Lewisham Council and PCT

Interview with Barry Quirk, Chief Executive of Lewisham

The aim of the 10-year partnership in Lewisham is to provide citizen-focused and people driven public services. The council's chief executive Barry Quirk says this focus has demanded a huge cultural shift in the borough.

“All organisations are inherently provider driven. You have to turn public service organisations inside out to remind them that they exist for the public benefit. That has been the responsibility of those at the top of the organisation, to remind people what we are about. This is the ethic of partnership working across the public sector, to build the size of the cake and the capacity of our organisations to deliver.”

This cultural leadership has been the bedrock of the partnership, Quirk says. It has depended to a large extent of the continuity and exchange of senior personnel at the council and the primary care trust.

Recently, he was involved in appointing the chief executive of the trust and the directly elected Mayor, Sir Steve Bullock was Chairman of the local hospital for six years. He says these managerial, governance and political connections are crucial.

“There are very good operational connections as well as these strategic links - this creates a high degree of trust. People say what they mean and stick by it.”

Solid partnership working

He concedes that the partnership has been tested over its 10-year history most recently by the financial management problems in the NHS.

“There has been an air of budget management crisis in the financing of some health services in some parts of London. This did stretch the trust and confidence in the partnership. Put bluntly, it has been quite difficult on the PCT side to afford some of the partnership agreements. But partnership realtionships are not a straight trajectory - they are not in anyway linear. The recent blip has been overcome through solid partnership and high-trust working between the PCT and ourselves over the last six months.”

He says the “classic functional rigidities” of professionals across public service has also been a challenge at times.

“Specialism is crucial but unfortunately, it can sometimes be accompanied by the
arrogance of the expert. This is evident in professionals as varied as civil engineers and medical professionals. These professional rigidities can affect how you manage change and how you encourage people to work across professional boundaries to solve multi-disciplinary problems.”

He says it's important to respect different perspectives on common problems and while sometimes you need to bring these perspectives closer together, at others you need to let people work more independently.

“Local government is quite good at this as we already have so many different professional cultures and specialisms. We take children into care and we encourage waste recycling.”

He adds that the different cultures have to be understood and that “the best partnerships come from people most confident in their own professions and specialisms”.

Lewisham currently has joint service delivery in children's and adults' services, including pooled budgets and commissioning. Partners locally are keen to push their citizen's focus even further and have widened their public engagement to using citizen's panels as well as consulting residents at large.

“We are not just trying to change the behaviour of service providers but also of service users. Our service engagement is focused on best practice proposals for change. We need to build the widest consent for change - among service providers, service users as well as taxpayers and citizens locally."

Interview with Gill Galliano, Chief Executive of Lewisham's PCT

Gill Galliano, Chief Executive of Lewisham Primary Care Trust says:

“Lewisham is a borough for everyone. People here are always open to looking at what we could do better and the commitment to that makes for very strong partnerships.”

Galliano says there has been a robust recognition of the key part local government plays in the health and wellbeing agenda, with all partners determined that people access good preventative services rather than sickness services.

“We work together and look across children's, adult, housing and employment services.”

The partners have had a joint commissioning structure across children's and adults' services for four to five years. This has helped integrate services to ensure they are seamless between the partners. They also pool budgets and work together on providing individual packages in mental health, social care and nursing services for the borough's residents.

Galliano says the political strength and the support of a joint agenda has played a central role in the partnership's success. Lewisham has a directly elected mayor who works closely with the council's chief executive and the borough's partners.

“Both are very open to change. They are supportive personally and they don't want to stand still. They are people that want to work together and seize the moment.”

She says it has been crucial that both partners understand that they need each other and must to be supportive.

“Everyone has the same agenda and is on the same wavelength."

So much so that the council is seen very much as a key player in whatever the PCT does. In two of its recent inspections, PCT officials were invited by inspectors to meet them and feed in their views on the council's performance.

She says cultural differences between health and local government have slightly hindered the partnership, with the NHS often slow to make decisions. But she adds that this can also be the case for local government's committee system.

“It can be time consuming trying to get agreement.”

But the financial problems seen in health recently haven't slowed things down in Lewisham because, says Galliano, the partners have “sat down to work things through”.

“We understand that historically contributions will change. Sometimes they will pay more than we do and vice versa. But we know that gradually over time money will move to the right pots as we understanding funding more. We are talking about doing more and we recognise that if we want change to happen quickly we have to pump prime that.”

The partners have joint priorities and targets through the local area agreement and are focusing on raising life-expectancy in the borough and lowering infant mortality and teenage pregnancies. The sustainable communities strategy for the borough is currently being refreshed and she says it will build on what has already been achieved in the borough.

15 October 2007

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