moreover, Benson's approach may be particularly useful for understanding the operation of policy delivery or implementation networks and, indeed, for understanding the relationship between the two. This chapter sets out to apply the insights of both approaches to the child protection context. After describing the characteristics or ‘architecture’ of this complex policy area, the chapter will identify some of the key tensions that may be seen to characterise its operation.
eight - Agents of change? The role of the designated and named health professionals
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
Earlier chapters have begun to indicate the extent of change required to bring about improvements in collaboration within interprofessional networks. Attempts to facilitate change in the commercial sector highlight the importance of introducing a specialist position of ‘champion’ or ‘agent’ of change. This individual is responsible for encouraging staff to engage in best practice and to work collaboratively across disciplinary, organisational and cultural boundaries in the pursuit of mutual interests (Crane, 1998; Davenport and Prusack, 1998). In the child protection context, the introduction of the designated and named doctor/nurse roles can be seen as a means of developing this change agent role.
There are two interrelated roles undertaken by change agents. One may be described as that of the ‘knowledge champion’, and this role has received considerable attention in the growing body of knowledge management literature. The acquisition of new knowledge and its transfer among workers is increasingly seen as a critical corporate attribute, central to the pursuit of competitive advantage (Blackler, 1995). Organisations are exhorted by management theorists to tackle dysfunctional actions like knowledge hoarding, inertia or resistance to new knowledge by creating a specific position of ‘chief knowledge officer’ (Davenport and Prusak, 1998; Duke et al, 1999) or ‘knowledge manager’‘(Ichijo et al, 1998) to lead their corporate knowledge strategy.
Drawing on this literature, the tasks of knowledge champions can be delineated as being to:
• collate and distribute already explicit knowledge in accessible formats;
• exhort or cajole staff to engage in knowledge sharing and drop their resistance to new knowledge or ways of working;
• serve as a ‘human interface’ by passing issues from the field up to management levels;
• develop training content and the technologies to make it accessible and utilised;
• serve as the central focal point for knowledge use and sharing by providing ‘help-desk’ support and structured debriefings;
• coordinate and manage learning and knowledge-sharing initiatives; and
• encourage discursive reflection on actions and reactions.
Whereas these efforts are largely ‘internal’ in terms of building the necessary technological and cultural infrastructure to foster innovation between different disciplines/tiers within organisations, they may also involve relationships with other organisations.
three - Knowledge and networks
- Carol Lupton, Nancy North, Parves Khan
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Summary
Introduction
This chapter and the next seek to understand why securing compliance with the ‘cooperation mandate’ in child protection may continue to be problematic. One of the major problems identified in successive child abuse inquiry reports (DHSS, 1982; DoH, 1991) was the failure of professionals to share vital knowledge and skills. A new approach to practice emerged as a result, based on the twin assumptions that knowledge in child protection could be standardised into written procedures and that children would be protected as long as professionals based their decisions on these knowledge ‘stratagems’. This approach, however, posits a simplistic relationship between knowledge and its application. Drawing on theories of knowledge management, this chapter argues that the relationship between knowledge acquisition and human behaviour is complex. As such, it questions whether the introduction of knowledge stratagems such as practice protocols is sufficient to ensure effective interprofessional collaboration.
The chapter begins by considering the general tension between professional ‘ways of knowing’ and the attempt to codify this knowledge into detailed procedures that seek to influence, even control, professional action. It then examines the difficulties within interagency and interprofessional networks that may arise from the different, and at times competing, knowledge ‘domains’ of the various participants. The constraints over knowledge sharing are explored and the chapter considers the ways in which the propensity to share can be disturbed by external factors such as organisational change and wider ‘knowledge shifts’. A central concern is to illuminate the main factors that may serve to undermine the efficacy of knowledge stratagems as a means of controlling professional practice and ensuring network equilibrium.
Professional learning and social control
In the current political climate surrounding the public sector, demands for better evaluation of services, particularly of their ‘value for money’, have grown. These have been augmented by the desire for greater certainty, seeking solutions to variation in professional performance and service outcome. The next chapter highlights the ways in which the introduction of new public management (NPM) approaches to health and social care services attempted to ‘open up’ areas of professional practice to managerial scrutiny and control. These developments also sought to encourage the ‘scientification’ of professional practice by privileging the role of empirical ‘evidence’ over professional experience or intuition.
six - Reluctant partners: the experience of health and social care collaboration
- Carol Lupton, Nancy North, Parves Khan
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Introduction
The Government has made it one of its top priorities since coming to office to bring down the ‘Berlin Wall’ that can divide health and social services and create a system of integrated care that puts users at the centre of service provision. (DoH, 1998a, p 997)
The ‘Berlin Wall’ seen to divide health and social care services featured strongly in the policy debates of the late 1990s. Particularly in respect of community care services, but also in provision for children and their families, effective service interventions were seen to be frustrated by a lack of coordination between different professionals, agencies and/or departments. In the child protection context, successive official inquiries identified failures in communication or interagency/interprofessional collaboration as a major contributory factor (DHSS, 1974; London Borough of Bexley, 1982; London Borough of Brent, 1985; London Borough of Greenwich, 1987). Earlier chapters have set out some of the potential barriers to interprofessional and multiagency working, in particular the difficulties resulting from different, and possibly conflicting, disciplinary approaches and service paradigms. They have also highlighted problems arising from the diverse systems of regulation and accountability surrounding network participants. This chapter examines the impact of central policy initiatives designed to enhance collaboration between health and social services authorities and identifies further areas of organisational resistance to effective joint working in child protection. After providing a brief history of collaboration between the NHS and social care agencies, the chapter examines the implications for local provider networks of the 1997 Labour government's modernisation agenda.
