Kent Council and PCT

Interview with Peter Gilroy, Chief Executive

Peter Gilroy, Kent County Council's Chief Executive compares the local healthier communities partnership to family life: “not always happy but the closer you are in crisis the more likely you are to work together”.

In fact, Gilroy says the health economy in Kent is viewed as a family of public services all knitted together as one unit. He says it is this recognition that "we are all in it together" that has provided the glue for a successful partnership and allowed the county "to unhook itself from linear thought”.

Gilroy says the partnership has enabled the council, in particular, to transcend its traditional silo-based barriers to provide more support to its partners and to work more creatively. He points to Kent's TeleHealth system as an example. This provides remote and social care counselling sessions to patients on camera and is designed to promote independence with the added benefit of freeing up more clinical time. Kent County Council provided the £1.5 million needed for the scheme, despite it being a health and social care related project.

“This is a family of services - we recognise that people care less about who provides the service, what they want is a seamless approach. It's part of us pushing the envelope. The Department of Health came down for a presentation and were impressed that they couldn't tell who was from health and who was from local government because it's a family of services.”

Constant change

He says continuity of relationships has also been important in Kent and a constant churn of key people can disrupt partnerships. Within health there has been continual structural change in the past few years but he says that many people have simply changed jobs but stayed in Kent.

“People are still here and that does make a difference, it can be all about the sort of relationships you have. When people are new you do what you do in any relationship, you work at it quickly.”

He concedes that there are often issues of difference between the partners but they try and work as transparently as possible. He adds that they have also had to work to ensure that the "cut and thrust" of local politics and the national policy agenda do not destabilise the partnership.

He says public services in Kent are almost unique in their tradition of attracting innovators at a senior level both in the council, health and the police.

Maintaining the glue

The partners have also worked hard to "maintain the glue" of their joint working says Gilroy. He says strategic infrastructure is important with a public services board overseeing the partnership, which includes the public private and voluntary sector including district councils and the PCTs. It has also worked to break down traditional cultural barriers. Health officers have given evidence and spoken at council debates, which have then been webcast to residents.

"This gives colleagues an opportunity in health to educate members while orientating themselves with our infrastructure.”

The latest innovation in maintaining this glue is a strategic leadership programme being run by Kent County Council in collaboration with the University of Kent and Imperial College London, and a range of public and private sector organisations including Veredus, Tahaka Business School, Edexcel, Cap Gemini, Accenture, Kent Police and Kent First Rescue Service.

This is the first of its kind in the country and offers places to 10 senior officers from the partnership including a cabinet member, the assistant chief constable and two district council chief executives. The officials have to work on real business problems, which will ensure they “come back to the ranch with a much wider angle”, says Gilroy.

Interview with Ann Sutton, Chief Executive of Eastern and Coastal Kent PCT

“Pockets of severe deprivation in Kent and an acknowledgement that the primary care trust can't tackle health inequalities alone focuses the mind to work collectively.”

Ann Sutton says it became clear that improving health is dependent on decent housing, employment and education, none of which the trust has a responsibility to provide.

“We know that the PCT can't deliver a reduction in health inequalities in our areas such as Ramsgate and Margate without the help of others.”

Sutton says the area, which has both district and county councils, has a history of working together that has been built up over time. It is testimony to the strength of the partnership, she says, that it has managed to withstand various reorganisations.

The latest in October 2006 created the PCT in its current form, and Sutton took up the post. But she adds that she has worked around the county for a number of years and had built up personal relationships based on 'mutual trust and respect', which was crucial for the continuity of joint working.

Shared values

Sutton says:

"There is a mutual philosophy of partnership across the county. We all acknowledge the value of working together. People here expect to work in integrated teams. There is a strong determination to find solutions to problems and we have a zero tolerance approach to financial disputes."

She concedes that the healthy and stable financial state of the PCT, compared to others, has been a huge advantage. Being able to actively resource and commit funds to the partnership has helped it grow, she says. Having confidence in its partners, being prepared to pool budgets and to hand over money when needed have been vital.

The PCT has already incentivised the six district councils in the region to work on health prevention by giving each one £100,000 to pump-prime a health and wellbeing subgroup. When it closed an old hospital in the area, it handed over the £1 million needed to get residential services back on track to the council's social services department and Age Concern through section 31 agreements.

Inevitably there are some tensions about budgets, Sutton says, but the partners have an open book approach and this transparency ensures that everyone is aware of funding issues.

Overcoming cultural differences

There are some challenges to working in a two-tier area Sutton says, but we are very comfortable in working across a whole range of organisational boundaries.

She adds that cultural differences have largely been overcome through a long history of joint working. The partners have a number of integrated teams and the PCT and Kent County Council have a joint director of public health. The trust has also aligned its executive and non-executive directors with the district councils. Health can also learn a lot from local government in terms of accountability, she says, but they try and focus on the similarities not the differences.

“We have a strong drive here to improve services and not let cultural differences get in the way of that.”

15 October 2007

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