Background and Context

A central theme in UK government policy concerning healthcare delivery is the need for partnership working (DH 1999, 2001, SEHD 2006a, SGHD 2007b). This derives from the recognition that professionals and services do not function independently of each other. The need for partnership working is further evident in the number of government reports recommending this within the context of health and social care services and professional education for healthcare practitioners (DH 1999, SEHD 2001, 2005, 2006a). One of the main reasons for this has been the increasing demand and pace of change for care delivery, in particular, the shift from hospital-based services to that of community. Furthermore, partnership working has also been embraced by nursing and midwifery’s regulatory body (NMC 2006c), the QAA (2001) and NES (2005). The two professions at the core of this study, nursing and midwifery, are central to taking forward many of the policies, and as such there has been a major drive to ensure that programmes preparing them for their role are preparing them to be both fit for practice and fit for purpose.

Working in partnership to ensure a successful outcome has become central to ensuring that nursing and midwifery education in Scotland meets the requirements of employers and service users. Benefits to partnership working have been identified as maximising efficient and effective use of public sector resources, but also enables care to be designed around the needs of patients and service users (NES 2005). Recognising that nurses and

midwives need to be equipped to meet the demands of an increasing complex and rapidly evolving health care system have resulted in a realisation that academic-service partnerships present not just an opportunity, but are an imperative (O'Neill-Hewlett & Bleich 2004).

To meet and achieve these changes and challenges, Fitness For Practice (UKCC 1999) identified and recommended that:

Health Care Providers and HEIs should continue to develop partnerships to support students, curriculum development, implementation & evaluation, joint awareness and the development of service and education issues, and delivery and monitoring of learning in practice’ (Recommendation 23)

The recommendation identified the need to close the gap between higher education and service providers. Fitness For Practice (UKCC 1999) recognised that the NHS and HEIs had an equal partnership responsibility for the preparation of all nurses and midwives.

With this recommendation in mind, this chapter will explore the extent to which partnership working is applied across organisational levels and between key stakeholders involved in the preparation of nursing and midwifery students in Scotland. The chapter will identify the types of partnership arrangements that have been developed and the perceived benefits of these. It will also identify any limitations in partnership working whilst identifying areas of good practice and areas for further development. For the purpose of this report, it was important to define how the project team identified and measured the strengths and challenges of partnership arrangements.

The Audit Commission (1998) definition was selected for this purpose as this appeared to fit well:

Partnership is a joint working arrangement where partners are otherwise independent bodies cooperating to achieve a common goal; this may involve the creation of new organisational structures or processes to plan and implement a joint programme, as well as sharing relevant information, risks and rewards.

The overarching theme identified in this element of the project is ‘Partnerships in Practice’. Several sub-themes are identified and will be explored in this chapter.

8. 3 Partnership Arrangements between HEIs and the NHS

One of the aims of Fitness For Practice (UKCC 1999) was to seek to close the gap between higher education and service providers. Chalmers et al (2001) and Spouse (2002) indicate that the theory practice gap can be minimised by increasing collaborative partnership structures between the NHS and HEIs.

Across all case studies stakeholders were asked to describe partnership working arrangements. At the Strategic level there was evidence to assist in delivering the recommendations of the Fitness For Practice report:

Education Partnerships, it is a committee which has senior staff from NHS and senior staff from the school…four sub groups that work and feed into education partnerships. One is around the learning environment which includes Practice Education Facilitators. One which is around recruitment and retention, that one is really ahead at the moment. One on planning educational provisions which is looking at predicting health needs, what we need to put into the curriculum and one which I head up which is a joint posts steering group which oversees our associate lecturer scheme. (Senior academic Case study A)

With each of our NHS Board Partners we have a Partner in Practice Agreement. That outlines each of the parties’ responsibilities within the agreement and it’s signed by Head of School and by the Lead Nurse within each of the Boards. We have that for each of our NHS Board Partners where our students go on clinical placement. (Senior academic Case study B)

There are links with the University…A nurse education committee which is Service side led with co-members of university staff on that group…They have just launched Rights, Relationships and Responsibilities; we have close links with the university on each of those sub-groups, particularly on education. (NHS manager Case study C) We have partnership agreements with them at Director of Nurse level. (Senior academic Case study K)

The lead Midwife works strategically with the Heads of Midwifery (NHS) and inform of any changes that take place. For example Service Development, if they are closing a unit, turning it into a Midwife led unit what are the implications. I also work in terms of advising them about changes in the programme. (Academic Case study A)

A key driver in NHS Scotland is to develop partnerships with users, carers and communities (SEHD 2005, 2006a). In this study there is evidence of this being embraced by HEIs in developing curricula, however, it is limited:

The local Division has a User group forum…We asked user what they felt were the issues and what there expectations of nurses were…they came up with good ideas…all the things you would imagine, communication was an issue, pain management, nutritional management. (Senior academic Case study I)

We have different partnerships, particularly the learning disability partnership; we have carers involved in input into the curriculum development at that level. They don’t sit on the strategic group as we said, we don’t have members in the strategic group at all but they do input to the kind of programme level review group we have, you know, many carers that come in from mental health and learning disability, new mothers with babies etc all inputting into the programme. (Senior academic Case study G)

Systems and processes are in place to lead, guide and inform partnerships. These local arrangements demonstrate many of the key challenges facing nursing and midwifery preparation and service delivery. They clearly identify and articulate with Scottish policy imperatives (SEHD 2005, 2006a, SGHD 2007b) and demonstrate working together to achieve many of the recommendations laid down in the Fitness For Practice report (UKCC 1999) and QAA requirements (2001). However, further work is required to enhance and standardise carer and user involvement across all HEI-NHS partnership committees.