A brief history of health and social care collaboration
As we have seen, from its inception the NHS was kept administratively separate from the other two pillars of the welfare state – social care and social security. Effective collaboration between health and social care services was hampered by divisions between and within the NHS and the local authorities. Within the NHS, the core medical services – general practice and hospitals – were located outside local government control, effectively splitting them organisationally from the community or public health services – medical officers of health, community nursing and environmental health – which remained under the local authorities (Honigsbaum, 1989; Ottewill and Wall, 1990; see Chapter Five of this book).
Introduction
- Carol Lupton, Nancy North, Parves Khan
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Summary
These are not the opening paragraphs we would have wished to write. As we completed the final drafts of this book, news emerged of the abuse and eventual death of another young child. Anna Climbie was known to many of the local agencies responsible for child protection services: social services, the police and the health service. Understandably perhaps, the public again expressed disbelief at the apparent inability of these agencies to respond to the unmistakable signs of physical abuse endured by the little girl. Newspaper reports, and thus public debate, were quick to focus on the perceived failures of the professionals involved.
The response was also swift. The social services department (SSD) concerned was placed under ‘special measures’ and the social work case holder suspended pending an investigation into whether she and four other colleagues were to be disciplined. One of the police officers involved, although still at work, is reportedly facing a disciplinary inquiry and a total of eight officers are likely to be subject to internal investigation. Significantly, however, in the initial reaction to the event at least, relatively little public attention was paid to the role played by National Health Service (NHS) professionals. The actions of none of the health service's personnel who saw Anna in the months before her death, including, allegedly, a hospital paediatrician who considered her sores and marks to be self-inflicted, appear to have been subject to investigation by their agencies or professional associations. Although the formal inquiry has yet to be held, in the mind of the public and the press it is the performance of the social worker and, to an extent, the child protection police officers, that is widely seen to be the source of the problem.
As the 1989 Children Act and subsequent guidance make clear, however, effective child protection is a collective responsibility, involving the participation, to a greater or lesser extent, of a wide range of different agencies and professional groups. The NHS has a particularly important contribution to make to child protection, not least because of the number and diversity of its professional groups and services.
References
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twelve - Conclusion
- Carol Lupton, Nancy North, Parves Khan
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Since the original decision to keep the NHS organisationally distinct from the other aspects of the welfare state, improved collaboration between health and social care services has been a major policy objective. With the ‘hollowing out’ of the state and the emergence of a more ‘differentiated polity’ generally, and with the creation of internal markets within public sector services more specifically, the need for ‘cross-cutting’ solutions to enduring social problems became more acute. By the same token, however, the achievement of those solutions may be commensurately more difficult. On a practical level, public sector fragmentation increases the number and type of agencies involved and thus the potential for organisational or disciplinary dissonance in joint work. On a deeper level, there may be tensions between the exhortations to collaborate and the competitive ethos of the marketplace. The separation between politics and administration, moreover, and the growth of ‘intermediate agencies’ may make it less easy for the central state to provide effective overall coordination. As the 20th century drew to a close, there was a growing concern on the part of the international policy community about the discord between the precepts of new public managerialism (NPM) and the principles of good governance (World Development Report, 1997).
The search for ways to improve collaboration between the NHS and social care services has been most active in respect of community care, but has also characterised the development of services for children and their families. Particular pressures for greater collaboration in child protection resulted from a series of official inquiries highlighting poor liaison between different agencies and professional groups. Effective collaboration may be especially difficult to achieve in the child protection context, however, as a result of the sheer number of different professions and agencies involved. The NHS may experience particular problems in respect of collaborative work, given its complex organisational structure and its diverse professional groups.
The historical response of governments to the lack of collaboration has been to develop new mechanisms and procedures to underpin joint work. In child protection, these have ranged from the establishment of Area Review Committees (ARCs) (now the ACPCs), joint child abuse registers and interdisciplinary case conferences, to the detailed prescriptions of the Working together guidance and the incorporation of child protection work into wider national performance and assessment frameworks.
Observer variations in the evaluation of facial nerve function after acoustic neuroma surgery
- Christian Buchwald, Mirko Tos, Jens Thomsen, Henrik MØller, Agnete Parving
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- The Journal of Laryngology & Otology / Volume 107 / Issue 12 / December 1993
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- 29 June 2007, pp. 1119-1121
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This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976–90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0–100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient‘s own evaluation.