Title

Councils should take time to make sure their partnerships with health services are robust, says Charlie Adan, who describes experiences at pioneering Herefordshire Public Services It is now beyond doubt that both the provision and commissioning of healthcare and the public health agenda are undergoing radical transformation. The localism agenda, the drive for community empowerment and individual responsibility, and tightening of public finances, all mean that local government is undergoing major changes. In future, more complex relationships between local authorities and the health sector will be critical to the wellbeing of our communities, and Herefordshire Public Services (HPS) has helped pave the way in bringing health and local government together in a uniquely-strong partnership. Created in early 2008, three years of relentless focus on developing HPS has helped forge an organisation planning, purchasing, designing and delivering care services which are centred on people's needs. Close to where people live and work, with a set of agreed values, it puts the people of Herefordshire at the heart of everything it does. As a result, the partners are well placed to face up to the changes now facing them. The primary care trust board is leading the transition arrangements with a fully-developed plan, and a Herefordshire GP consortium is a pathfinder. Places with strong local partnerships are well located to respond positively to future reforms, while others may find they have to engage with health colleagues in new ways for the first time. Charlie Adnan: ‘ Both local government and health focus on established good governance principles ' (Pic: Shutterstock) Herefordshire embarked on its partnership at a time when many said it could not be done and there were few precedents. It did so to deliver sustainable health and social care services in a county with a largely-rural, dispersed and growing elderly population. The partnership has helped develop a comprehensive shared vision for the county based on a range of economic, environmental, social and health drivers. Where initially partners had a general sense of direction, over time, this has become more refined into shared objectives with a joint corporate plan setting out the detail on strategies and policies. It may just be that by avoiding the temptation to agree a detailed common agenda too soon, a dialogue developed which enabled difficult issues to be resolved more easily. What is clear, is that the partnership has been built on strong and purposeful relationships, with mutual understanding and a respect for each other. ‘The NHS is a system, not an organisation,' NHS chief executive, David Nicholson, has said. Local government is also a ‘system', but we also still tend to talk about local authorities as organisations, and this might be a good starting point for recognising our differences. Both the NHS bodies and local authorities are political management organisations – where policies and strategies are set politically and implemented by employed staff. But that is also a vast over-simplification of how councils and health services work. Each body within the NHS is autonomous, but follows centrally-set criteria, and the new GP consortia will also work within a highly-regulated environment, just as local government operates within a statutory framework – although councils sometimes seem to exercise greater autonomy. Health boards comprise executive and non-executive directors and there is a quite different relationship among them when compared with that of cabinet members and directors in local government. Public health directors are both board members and advisers, while the role of the NHS board is different from that of council cabinet. There is no equivalent in health to the role of the full council, but all this is set to change. The success of any organisation depends on people doing the right things at the right time and in the right way. Although everyone involved may have quite different ideas about just what that may entail, the trick is to find solutions with partnerships sharing an understanding of what works best. Both local government and health focus on established good governance principles, but in reality, there are great differences in the way they operate. Notwithstanding any reforms, both health and local government are likely to retain many of their distinct structures, systems, processes and cultures. Before embarking on a new era of partnership working, it may be worthwhile taking time to recognise these differences and trying to understand each other's worlds a bit better. Tension and conflict often arise from misunderstanding. Time taken to develop an approach to partnering which respects the differences and reflects the similarities between the two sectors may prove just as valuable as any formal agreement. Received wisdom often suggests it is important to set out the detailed terms of the relationship at the outset, and a lot of effort can go into agreeing what this should include. Certainly, it is important to have clarity of purpose, but the experience in Herefordshire suggests to me a different approach is needed – and the relationship metaphor is quite important. Take a respectable amount of time ‘courting', and try ‘living together' for a while first. In other words, don't try and agree all the terms of the arrangement at the outset, allow relationships to develop and ideas to flourish. Don't try and write the ‘pre-nuptial agreement' before you are engaged – it is important to think about what happens if things do go wrong, but focus at first on making the relationship work, and then deal with the worst-case scenarios. And finally – bearing in mind that these relationships have got to work if the NHS and local government are to fulfil their roles – keep a sharp focus on what can be achieved by working together, and do not be distracted. Certainly, that is the approach which enabled Herefordshire to build a strong and healthy partnership, and to prepare it for the changes ahead. Charlie Adan is former interim assistant chief executive of Herefordshire Public Services

Title

WHITEHALL

Make time for courting

SUBSCRIBE TO CONTINUE READING