Interview with George Garlick, Chief Executive of Stockton-on-Tees Council

It is the “unusual continuity of people” and their close relationships that have contributed to strong partnership working in Stockton.

The council's Chief Executive, George Garlick and the director of adult social services and children's services, have both been in post for a number of years, with the primary care trust's chief executive for seven. Garlick says this continuity has proved hugely important in overcoming some of the challenges involved in joint working.

He says that the council and its other partners had to acknowledge that health is part of a national service and subject to national policy changes.

“We can agree things locally but these can be blown off course by changes in national direction. Health's level of discretion is nowhere near the level we've got and we've had to accept that.”

The pace of change in the NHS has been a huge hindrance in growing the partnership more recently, he says.

“We'd just get to a stage of development then the sheer rapidity of change in the NHS would jolt it away. We are learning to maintain sufficient distance from NHS changes, which often seem lost in functional structures.”

Due to these inherent differences the two partners have found it easier to have joint-commissioning roles based in both organisations. These long-standing posts in adults, children, learning disabilities and mental health have helped to integrate and deliver joint services. Garlick says the partners have worked hard on getting these posts to work effectively. But he says there are no plans to merge them into one organisation.

“The sheer differences in structures are so huge that to try and merge would be too great. The pace of change in the NHS would be too distracting."

Partnership networks

Despite such challenges, Garlick maintains that as a council Stockton has always emphasised working through partnership networks for a range of services. The local strategic partnership brings all of these together. He says it vital for partners to share a vision, have a common set of criteria in terms what they want to achieve, the standards of service and resource allocations.

“In the early days when we set up joint funding we had to work through our criteria. We then merged it and that formed the basis of how we work today. You can't operate on two sets. Otherwise services from the NHS would be entirely different.”

This joint criteria and commissioning approach has helped smooth some of the financial problems experienced across the NHS. Garlick says through joint commissioning Stockton hasn't had a single case of bed blocking in four years.

“We've haven't had the budgetary issues in health as others have. This is entirely down to our commissioning structure as it's the same person doing it across the council and PCT.”

The partnership also operates a community strategy that feeds directly into the local area agreement. It measures the impact of the partnership through a single set of health indicators and targets agreed and set by all partners. Garlick says it's vital that all the partners subscribe to them and jointly measure their successes and struggles.

Interview with Chris Willis, Chief Executive of North Tees PCT

North Tees Primary Care Trust and Stockton Council realised they had a common agenda in the community ten years ago. But the key to developing the partnership they have today was recognising and acknowledging the roles each one should play. Chris Willis, Chief Executive of the PCT, says:

“There is often a debate in health prevention about who should do what. We demonstrated that each had a part to play but inevitability some have a bigger responsibility. That has been very helpful for us.”

It was agreed that the council would lead on prevention, the PCT on treatment and there would be a joint approach to care.

Willis says that like any partnership you need to constantly work at it and recognise the differences in cultures and structures.

“There is a perception that the NHS is very centrally directed as opposed to local government being locally freed up. Health is part of a national service and you have to translate that locally rationally. You have to get over that tension and find where the gives are in the system.”

The continuity of people in the borough over the 10 years has given the partnership stability to grow. But Willis says they have worked hard to ensure it is not based around the relationships of individuals but that a commitment to joint working is filtered down to all levels.

“We developed systems and a culture that are sustainable without these leaders. As part of that we made sure that senior officers, councillors, frontline workers, non-executives of the PCT and health workers were all sitting round the table talking. That created so much more understanding and there was not quite the same room for myths and rumours. By joining up thinking, you avoid the fights and everyone is committed to sorting things out together.”

She says in some areas getting different groups talking has also given the two organisations new perspectives on service delivery.

“After library services and adult care groups talked we developed ideas on contacting hard-to-reach people.”

This culture has helped health and local government work closer on the ground over the years, as has the borough's coterminous boundaries. She says from the early days they tried to align their planning systems as they were “serving exactly the same people”. And in terms of efficiency single and joint commissioning teams have helped to remove duplication.

“We don't have loads of different people going around treading on each other's toes.”

Teams also work much more closely with pharmacy staff now working in tandem with care personnel in residential homes, for example, and leisure staff offering excise programmes in partnership with the nursing teams.

Willis says when times have been hard, particularly with financial challenges or organisational change; these have helped the partnership work more creatively.

She adds there has been a marked success through partnership working in some areas such as drug misuse.

17 October 2007

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