Partnership Working That Actually Works: How We Collaborate With Clinical Teams

“Partnership working” turns up in nearly every tender document I read, usually near the top, usually followed by a paragraph that says very little about what it involves day to day. I’ve grown a bit wary of the phrase, mostly because I’ve seen how rarely anything real sits behind it.

So instead of talking about partnership in the abstract, I want to talk about one specific example that’s been running since 2013 and is still going: our forensic service, Tilt, delivered jointly with Oxleas NHS Foundation Trust.

Who does what

Bridge provides 24-hour social support to the men living at Tilt. Oxleas handles the clinical side — a responsible clinician, a care co-ordinator, a social supervisor where one’s needed, plus occupational therapy and psychological input when required. Every resident also has a key worker and a STaR worker from our team.

None of that tells you much about how it actually functions, though. The weekly MDT meeting is where both teams sit down and go through each resident’s progress, risk factors, and whatever’s changed since they last spoke. If someone’s mental health starts to deteriorate, we flag it to the clinical team straight away, out of hours if it comes to that, with access to an on-call forensic psychiatrist. Our staff then carry out the care plans the clinical team has prescribed for that person, and more than once that’s stopped a crisis turning into a hospital admission.

Why it’s lasted this long

The service started small, an 11-bed unit under a different name. By 2013 it had grown into the 18-bed hostel we now call Tilt, and Oxleas re-let the contract to us for a further five years in 2022, with an option to extend to 2028. That’s over a decade of the same referral pathways and the same risk processes, refined rather than rebuilt from scratch each time.

Staying together that long took real effort. These contracts get re-tendered and change hands more often than people outside the sector realise, and something gets lost whenever that happens — a new provider learning a resident’s history from a standing start, a clinical team working out whether it can trust support staff it’s never met, whatever momentum existed having to be rebuilt. We’ve largely avoided that by being good at the job, and by treating Oxleas as partners rather than a commissioner to be managed.

The part that doesn’t show up in a contract

You can write “close multidisciplinary working” into a service specification as many times as you like, but the thing that actually delivers it is harder to put on paper. It’s a care co-ordinator picking up the phone the same day something’s wrong, because they know our staff well enough to trust the call was worth making. It’s key workers knowing which clinician to go to for which resident without having to check first. It’s the fact that the Metropolitan Police’s Public Protection Unit, local probation officers, and GPs are all woven into the same working relationship, because forensic recovery rarely stays inside one service boundary.

That kind of familiarity takes years to build. It comes from the same people turning up to the same meetings, disagreeing sometimes, and working it out because the resident in front of them matters more than who’s technically right — not from anyone deciding at the outset that it should exist.

What this means for commissioners

When a commissioner asks how we manage risk, or how we prevent avoidable hospital admissions, the honest answer isn’t a policy document — it’s this partnership, tested over more than a decade. Reoffending has stayed low, move-on rates have held up well, and the clinical relationship behind both of those numbers has survived several contract cycles because both sides kept choosing to make it work, year after year, even when it would have been easier not to.

If you’d like to talk about how Tilt or our other services could work in your area, get in touch — I’m always glad to walk through it.