Background Social welfare legal problems are root causes of health inequality. Legal advice services can improve socio-economic circumstances and mitigate the financial and social costs of illness. With these aims, partnerships between healthcare and legal services exist across England to support patients with welfare needs. They occur in diverse health settings and take many forms. Success is markedly variable in developing collaborative working and sustaining cross-sector partnerships. This study investigates how such partnerships are implemented and what factors determine differences in implementation outcomes.
Methods A comparative case study of health-justice partnerships across England was undertaken. Services were recruited from different regions, representing diverse health settings and service models. Data were collected through: i) One-to-one semi-structured interviews with staff members and funding organisations; ii) Service records and documentation. In-depth qualitative analysis using the process tracing method was applied to each case study individually. Cross-case comparison of the resulting themes identified key patterns and determinants of implementation success.
Results Nine services participated in the study. Four were based in primary care, four in acute or specialist care (cancer services, mental health services, a children’s hospital and an HIV clinic) and one spanned both primary and secondary care. Thirty-eight interviews were undertaken with staff members in frontline and management roles. The case studies provide detailed descriptions of service models, including: co-location or remote working arrangements, referral methods and routes, cross-sector communication and data sharing, funding and management arrangements. The partnerships had experienced different trajectories: while some were long-lived (up to two decades), others had been discontinued, cut in size or had failed to properly establish. Factors influencing sustainability included decision-making processes around funding, strategic-level support and leadership characteristics. The extent of collaborative working was highly variable and influenced by: i) willingness to engage; ii) confidence to engage; iii) ability to engage. These factors were amenable to change. All the partnerships indicated benefits for patient access to legal assistance, positive welfare outcomes, improvements in mental wellbeing and patient experience. Benefits were strengthened where health and legal teams collaborated closely, with improved identification of need, professional skills and service efficiency.
Discussion Health-justice partnerships have a critical role to play in supporting the NHS Covid-19 recovery and tackling health inequalities. Opportunities for cross-sector working are growing with the movements towards Integrated Care Systems and social prescribing. This study provides information to support the successful implementation of heath-justice partnerships in the near and longer term future.
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