The H1N1 pandemic never reached the intensity feared, but the emergency response set in place has strengthened partnership working.

Partnership working is the cornerstone of any emergency response, but it is rarely tested over a prolonged period of time in the UK A pandemic, arguably, redefines the timescales of the emergency response. The response to the classic “big bang” emergency that all organisations are able to sustain eg 7 July 2005, where all organisations can be seen to be pulling together was, debatably, not as visible during the H1N1 2009 pandemic. 

From the outset, the 2009 pandemic was viewed as a health emergency; and it’s well established that to “improve healthcare delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met”[1]. The status quo of pandemic influenza partnership working prior to the H1N1 2009 pandemic rested in the hands of multi-agency pandemic influenza committees.

The pressure of continuing with “day jobs” and managing an emergent high profile, fluid situation operationally tested all organisations; not just healthcare delivery. It became quickly apparent that a more pragmatic approach was required to ensure the continuity of services and appropriate responses to the developing situation. 

Healthcare providers in the public sector are obliged to work in tangible partnerships, but reportedly “effective collaborative working within health and social care is hard to achieve”[2]. Nevertheless, the authors found that the H1N1 2009 pandemic enabled personal relationships to come to the fore and transcend these tangible more regulated partnership workings to enable the health economy to affect an appropriate and sustainable response. 

Consequently, in the authors’ local health-economy an operationally-focused sub-group of the committees was set up with the remit of providing “clear co-operation between multi-agencies and an understanding of others services”[3] and an aim “to maximise the capacity of all care providers through multi-agency co-operation and collaboration”[4]. In effect, this meant a number of simple actions:

  • sharing multi-agency contact details
  • weekly teleconference between NHS healthcare providers, ambulance services and local authorities
  • proactive attendance at partner organisations’ meetings
  • daily situation reports developed and shared to enable all partners to have an overview of the evolving situation across the local health economy.

This may appear an onerous addition to what the DH was already requiring, however it became apparent that the regular interactions between those involved resulted in a clarity of objectives on all sides.  There was a sizeable contrast between the NHS “war footing” and other organisations’ “peace time” view of the situation. These organisations recognised the implications of the pandemic, took action to prepare for a pandemic and shared information, but were not able to match the NHS resource intense approach.

Nonetheless, with increased understanding leading to an ability to refine and temper expectations, ably aided by the use of technology to facilitate easy communications between personnel, the known barriers to partnership working[5]“and imperfect communication between policy and action”[6] transcended to a point where intangible partnerships enabled participants to ask for help, proactively view the potential for gaps in plans together and suggest innovative solutions to try and support each other. 

From an NHS perspective, “at the heart of this intractability lies the recognition that most organisations work to their own agendas, make the best use of their own resources and perform to standards and targets that can inhibit joint working[7]. This supports the view that “there is a tendency to view health and social care in isolation without locating them in wider partnerships (such as local strategic partnerships). Differences in approach did lead to frustration, especially when whole patient pathways came under scrutiny. At times it was apparent that what DH thought was practical in the areas of social care was not possible with practitioners at the local level. There is a difference in culture between the NHS and the local authority; these differences need to be recognised in future plans.[8] Partnerships rely upon good systems of inter-professional collaboration[9] and the recognition and acknowledgement of the differences allowed the IPC sub-group to focus on what could be achieved rather than what couldn’t, taking into account different organisations’ agendas. 

Undoubtedly, the lack of clarity and direction of organisations outside the NHS umbrella that had to play within whole system processes, lead to a tension that the duty of partnership alone could not overcome. For all intents and purposes, the authors’ conclusion is that, despite differing organisational agendas, there have been substantive long-term benefits from the partnership working that occurred during the 2009 pandemic that will be carried forward into the post-pandemic local health economy. 

Hazel Gleed is emergency planning and liaison officer (acting) at St George’s Healthcare NHS Trust, Samara Hammond is associate director quality, innovation and clinical governance at Wandsworth Teaching PCT and Hamish Cameron is emergency planning and liaison officer at Wandsworth Local Authority

References

[1] Plochg et al (2006) ‘Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership’ BMC Health Serv Res.2006;6: 37

[2] Lymbery, M (2006) ‘United We Stand? Partnership Working in Health and Social Care and the Role of Social Work in Services for Older People’ British Journal of Social Work 2006 36(7):1119-1134

[3] NHS Wandsworth (2009) Terms of Reference, WandsworthMulti-agencyWinter Health Resilience Steering Group.  Unpublished, but available upon request. 

[4] NHS Wandsworth (2009)Terms of Reference, WandsworthMulti-agencyWinter Health Resilience Steering Group.  Unpublished, but available upon request. 

[5] Glasby J, Dickenson H, Peck E (2006) ‘Guest editorial: partnership working in health and social care’ Health Social Care Community, 2006 Sep; 14(5): 373-4 (10 ref)

[6] Stewart M  (2002)  Paper to the Health Development Agency Seminar Serieson Tackling Health Inequalities, The Cities Research Centre, Bristol, UK

[7] Stewart M  (2002)  Paper to the Health Development Agency Seminar Serieson Tackling Health Inequalities, The Cities Research Centre, Bristol, UK

[8] St. George’s Healthcare NHS Trust (2010)  Review of the St. George’s Healthcare NHS Trust’s response to the H1N1 Flu Pandemic 2009/2010 as part of the Wandsworth Health Economy.  Unpublished, but available upon request.

[9] Lymbery, M (2006) ‘United We Stand? Partnership Working in Health and Social Care and the Role of Social Work in Services for Older People’ British Journal of Social Work 2006 36(7):1119-1134