Barnsley council and PCT
- Interview with Phil Coppard, Chief Executive of Barnsley Council
- Interview with Ailsa Claire, Chief Executive, Barnsley PCT
Interview with Phil Coppard, Chief Exectuve of Barnsley Metropolitan Borough Council
“It was failing services in Barnsley seven years ago, and the shock of recognition that something had to be done, that spurred on partnership working."
Chief Executive, Phil Coppard says this recognition coincided with a regime change at both the health authority at the time and the council's social services department. The new leaders, faced with dire health inequalities and social services in special measures, realised the only way of getting out of that was to pool resources and expertise.
“New people came in and it was all about personalities. Their frame of mind was allied to the ethos of strategic partnerships. They knew where they wanted to take it and where they wanted to go with it from there.”
He says the strength of the partnership still does rely on the four leaders - Coppard, the Chair and Chief Executive of the PCT and the Leader of the Council - working together.
“It's not always smooth but the four of us keep it on track.”
Today, he says, the partnership is at the cutting edge of social service and health delivery. It is piloting individualised budgets and delivers integrated care through five boards covering older people, mental health, physical disability, learning disability and drugs, alcohol and tobacco.
For the last two years social services have been judged among the best in the country, with a three-star rating, along with a high performance rating for mental health. He says the partnership was key in getting services up to a higher standard. He recalls:
“There is no question that the partnership helped us to get out of special measures. People could visibly see that by working together we could do it, and it inspired confidence."
He says there is now an all-embracing approach to partnerships in the borough and they tend to enfold agencies into it. The coterminosity of all the partners has undoubtedly helped this, he says.
"Being able to work with the council, PCT and police within the same boundaries has made things so much more straightforward."
But the partnership has not been without its challenges. He says the constant change in the government agenda can make partnership working “uneven and messy”.
“For us there have been loads of issues around health reorganisation, we've had to hold things back. And there are continual directives on adult care. It is a picture of constant institutional change that we have to adapt the partnership for.
“Cultural differences and government systems can also get in the way. Inspection regimes do tend to pull us apart. You don't get brownie points from them for the trade-offs you have to make to work together successfully.”
He adds that individual staff can get territorial.
“If I had a pound for every time someone referred to ‘our' part of the pooled budget, I'd be a rich man.”
The partners have overcome some of this, he explains, by insisting on pooled budgets that are reallocated on a partnership basis. He also concedes to a few tensions with the council's backbench members, many of who are concerned about a perceived “democratic deficit” in the partnership.
“Reporting back hasn't been as good as it might and we need to work on that.”
Interview with Ailsa Claire, Chief Executive, Barnsley PCT
It was failing services in Barnsley forging such a strong partnership that today it is leading the way on individualised budgets for care. Ailsa Claire, Chief Executive of the PCT, recalls:
“Everything was so awful in many ways that unless we worked together we knew that none of us would solve anything.”
She says the partners started seven years ago by having “honest conversations”.
“It was not about who was in charge but if we could make things work.”
The political leaders were prepared to make that cultural shift she says. And with a cabinet structure and coterminous boundaries, the partners she believes, have forged one of the most advanced integrated service models in the country.
The vision behind the partnership was to change residents from being “passive” and dependent on the state for services to being more responsible for their own care.
“We couldn't keep telling people what was wrong with them, that was not the right approach and we realised we needed a new one.”
For this change the partners required a different infrastructure and they took the huge step of merging their adults, children, disability, mental health and drug prevention into one joint system with pooled budgets and joint commissioning. They have five directors overseeing the services and joint criteria for all delivery.
The next stage is moving towards self-directed care with individualised budgets, which the partners are piloting. As part of this it has stepped up its engagement with service users, away from focus groups, to asking patients exactly how they would spend their own budgets and what they would expect.
“It has been a way of getting more people involved and we've seen that people require completely different services. In two to three years services will look completely different to what we have at the moment. It's been quite a test and led us to question our own services and ask if they are viable.”
She adds that it will put control back into the service users' hands and break the dependency on the state.
She says that one of the biggest difficulties with such integrated partnerships has been with people holding on to the more traditional ways of working.
“We do point out that this is the way the clients want their services, so in a way we can take the moral high ground. It's not command and control line management and some people have had difficulty with this.”
The quartet of Council Chief Executive, Claire, Leader of the Council and Chair of the PCT, has also helped to maintain and reinforce this distinct way of working, she adds. But in political terms some of the members are also attached to old ways of working and overcoming this has caused tensions.
Structural and policy differences have also caused some problems, with neither financial nor accounting systems in health and local government matching. In addition, changes in Whitehall policy can test the partnership. She adds:
“The national IT programme for health and its requirements has a tendency to split us off from the council.”
But from failing services both the PCT and council now provide services in the top five per cent and have been early implementers for local area agreements.
17 October 2007