Bradford MDC and PCT

Interview with Moira Wilson, Strategic Director of Adult Services, City of Bradford Metropolitan District Council

Bradford Council and its partner health organisations have looked for opportunities to provide joint services since the early 1990s.

This, says Moira Wilson, Strategic Director of Adult Services stems from a long-term commitment to partnership working first triggered by a need to alleviate local winter pressures.

Since then the relative stability of key people across the NHS and social services has kept that commitment constant, as has strong relationships between the leaders of the health authorities and the council. Now she says the partners take a “whole system” approach when addressing any issue, which has been formalised by setting up joint commissioning posts.

But Wilson concedes that it has not all been plain sailing over the years. Until recently Bradford had four primary care trusts (PCTs) working in the borough, which she says, made joint working more challenging. Since October last year the council and the new Bradford and Airedale teaching PCT are coterminous, and this has given a step change in partnership working.

Appreciating different organisational cultures

The council and the PCT have also made significant efforts to understand and appreciate the different cultures that operate in each organisation. For example, staff from the PCT regularly attend committee and scrutiny meetings to get an understanding of the political role of councillors. Officers from both organisations work jointly and the healthier communities partnership plans to strengthen the joint working between political members.

And when inevitably people don't agree she says there are, and have to be, mechanisms for addressing that.

“People understand the need to find common ground; it's the way we do business. So people don't stand on their soapbox.”

She says the local strategic partnership is integral to this.

The sticking point for many partnerships can be risks and budgets. But Bradford with its joint commissioning teams avoids making unilateral decisions. Information is shared at all stages and qualified so all parties are aware of any constraints. Wilson says she has been positively impressed by how the partnership has overcome challenges and tackled problems creatively.

The council and the PCT take responsibility for certain elements of a service, but work under an overarching joint commissioning executive to ensure that the partnership work is sustained.

Wellbeing cafés

The partners have worked together on the health action zone and have integrated service delivery teams for mental health and older people's services. As part of this approach, the partners have established wellbeing cafés that provide support and advice on a range of health and local authority services for the older population. There is also a dementia outreach service for the south Asian community.

The partners have also chosen to work jointly in public consultations - with an infant mortality commission and a scrutiny review into obesity in the borough. The partners routinely make a joint response to any national consultation.

It is this shared mission to deliver services that has allowed the partnership to develop over the years. Wilson says a lot has depended on good professional and personal relationships that have helped to overcome cultural differences between health and local government. She says the partnership has already demonstrated its impact through its outcomes in the borough, many of which have been recognised nationally.

Interview with Dr Anita Sims, Director of Public Health, Bradford PCT

Most areas have signed up to partnership working to varying degrees but Bradford “has truly gone for it”, says Director of Public Health Anita Sims. Dr Sims' appointment is a joint one but unusually she is a Strategic Director on the board of both the primary care trust and the council. She says:

“This level of integration and commitment by a local authority is unusual for a director of public health. My brief is around health and wellbeing and it goes right across the service working with many parts of the council from social care to environmental health.”

The health inequalities and deprivation in the district has meant that partnership working between statutory organisations is imperative in Bradford, says Dr Sims.

According to statistics collected by the regional public health observatory, Bradford has a higher than average proportion of residents on benefits - 18 per cent compared to 13 per cent nationally. Over a quarter of children are living in poverty - 29 per cent compared to 21 per cent nationally. And life-expectancy for both men and women is lower than the national average.

Challenging infant mortality rates

But it is in the area of infant mortality where Bradford has real problems. It has the worst rate in England and Wales with eight children in every 1,000 dying before their first birthday. In 2004 Bradford's local strategic partnership decided to do something about this and set up an infant mortality commission, which came up with 10 recommendations last year. Dr Sims says:

“The commission was set up to look at the epidemiological causes of the high rate of infant mortality and to see what we could do in terms of joint action to address it.”

While the work on reducing infant mortality is long-term, Dr Sims can point to a recent success in encouraging smokers to quit that can be directly attributed to partnership working. Last year the four PCTs in Bradford district were merged into the Bradford and Airedale Teaching PCT which, says, Dr Sims has made partnership working more straightforward.

“My background is very much around the monitoring and evaluation side of public health. One of our weaknesses has been that there's a lot of stuff going on and we haven't been able to show what hasn't worked. Now that the four PCTs have come together we are setting up a Bradford [public health] observatory.”

Benefits of transparency

The benefits of having just one PCT have been felt in other ways, says Dr Sims, as it makes relationships between senior members of staff at the council and PCT more straightforward. There are now regular meetings between council and PCT directors and the two organisations are looking at ways to make savings by sharing various services.

“The thing that makes the relationship work is communication and being transparent and honest. If there is going to be some cost shifting we have created an environment where we can talk about it.”

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29 October 2007

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