Shropshire County Council

Interview with Carolyn Downs, Chief Executive, Shropshire County Council

“'People do make partnerships.”

This is the view of Carolyn Downs, Chief Executive of Shropshire County Council.

Downs says a combination of the right people and the right circumstances has allowed the county to foster very strong partnerships over 10 years.

The fact that the former chair of the primary care trust (PCT) had also been a county councillor, she says, was very fortunate.

“It helped that we specifically had people in the PCT that understood local government.”

People have changed and moved on and she concedes that it makes a difference, but adds that there are just as strong links at all levels between the Acute Trust, the county council and the PCT.

She says having had just one PCT in the partnership for the past five years, rather than the previous five, has accelerated joint working. She believes even greater benefits can be achieved when the county changes to a unitary authority in 2009 which will help link housing services to the health and older people agenda.

Joint appointments and commissioning

Working with the PCT the county has helped to fund a number of joint appointments and commissioning. The partnership has numerous shared members of staff and a director of joint commissioning. Services have been redesigned and staff teams have been brought together. She says the partners have managed to overcome cultural differences through these joint teams, but it is a hindrance that terms and conditions between health and council workers can't be fully aligned due to different employment structures.

The nature of the partnership in Shropshire, says Downs, is very much about outcomes.

“Partnerships should be there for a purpose not for talking. We are involved in delivering services and are very productive. When partnerships become talking shops it is very frustrating.”

She says the financial climate in the county has been challenging with both the PCT and acute hospital trust in deficit for three years. This has tested the partnership, she concedes, with some lower level cost shunting getting in the way of working together. Equally the county council now has serious budget pressures, which causes frustration to the PCT and Acute Trust. She says this is where there are limits to partnership and again it comes down to people and relationships.

“When things are difficult and you are battling with budgets it comes down to the Chief Executive and the Chief Executive sorting things out. That's where the discussions happen regardless of partnership structures."

Technical differences and government policy can also get in the way of joint working, Downs laments. She says the differences between health and local government accountancy systems sometimes mitigate against doing large-scale capital projects, despite it making perfect sense to work together on projects like nursing homes. These “bureaucratic impediments” also exist in IT and payroll with health policy tending to pull the partners even further apart regardless of the obvious cost savings of merging systems locally.

Time for more change

There is also a frustration that health is wedded to its national public service agreement targets, which means the PCT is often hamstrung and unable to prioritise local health prevention needs because of Whitehall's pursuit of national priorities. However, new local area agreements may help in this area.

But nonetheless Downs says the partnership can't sit still and it is now time to inject 'more pace' in its bottom-up, top-down integrated healthier community strategy.

“It's time for more change.”

15 October 2007

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