Promoting partnership working in the NHS

How we do partnership

The SPF recognises what a powerful tool partnership working between employers, policy makers and trade unions can be, and how it makes a real difference to patient care and influences employment practice in healthcare and beyond. The how we do partnership hub contains details of the growing body of evidence on the benefits and importance of true partnership working. You will also find useful case studies, tools and resources to support successful partnership working.

Although social partnership arrangements have been in place since 1998, a refreshed approach to partnership working was needed following the major announcement on transforming community services in 2006. The announcement caused concerns and difficulties for stakeholders in the NHS for England. The concerns were addressed by Patricia Hewitt the then health secretary and the ensuing discussions, facilitated by the TUC, led to an agreement by the end of that year which established the SPF. A key principle of the SPF was that there should be no surprises caused by government announcements on NHS strategy and developments. The SPF, chaired by a minister, has developed its role and ensured that major initiatives in the health service including transforming community services and the new structures established by the 2012 Health and Social Act, and the staffing and organisational issues arising from these changes have been dealt with in partnership. The effectiveness of the SPF has been further enhanced by the work undertaken in sub groups such as the Workforce Issues Group (formerly known as the staff passport group) and the Francis sub group.

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There is a growing body of academic evidence which shows that good staff engagement, such as the partnership approach, can deliver better patient outcomes, as well as improve overall organisational performance (West et al 2011, West et al 2013 and The Point of Care Foundation 2014.)

The NHS Constitution emphasises the importance of staff engagement and partnership working and requires the NHS to commit to 'engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements.' The potentially serious impact of a disengaged workforce was highlighted in the Francis Inquiry Report (2013).

 National and regional, partnership working:

  • gives an opportunity for employers and trade unions to contribute their experiences and ideas on the development of policy that impacts on the health and social care workforce
  • gives partners the ability to assess the likely impact of emerging policy on the NHS workforce and to mitigate risk
  • enables more effective implementation of policy
  • supports high standards of employment practice.

A summary of what the national SPF has achieved and its priority work areas can be accessed here.

Locally, partnership working:

  • provides a transparent and streamlined structure for trade union, employer and staff engagement
  • supports an improved mutual understanding amongst management, trade unions and staff
  • has been shown to lead to better services for patients and users.

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The SPF enables partners to work together to promote effective partnership working on the workforce implications of policy and strategy. It brings together representatives from the Department of Health and Social Care (DHSC), NHS England and NHS Improvement (NHSEI), Health Education England (HEE) and the NHS Trade Unions (representing NHS staff) and NHS Employers (which provides the employers' voice). This model enables early discussion, debate and involvement in the development and implementation of policy that impacts on the workforce.

DHSC perspective:

Ministers and the DHSC value the SPF, as it provides a forum which upholds high levels of cooperation and commitment to improve health and social care outcomes for patients. The forum provides valuable input and insight into the workforce implications of policy development and supports the implementation of policies.

Working in partnership across the health and care landscape and engaging with the workforce is key to making the best decisions about patient care. Evidence shows that engaged, satisfied employees are more productive and that in the NHS, staff and patient experience are closely linked. DHSC believes that engaging NHS staff in decisions that affect them is a crucial factor in the delivery of safe and high-quality care for our patients.

Trade Union perspective:

The NHS Trade Unions believe it is in their members' best interests to engage in partnership working with governments and employers, to seek solutions to challenges and problems. Partnership working puts an onus on both employers and trade unions to engage and consult on all decisions that affect staff. Partnership underpins and facilitates sound and effective employer and trade union relations and has a track record of delivering real gains for staff and patients. As a crucial determinant of the quality of healthcare, a growing body of evidence-based research shows that effective partnership working and staff engagement in NHS organisations improves the patient experience and healthcare outcomes.

Employers’ perspective:

The SPF allows employers to get an early sight of health policy. It also allows them to give their perspective on how policy should be developed and highlight the possible workforce implications of a policy. In particular, the forum allows employers to influence how proposals are implemented and, through discussions with partners, to make sure they are workable and realise maximum benefits for patients.

NHSEI's perspective:

Responsible for the wise investment of over £100bn of taxpayers’ resources, NHSEI makes critical decisions about patient care which affect the NHS and the people who work in it. The SPF is an invaluable forum which allows for the workforce implications of those decisions to be discussed with employers and staff representatives in an atmosphere of constructive partnership.

NHSEI is also responsible for supporting foundation trusts and NHS trusts to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable.

With the workforce at the heart of all NHS providers it is imperative that NHSEI maintains strong working channels through the SPF to fully understand any concerns and issues that partners may have. There is clear evidence showing the link between staff and patient satisfaction, and NHSEI believes that a well-motivated and committed workforce is of benefit to patients.

HEE's perspective:

HEE is responsible for the education, training and personal development of every member of staff, and recruiting for values in order to deliver a better health and healthcare workforce for England. HEE is committed to working in partnership with its recognised trade union partners, to maximise both the successful delivery of HEE’s strategy and corporate objectives and to work for the wider development and benefit of the service in general.

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The SPF has developed a communications toolkit including promotional materials for partners to use to promote the work of the SPF, and the benefits of partnership working through their own communication channels.

The communications toolkit resources are available to download here:

Branded SPF Presentation

SPF Aims and Achievements

National and Regional SPF Factsheet

SPF Infographic

An SPF postcard is also available on request. The postcard can be used to promote partnership working and encourage partners to subscribe to the SPF bulletin. If you would like to order some please send an email to

The SPF has also recorded podcasts from members of partnership forums who have shared their experiences of partnership working. These can be listened to below.

Pam Johnson retiring Regional Head of health for UNISON at Yorkshire and Humber on partnership working

Dino Williams talks about the development of partnership working from a staff side perspective at Guys and St Thomas


Through their respective membership of European Federation of Public Service Unions (EPSU) and HOSPEEM, a number of the NHS trade unions and NHS employer organisations participate in European level social dialogue, via the NHS Confederation European Office. EPSU and HOSPEEM representatives work together to develop agreements that become legislation such as the sharps injuries in healthcare agreement, and non-binding agreements such as ethical recruitment and retention. They exchange good practice and agree joint responses to European Commission (EC) consultations, for example the Directive on the recognition of professional qualifications and are involved in EC initiatives and projects relevant to the healthcare workforce like CPD lifelong learning and workforce planning. 

Further information on the work and various projects of EU social partners can be found on the EPSU website and on the NHS Confederation website.