I’ve been giving loadsa lectures this last couple of weeks, mostly about multi-inter-professional-disciplinary practice, partnership working and so on.

Strikingly, the lecturer on a course for health service administrators commented that my suggestion that partnership working is a response to command and control managerialism of the 1990s was new to her. Do you remember the time when managers were supposed to manage, and generalist managers could develop more effective services than professionals because they were not caught up in personal commitments to a particular professional approach to services? Partnership working reflects a realisation that that command and control does not create the effective interpersonal relationships within a service and it is solid interpersonal interprofessional relationships that actually makes it work for patients and service users.

Command and control didn’t work, of course, because managers who take their aims from financial and political objectives haven’t really thought through and understood the various aspects of what patients and service users actually need and want: their aims are purely managerial instead of service-oriented. And of course, they can only do what the bosses and the politicians tell them, rather than contributing their judgement and experience.

Professional judgement and experience also contributes to a participation policy based on individual and public choice. The public choice agenda says that if you respond to the individual choices of patients and service users, you accumulate their choices into a service that really responds to their needs.

No: you have a service that does what they want. But professional experience and judgement contributes a commitment to looking wider than what people want and an understanding of what happens as they approach these new issues in their lives and therefore what it is best to do about that to help them. Best for them, but not necesssarily what they want.

In end-of-life care, many of the people we work with have not approached their own deaths before; they do not have a lot of experience of other people’s deaths either. What they think they want beforehand is often wrong for them as they come to the point. Purely personal choice, or purely political sentiment (I say sentiment rather than policy, because I think the political reaction to end-of-life care is often sentimental rather than thought through), is not a good guide to providing the service. But a flexible professional commitment, based on secure professional knowledge and understanding and a strong research base is a necessary part of a good service.

And professional understanding from a variety of points of view also helps. The knowledge management approach to teamwork says ‘forget about having group love-ins as team development. Instead, cultivate appreciation of different knowledges that contribute to your field’. Appreciating and understanding a range of professional knowledges is the strongest basis of good partnership working.