Perceptions of partnership. A documentary analysis of Health Improvement Programmes.

Health Improvement Programmes (HImPs) are at the heart of the UK government's partnership agenda for the National Health Service (NHS). This paper assesses the nature of HImP partnerships in England by analysing 50/99 first-round HImP strategies (randomly selected). The documentary analysis quantifies the structures and mechanisms of partnership, the degree of inter-sectoral participation and the extent of voluntary sector involvement.Three-quarters of responding health authorities (37/50) appear to have set up formal partnership structures to produce the HImP, or are planning to do so. After health authorities, local authorities (47/50) appear to be most involved in contributing to the HImP, particularly social services departments. Within the NHS 'family', acute and community trusts (43/50) appear to be the most involved, with Primary Care Groups (PCGs) contributing less (39/40). Community Health Councils (CHCs) appear to be similarly involved (40/50). The voluntary sector appear to be involved in all but four HImPs, mainly through umbrella organisations represented on strategic partnership boards (34/50). User and carer and community groups appear to participate far less. Lack of endorsement of HImPs by partner organisations, poor delineation of responsibilities and absence of transparency in resource allocation suggest that ownership of, and commitment to HImPs may be weak. HImPs appear to have focused on creating structures rather than developing aspects of partnership process. If levels of inter-sectoral involvement and voluntary sector participation are to be maintained or increased in future, Primary Care Trusts (PCTs) will need to develop a strategic approach to partnership.