Joint working
All partnership working ultimately depends on practitioners working together and building a professional relationship to improve the quality of care that they jointly provide. However, as in any relationship, joint working can lead to interpersonal tension – or instance, if any power imbalances are not addressed or if incorrect assumptions are made.
Recommendations arising from our workshops:
- Co-production.
Sometimes health and social care professionals can assume that the needs of people from South Asian communities will best be met by tweaking or adapting an existing intervention in order to accommodate their cultural and linguistic needs. Instead, workshop participants emphasised that it was important to work together to identify the needs within the community and how to meet these. This may involve the joint delivery of a service or for people within the community having responsibility for the delivery of an intervention with support of health professionals.
- Sharing information.
The joint delivery of any service requires information to be shared between members of different organisations. However, health and social care professionals may feel inhibited from sharing information on the basis of concerns – for instance, around confidentiality. It is important to agree together at the outset of any collaboration about what information and data can and can’t be shared. This may require volunteers or staff from voluntary organisations to have honorary contracts, for data sharing agreements to be established, or for clients to be asked to give their consent to share information.
Unconscious bias
As well as examples of service delivery being consistently skewed towards the needs of white-British people living with dementia, participants also identified how unconscious bias within systems can emotionally affected family carers. One instance that we were told about was when a daughter tried to arrange for a paid carer who spoke the same language as her father living with dementia. When she was told that local services didn't have any capacity to meet her father's language needs, she was left feeling that she was making an unreasonable demand and that if she was to persist with her request, that she might be viewed as a troublemaker.
Unconscious bias means that people are taken advantage of, whether that’s about unpaid use of their expertise, building their trust, taking that expertise for their own benefit … people that have a paid job, they want me to tell them what to put in their presentation …. you help me to find these people, you help me to do my job, thank you very much that’s it … without any acknowledgement, without any reimbursement
Recommendations arising from our workshops:
- Unconscious bias training.
The value of voluntary sector organisations should be a central feature of unconscious bias training in health and social care services. This should be tailored to local circumstances and needs, so that it is relevant to the local communities in which services are being delivered. Workshop participants suggested a range of innovative methods of unconscious bias training including workshops incorporating dementia workers from both the health and the voluntary sector.
- Facilitating an open dialogue about differences.
Some workshop participants felt that white health and social care professionals were sometimes afraid to ask questions of South Asian colleagues in fear of giving offence. It is important to create a culture in which there is an open dialogue about differences and commonalities within communities, as well as their impact on service use. Clinicians should be prepared to have frank and sometimes uncomfortable discussions with colleagues and to talk openly about their own lack of knowledge.