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• Argument over dismissal led to break up of pioneering role

The same is true of health and social care with many differences to be overcome.

This challenge is central to the government’s agenda for care trusts to be formed for the delivery of adult services, and children’s trusts, which both require staff to come together and form a single body.

Recent events in Barking and Dagenham have shown that even a new arrangement held up as a model for the future can easily be buffeted by events. It shows that closer integration, which is short of being a care trust, can still be a rocky road.

In this case the cold winds of a zero star rating for one of the partners, the primary care trust, led to a fall out over how to respond.

The PCT and strategic health authority wanted to make the holder of the joint leadership role responsible for the poor inspection outcome by dismissing her.

But Julia Ross’ employers were still the council and it made a unilateral decision to withdraw her from the role, leaving the PCT to find a new chief executive.

Graham Farrant, chief executive of Barking and Dagenham Council, said structural change in the NHS led to misunderstandings between both sides of the partnership. The arrangements were drawn up with the former Barking, Dagenham and Havering Health Authority, which was superceded by North East London Strategic Health Authority and a primary care trust.

“It was set up with the previous health authority with a clear understanding of what the advantages were, but the current strategic health authority does not have the same view of it,” he says.

The primary care trust has also evolved quickly in three years since it was formed, taking on more services and powers from the time when the arrangement was drawn up, which also changed the dynamics of the relationship and placed extra responsibility on Ross’ shoulders.

Farrant is eager to stress that the relationship will still flourish, pointing to many examples of how this is benefiting service delivery especially in older people’s services.

New lines of accountability have been drawn up though with staff who were reporting to Ross in her joint role, now either answerable to her as social services director or to the new PCT leadership.

One point of contact

In Barnsley a different approach has been taken, with a sophisticated commissioner/provider relationship developed to ensure joined up services and one point of contact for the service user.

Six boards have been formed by the council and Barnsley Primary Care Trust, and each one commissions services. A lead provider, either the council or the PCT, is then contracted to deliver those services.

Social services is the lead provider in learning difficulties and children’s services, with the PCT controlling services for older people, disabled people and mental health sufferers.

This set up is overseen by a ‘joint agency group’ made of councillors, chief executives and treasurers of the two organisations, and the JAG allocates the budget to each board.

Staff are ‘seconded’ from social services to the PCT and vice versa, and they are given the option of retaining the same pay and conditions or of taking on the terms of the lead provider.

The lead provider only manages the staff member in their day to day job, but their contract remains with their employer and they can go to their ‘original’ manager to discuss personal or professional issues. So, for example, nurses seconded to the council retain a manager from a medical setting.

Graham Gatehouse, Barnsley Council’s social services director, says it is vital staff can keep their professional background. It gives them the confidence to know they have support behind them as they go into a joint team environment.

Cross the boundaries

Mark Feinmann, who is joint general manager of learning disabilities, working across the boundaries of three organisations, agrees that you have to keep staff onboard all the time.

“That’s the job – negotiating with people and engineering compromises. It’s bringing people to water and getting them to drink together rather than forcing change on them,” he says.

Some people actively resist closer working arrangements, he admits, and that is because they fear a take over by the other side.

He brings together services and 250 staff from Glasgow Council, Greater Glasgow NHS Board and Greater Glasgow Primary Care NHS Trust. He has an enormous workload and the job is very stressful, but he believes in what he is doing: “I am convinced it is the only way to go, and there is a fairly strong view in Glasgow that this is the only show in town.”

The key element in the equation is support from the top: “It is when you haven’t got support upstairs then that’s when you struggle,” he says.

Feinmann is accountable to a joint board, similar to the JAG in Barnsley, which is made up of the chief executive of the PCT, the deputy director of social work, the deputy commissioner of the health board, senior councillors and non-executive members of the trust and the health board.

Any disagreements between the organisations are thrashed out in meetings of the joint board. There are other officers with dual roles such as joint general managers for homelessness and drug addiction, who also report to the board.

So there are other models of how to run a joint arrangement successfully. Barking and Dagenham was certainly the most high profile example, which was examined by other authorities such as Barnsley, but for areas starting out on this road there are some interesting innovations which could be copied.

If a closer working deal is too complicated for some then there is always the option to go the whole way and create care trusts, which are being piloted in eight areas.

Will Barking and Dagenham’s experience put off some potential partners?

"Must have an impact"

John Ransford, who is director of education and social policy, at the Local Government Association, said: “It must have an impact simply because it is so high profile. The Department of Health used and pointed to it.”

He believes service users rarely differentiate between providers, and just want flexible and adaptable services. He doesn’t believe anyone should be prescriptive about how service providers are structured.

“The LGA has always wanted to think of care trusts and children’s trusts conceptually,” he says. Local solutions based on a theme of much closer working is the best way forward.

“We have to remember that we are dealing with fundamentally different cultures. The NHS is obsessed with avoiding a postcode lottery of services, whereas local government is about postcode difference,” he says.

But Ransford does not want too much caution to seep into people’s minds, or barriers will not be broken down.

“When you have a pioneering thing risk taking is very important,” he says.

Perhaps others areas will have to suffer setbacks like Barking and Dagenham has experienced before progress can be made towards the cultural harmony needed if closer integration is going to work.

The government obviously needs to be patient if partnerships are to be allowed to work through the problems they encounter. But with only three years given in the green paper on children for children’s trusts to be established, will ministers be prepared to wait?