title: Barriers to partnership working in public health: a qualitative study.
abstract: BACKGROUND
  Public health provision in England is undergoing dramatic changes. Currently established partnerships are thus likely to be significantly disrupted by the radical reforms outlined in the Public Health White Paper. We therefore explored the process of partnership working in public health, in order to better understand the potential opportunities and threats associated with the proposed changes.
  
  
  RESULTS
  70 participants took part in an in-depth qualitative study involving 40 semi-structured interviews and three focus group discussions. Participants were senior and middle grade public health decision makers working in Primary Care Trusts, Local Authorities, Department of Health, academia, General Practice and Hospital Trusts and the third sector in England. Despite mature arrangements for partnership working in many areas, and much support for joint working in principle, many important barriers exist. These include cultural issues such as a lack of shared values and language, the inherent complexity of intersectoral collaboration for public health, and macro issues including political and resource constraints. There is particular uncertainty and anxiety about the future of joint working relating to the availability and distribution of scarce and diminishing financial resources. There is also the concern that existing effective collaborative networks may be completely disrupted as the proposed changes unfold. The extent to which the proposed reforms might mitigate or potentiate these issues remains unclear. However the threats currently remain more salient than opportunities.
  
  
  CONCLUSIONS
  The current re-organisation of public health offers real opportunity to address some of the barriers to partnership working identified in this study. However, significant threats exist. These include the breakup of established networks, and the risk of cost cutting on effective public health interventions.
authors.affiliation: Department of Public Health and Policy, Liverpool, United Kingdom. dctr@liv.ac.uk
authors.forename: David Carlton
authors.initials: DC
authors.lastname: Taylor-Robinson
authors.forename: Ffion
authors.initials: F
authors.lastname: Lloyd-Williams
authors.forename: Lois
authors.initials: L
authors.lastname: Orton
authors.forename: May
authors.initials: M
authors.lastname: Moonan
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D003144:Communication Barriers; D003299:Cooperative Behavior; D003469:Culture; D004739:England; D006801:Humans; D033183:Interdisciplinary Communication; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D010465:Perception / Q000502:physiology; D011634:Public Health / Q000379:methods; D011635:Public Health Administration; D055818:Public-Private Sector Partnerships; D054928:Validation Studies as Topic