Tameside Metrpolitan Borough Council

Stephanie Butterworth, Director of Adult Services

Tameside has a 10-year history of providing joint services in learning disability and mental health but in the last four years its partnership working has gone a lot deeper. The council and PCT now have integrated commissioning arrangements for older people's services with both parties signed up to a formal partnership agreement.

Stephanie Butterworth, Director of Adult Services at Tameside Metropolitan Borough Council, says there was a recognition that joint working was the only way forward.

"We realised that this was an area where we needed to work together. It made sense."

Health improvement posts

A more recent development has been the creation of two health improvement posts - one is based at the council and the other at the PCT with both employees working for both organisations. Tameside has significant levels of deprivation, and health inequalities linked to poor lifestyle are a problem in the borough.

Butterworth says the fact that the PCT and council are virtually coterminous has made the working relationship straightforward.

"It's less complicated for us. We're not working with a number of different PCTs."

The council and PCT can point to a number of areas where their joint working has made a difference to health outcomes. There has been a reduction in the number of people attending A&E following a fall as homecare arrangements have improved. Inappropriate A&E attendance has also been reduced. Beds are not being unnecessarily taken up in hospital due to social care delays. And people are moving into intermediate care much more quickly.

Where it is not so easy to get data is in the area of health improvement. Erika Wenzel, Executive Director of Neighbourhood and Community Services, says:

"We've not been going long enough here. We're just starting on the journey."

There are plans afoot to take the healthy lifestyle message out to the community, including a 'Know Your Numbers' campaign, which will offer cholesterol and blood pressure checks and give advice on healthy eating and exercise. Wenzel is keen for the health message to be taken beyond the doctors' surgery to places like the local museum.

Investment in community engagement

The council and PCT have long worked on community engagement and although certain events - such as Tameside's Annual Older People's conference - might have started off as council initiatives, they are now jointly owned. Butterworth says:

"It would be very difficult to unpick which was the council's work and which was the PCT's."

The close working relationship means that the council has been consulted on some of the PCT's staffing matters.

"The PCT is going through a reorganisation of its public health and they have been looking at the staffing structure. We have been consulted on this even though it doesn't directly impact on us."

The PCT is sound financially but if it were to have problems in the future Butterworth is certain that the relationship would withstand this. She says:

"There would not be any arbitrary cuts without consultation with us."

Dr Tim Riley, Chief Executive of Tameside and Glossop PCT

Tim Riley, Chief Executive of Tameside and Glossop Primary Care Trust, employs a little-used term when talking about building strong partnerships with other agencies: "friendliness". For Dr Riley a more personable business style strengthens professional bonds, which he and his organisation view as vital.

"Unless you can find common ground when working with people and develop a rapport, trust at an organisational level will be difficult."

The PCT has a strong partnership with Tameside Metropolitan Borough Council, which, says Dr Riley, has been formed over a number of years. The PCT also works with Derbyshire County Council as 30,000 of the patients it serves live in the county - this relationship has required more work. Part of the reason is geographical - Derbyshire County Council's head office is in Matlock, 70 miles from Tameside's.

Since Dr Riley became Chief Executive 11 months ago he has been working hard to strengthen the links with the county council. He says:

"Historically we have always had a good relationship with Tameside Council but the relationship with Derbyshire had been neglected over the years. One of the things I did when I arrived was to rebuild our relationship with Derbyshire."

He acknowledges that this takes time though.

Strong rapport

"It has taken some effort to make clear that we are a different organisation to the one that had become Tameside-focused, especially since some of the people were the same. However, through personal leadership I have been able to demonstrate a change in culture and approach."

The relationship with Tameside is so strong that the two agencies have been able to have some fairly awkward conversations with each other. Where, for example, teenage pregnancy targets were not being met and frank discussions were needed on where there had been performance shortfalls. Dr Riley says:

"Those kinds of conversations are difficult to have within your own organisation, let alone with a different organisation but our strong relationship allowed us to reach a mutual approach to addressing the issues."

Management responsibility for pooled budgets

There are a significant number of joint appointments between the two organisations and when discussing working together it's not a question but an assumption, says Dr Riley. However, one area where the organisations do not feel they need to share is pooled budgets. Dr Riley says:

"Section 31 pooled budgets can be counter productive. We support joint funding but it must be clear where the management responsibility lies. Pooled budgets can lead to suspicion about who's in control.

"There's a mutual recognition between the local authority and PCT that the level of trust is such that we don't need statutory agreements about how budgets are shared."

Dr Riley welcomes scrutiny as "another way of linking in with our customers". He says:

"We're not going to get everything right and it's good to have people asking questions."
Throughout the year, the council and PCT put on health conferences held at different venues across the borough, which address different themes, such as elderly care or children's services. Dr Riley says:
"These could have been tokenistic, but in practice they are an excellent way to connect with our population".

10 May 2012

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