Behind the headlines

The government’s plans for more integrated working between
health and social care have been dealt a blow following the
dismantling of the country’s first joint social services director
and primary care trust executive role. Julia Ross is now to work
solely as social services director for Barking and Dagenham
Council, which claims that Barking and Dagenham Primary Care Trust
wanted to dismiss her after the PCT was given a zero star rating in
July. The local authority said this was unfair given that the PCT
received insufficient funding from the government in an area of
high deprivation. But the council decided to scrap the role. The
joint post was created two years ago and was heralded as a
pioneering move leading the way to closer working between local
government and the NHS in line with the government’s joint working
strategy. Similar joint posts have been set up by Knowsley and
Southwark Councils among others. The council’s chief executive
highlighted a greater tendency in the NHS to blame individuals for
an organisation’s performance.   

Bob Holman, community worker at a project in
Easterhouse, Glasgow

“The politics of this decision look murky and the outcome is
disappointing. Two main lessons can be drawn. First, that
partnership working is inherently fragile, and needs roots that are
strong enough to survive such crises. And second, that the position
of individuals needs to be separated from the role attached to
positions. Effective partnership working cannot be entirely
dependent upon one individual.”

Julia Ross, social services director, London Borough of
Barking and Dagenham

“Councillors are elected by local people to serve local needs. At
the moment, the health service is larger, more bureaucratic and
even more political. What I have learned is that it takes a lot of
listening and constant finessing to bring and keep together two
different cultures, especially in an area of London under-funded by
£24m. We have changed accountabilities in order to bring about
a stronger focus on improving primary health care. Integration will
only work when we bring together cultures better and don’t panic
when things go wrong. We must learn how to stick together through
bad times as well as good or we will never improve health.”

Bill Badham, development officer, National Youth
“Barking and Dagenham Council says it ended joint
management of social care and health because of poor PCT
performance and differences in culture and accountability. The
manner and timing of the decision is not good. Locally stated
commitments to joint working will sound hollow when the decision
was made with no evidence of consultation or thorough review.
Nationally, it clashes with the green paper on children that
announces pooled management across sectors.”

Felicity Collier, chief executive, Baaf Adoption and
“This lack of agreement between the NHS and the council
over such a critical leadership issue has the makings of a fiasco.
Agreed protocols should have been in place, with arbitration if
required, before any joint appointments were made. And where is the
communication strategy that will inspire public confidence? The
Department of Health should have made greater efforts to resolve
the impasse if it wanted the integration agenda to succeed. It is a
relief the council is to safeguard its staff.”

Martin Green, chief executive, Counsel and Care for the
“This move fills me with dismay, but it demonstrates the
problems that arise when you try to force two structures into more
co-operative working. It shows that if we are going to have
integrated services, they need to be within one structure that is
accountable to one single governing authority. This situation
should provide the government with a wake up call. It needs to
start thinking about how you integrate services and structures and
they need to do it now.”

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