Partnership is a key theme running through the government's plans for change across the public sector. It assumes particular importance in the health policy arena where a plethora of professionals and agencies contribute to the health enterprise. Making partnerships work in the health sector is the ultimate challenge.

Should they fail, so will much of the government's health strategy.

The difficulty lies not so much in a lack of know-how but rather in applying what we know to ensure that robust, sustainable partnerships are in place.

The government is to be congratulated on its determination to make partnerships work. Its discussion document on the subject endeavours to go beyond mere exhortation and to promote the process through a range of devices.

1Of course, all these instruments beg the question: collaborate for what?

Unless there is a shared vision, or agreed set of principles concerning what it is that agencies and practitioners are trying to do to improve the quality of support offered children or elderly people or whoever, then all the pooled budgets in the world will make little difference.

More worry ing, the government's determination to see partnerships succeed is being rendered more difficult by some of its other beliefs and changes. Indeed, when these are probed they appear little different from the last government's stance towards the end of its life. In the case of the NHS, the government let it be known that the internal market was to be replaced because of the dysfunctional behaviour and perverse incentives it had spawned.

But in much of its theorising about social democracy - captured in the phrase 'the third way' - the government appears to support the notion of internal markets, or at least what actually emerged from the previous government's skirmish with them. Although the NHS has so far remained immune from the full impact of 'third way' thinking (maybe clinicians do still retain considerable influence), local government has felt the full impact of the government's overall coolness towards the public sector.

As far as its details can be discerned, third way public policy is all about steering more and rowing less. This means that while public services ought to continue to be financed publicly, it need not follow that their provision should automatically be provided through the public sector. There ought to be scope for outsourcing and competitive tendering if the same or improved quality of service can be obtained. So the 'contract culture', ostensibly detested by the government, is set to continue with a vengeance under the 'best value' initiative. Indeed, many think the private sector is poised to play an even bigger role than it has played under compulsory competitive tendering. Resistance to the private sector may have melted in the face of financial pressures, but it is probably a case of outsourcing becoming unavoidable rather than acceptable.

The policy is certainly not evidence based. Indeed, the claims made for outsourcing remain untested.

2It is likely that outsourcing will make partnership working more difficult to achieve on a sustained basis. One of the criteria for effective partnerships is to keep the number of interfaces to be managed to a minimum. If local authority services are outsourced, this must surely make the task of securing sound cooperation and collaboration considerably more time-consuming and costly.

There are also issues of culture and values to be considered. Successful partnerships are characterised by strong and committed teams whose members all share the same values. If teams are composed largely of contracted individuals from a variety of organisations, each with their own value systems, then surely achieving a shared purpose is much more difficult in a context where team members are bound by the terms of their contracts rather than the service philosophy expounded by the organisation buying their services.

A key motivation for outsourcing is to save costs. This may only be possible through the adoption of flexible labour markets and short-term contracts. The high-trust relationships and reciprocal obligations upon which effective partnerships crucially depend will not be easy in a context where there is high staff turnover and where employees are likely to display less loyalty to their organisation.

Contrary to popular myth, restructuring has been pursued more vigorously in the public sector, and managers have undergone greater change than almost all sectors of the business world. The effect has been a dramatic lowering of morale, loyalty and motivation.

But perhaps the most depressing observation is that restructuring is far from over. Indeed, the pace of change is quickening. For the government, a further overhaul of the public sector is only just beginning. In such a climate, it is hard to see how, or even why, partnerships should flourish. It is a sad paradox. For the first time, we have a government which is serious about breaking down barriers between agencies and practitioners and wants to invest in partnerships.

But the very same government is actively putting in place public sector reforms which look destined to make partnership working even more difficult.

In support of its faith in partnerships, the government subscribes to the notion that none of us is as smart as all of us. Perhaps the government has yet to apply that philosophy to itself. Creative collaboration cannot be outsourced.


1 Department of Health Partnership in Action, DoH, HMSO, 1998.

2 Boyne GA. Bureaucratic Theory Meets Reality: public choice and service contracting in US local government . Public Services Research Unit working paper No 3, Cardiff Business School, 1998.