Acute problems of trust

The breakdown in relations between Barking and Dagenham Council and
the local primary care trust will cause concern further afield than
east London.

Barking and Dagenham was the first area to appoint a joint director
of social services and PCT chief executive; a brave move in a
deprived area with mainly sole practitioner GPs, but the gamble
appeared to be paying off.

Appearances were deceptive. Barking and Dagenham’s downfall
highlights several obstacles to integration, which will have to be
addressed, otherwise – as happened there – when the heat is on,
joint structures will melt away.

Despite a recent positive appraisal, the chief executive of the PCT
and director of social services, Julia Ross, came under intense
pressure when the PCT received a zero-star rating. Public sector
managers must not be treated like football managers, particularly
as the NHS star ratings are a blunt instrument, which ignores local

In a partnership where a PCT and a council are accountable for
managing staff and agreeing strategic and operational decisions,
both partners must share an analysis of the challenges, the way to
overcome them, and the outcomes by which success will be judged.
Such an agreement may have existed in Barking and Dagenham, but if
it did, it soon dissolved under pressure.

It is impossible, however, to ignore the suspicion that such an
agreement never existed in a meaningful way. Perhaps, in fact, all
that matters to the NHS is acute care, with primary care only
featuring on the radar when a problem, which managers of course
already understand, becomes a crisis in the eyes of the powers that
be. Then panic ensues.

There is much work to be done in many areas to make the NHS fit for
true partnership. Those working hard on the ground to make
partnerships work will only hope that the Department of Health can
lead the massive cultural change required, given the sheer lack of
interest within the NHS in many areas, and particularly given the
greatly reduced presence of social care within the department.

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