Local authorities and PCTs
Under the proposals of the new White Paper 'Equity and Excellence: Liberating the NHS', Primary care trusts (PCTs) are to be abolished by 2013, resulting in a restructuring of councils' responsibilities in relation to health improvement and the coordination of health and social care.
The Local Government Improvement and Development's (formerly IDeA's) National Adviser for Healthy Communities Liam Hughes introduces a compelling series of case studies that explore the relationships between councils and primary care trusts (PCTs). These case studies, which offer an insight on how good partnerships are forged, will continue to be important long after PCTs are abolished. Organisations may be restructured or close and new ones may take their place. However, excellent practice and experience of various localities remain as lessons learnt and they are always valuable as good partnership and the basic principles to make it happen are totally transferable and a prerequisite for success.
They are expected to work together to identify local needs and priorities, and to make improvements. This requires them to become both better service providers for the whole population, and more effective leaders in their local partnerships. The chief executives of these organisations have key roles in making partnerships work. They also have to handle inter-organisational pressures that arise from time to time, given the differences in governance and accountability between them.
The IDeA's recent research into the essence of these relationships demonstrates this can be very demanding. It also illustrates the high level of commitment and application given by these senior public representatives to making a difference for local people.
In many parts of the country, effective long-term alliances have been in place for many years, and better services have been produced as a result of the strong working relationships nurtured between these executives. Over the past two years, progress has been interrupted in some places, and stretched to breaking point in others. This is due to an imperative to control health service deficits and the disruption associated with PCT mergers.
Despite this, in most parts of the country, the senior managers have kept their partnerships on track, and are preparing for the new national strategic framework with enthusiasm. The local area agreements (LAAs) have moved firmly to centre stage, and there is renewed interest in both the health of the whole population and the longer-term future of the area. The chief executives in this study have clearly understood the bigger picture and risen to the challenge of local leadership. Even when disputes have arisen, they have been dealt with maturely.
Vital ingredients for good partnerships
From the reflections of both executives, local authority and PCT, it is possible to identify some of the key features of effective partnerships. Pride and passion for the local place and its people shine through. It helps if there is a shared long-term vision for the area. In Greenwich, it is recognised that local regeneration needs the support of both the NHS and the local authority if it is to lead to sustainable improvements. In Lewisham, Barry Quirk and Gill Galiano, respectively the chief executives of the council and the PCT, share a common determination to increase the pace of improvement.
In Barnsley, the driver for change came from a joint recognition that public services had failed the local populations, and the two chief executives rebuilt their local partnership in a very demanding turnaround situation. It allowed them to take risks and to think more radically about the objectives and nature of the local partnership.
Long-term joint working can help. In Stockton, the seven-year partnership between local chief executives has helped with long-term planning. Both Chris Willis and George Garlick stress that this stability has helped them maintain the momentum for improvement. The view from Cannock Chase shows how difficult it has been for district councils to do this in the face of PCT mergers, and there is a keen sense of what has been lost. This sets quite a challenge for the new PCTs.
In Gateshead, the complex sub-regional health arrangements have raised anxieties about the strength of local roots and relationships. The new sub-regional organisations for mental health and primary care seem more remote from local government, even if they are more strategically placed from the NHS viewpoint. The successful partnerships have been proud of the political support they have been given. They see they are valued for their involvement in local partnership issues.
Making a difference
But funding does make a difference. Take the example of Kent, where the Eastern and Coastal PCT, which has been in relatively good financial health, funded health prevention through the district councils and the county council has paid for the TeleHealth system. Contrast this with the conflict concerning the deficits and cost-shunting in Brent. It is very difficult to maintain the morale of a local partnership when the financial figures are so large and potentially unsettling. The tension between cities and rural areas concerning the fairness of their allocations also plays into this, with each feeling they have lost out to the other. Despite the scale of the problem last year, there is a renewed sense of confidence in most of the localities that took part in our interviews.
Expectations are rising, and local partnerships will have to raise their game. Caroline Taylor from Croydon PCT reminds us that partnerships exist for a purpose and are of no use unless they deliver real benefits to local people. The LAA framework has been designed to move them to a different level. The next 12 months will test the local resolve of those senior people to work effectively across local organisations, and challenge the capacity of these organisations in the face of the clear demand to make a difference.
13 November 2012