Jana Burton has over 25 years experience in the field of Health and Social Care. As a former PCT Chief Executive, she has spent the last four years working in interim management assisting organisations to modernise, improve performance and work on areas of integration. Here she shares her views on improving the health and wellbeing of the adult population and asks is closer working between Health and Local Authorities the way forward?
The White Paper: “Our Health, our Care, our Say: a new direction for Community Services” published this time last year signalled a number of changes about the way Health and Social Care work together in partnership. At the start of 2007 where are we, and what has really changed? What impact has the paper had on the way in which GP practices, Primary Care Trusts and Local Government work together?
There are some excellent examples of Section 31 agreements, more general integration agreements and joint arrangements. These have included Joint Equipment Services, Community Mental Health, Learning Disabilities, Intermediate Care and Interpreting and Translating Services. Many of these have developed and evolved over time. So why have more not taken place?
Many PCT’s and Local Authorities have also been facing major change, growing demands and increasing financial pressure. The pressure for PCT’s to meet national targets and manage significant deficits has meant the more local agendas for meeting the health and wellbeing of the population takes second place.
There is an increased tendency to concentrate on core business and become more inward looking. The real test of partnership and the robustness of integrated arrangements is what happens when the going gets tough.
I would suggest that for many it has not inspired closer working and sound business cases for streamlining and developing seamless services. Why would it? Organisations have been going in opposite directions with increased separation of Commissioning and Providing within PCT’s, whilst at the same time many local authorities are strengthening commissioning, but also choosing to retain significant amounts of provision within the same management structure. Each organisation then convinces itself that the population and needs it is responding to are different with different priorities. Partnership becomes seen as a ‘nice to do’ extra to which it becomes increasingly difficult to devote the time and resources. Additionally, the pressure around funding in areas such as Continuing Care, which is really an issue for Central Government, has become a major bone of contention between many PCT’s and Local Authority Social Care Departments.
Over the last five to seven years, whilst all this has been taking place, provider organisations (particularly acute and mental health trusts) have become stronger, smarter and a number are demonstrating the ability to successfully gain foundation status thereby gaining increased independence from the NHS. Similarly, independent sector providers of Social Care have learned how to meet more and more regulatory, inspectorial and contractual requirements in order to survive and expand. Often one might be forgiven for thinking that providers not commissioners shape what is being delivered.
Given this background the message soon becomes clear. Local Authorities and PCT’s would benefit from pooling their commissioning skills. A lot more work needs to be done to face the challenges and requirements of the White Paper which seems to embrace modern values, principles and approaches to which most people would subscribe. Given the pressures and priorities described above there is much catching up to do if PCT’s and Local Authorities are to work together as envisaged.
Proposals due to be announced next month could have a single regime which assesses them against joint outcome measures. Under an amendment to the Local Government and Public Involvement in Health Bill PCT’s and Local Authorities will be required to produce joint assessment’s of the health and social care needs of their populations. Greater powers for local councils and more independence from national politics for the NHS will go hand in hand. Foundation Trusts will become possible new contenders for Community Services. Local authorities need now to work together to analyse the needs of their local communities and how to ensure they are provided for efficiently and effectively.
The benefits are real and tangible and make sound business sense. Agreed outcomes could encompass:
- Holistic and seamless services for service users
- Effective strategic commissioning of a range of services and entire care pathways for a user group from a single point
- Reduction and eventual elimination of duplication of function between agencies in service planning, management and delivery
- Rationalisation of the workforce and enhanced working practices
- Value for money through the intelligent use of pooled funds and other resources
- The elimination of disputes between agencies regarding relative responsibilities between agencies for the purchase and delivery of services
Working together to improve the health and wellbeing of the population makes eminent sense. The scale of change is daunting but there is already a vast wealth of skill, knowledge and experience contained amongst staff that have been working in community services for years. Given encouragement and support from a senior level, they are the means by which to make the necessary changes and improvements and overcome the organisational barriers and constraints. The real challenge is to invest the time and commitment to make partnership a real and high priority.