Health and Social Care Policy and the Interprofessional ... - CAIPE

to be a top priority. This means in many instances, reconfiguring health care
services, embracing new technology and optimising the skills of the
workforce. Indeed some will argue that the hidden agenda is to address
workforce shortages. Ways to achieve this have been identified including
strengthening the role of public health, diversifying funding and strengthening
the concept of governance.
Thomas et al (2000), in a major study funded by the World Bank, concluded
that ‘no country has ever achieved sustained development without substantial
investment in the education and health of its people’ (p67) with their
conclusions later supported in subsequent studies by Bloom et al (2001) and
the Commission on Macroeconomics and Health (2001) who found, in a study
of more than 100 countries, that improvements in a nation’s health have a
significant positive effect in improving economic performance and hence on
Gross Domestic Product.
There are very different approaches to healthcare delivery in the various EU
countries, examples being patient autonomy, multi-professional teamwork and
confidentiality. Many of the differences are historically and culturally based
and before the EU general system Directives that allowed free movement
throughout Europe and mutual recognition of the majority of health
professions this did not pose a problem (EU 1989 & EC 1992). In this
millennium it does! Whilst responsibility for qualifications remains with the
Internal Market Directorate General many would support its move to the
Health and Consumer Protection Directorate General.
McKee et al (2004: 101) perhaps hit the nail on the head when they wrote:
‘Nurses and other health professionals in the United Kingdom have developed
their roles to an extent that might well be unthinkable in some other countries,
taking on many tasks previously carried out by doctors. Multidisciplinary team
working is essential in a hard-pressed NHS. In a relatively centralised system
where most professionals are salaried or hold contracts involving capitation
fees and the like, these developments are less likely to be perceived as a
threat than they are in countries where doctors may perceive other health
professionals as competing for fees’.
They continue by saying however that ‘It would be impossible to standardise
the roles of health professionals and senseless to try. Some degree of
diversity is inevitable and indeed desirable. At the same time, increasing
familiarity will also bring with it a degree of convergence as colleagues share
experience and learn from each other’ (ibid:101).
These two quotations bring into sharp focus the whole interprofessional
debate. Many individuals in every country, including a significant minority
within the UK, view the concept of working together, collaborative practice,
and all the other derivatives of these, as a dilution of, and a direct threat to,
their professional autonomy. While it is true that multidisciplinary team
working when it works well helps the ‘hard pressed NHS’ (ibid) in part, it is
certainly true that interprofessional/interagency collaboration helps deliver
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