The social services director who runs a hospital

    Jon Skone (pictured) is Britain’s first social services director also to run a district hospital. How does he combine the two roles? Jeremy Dunning reports

    Flitting seamlessly between social services and health is a way of life for Jon Skone. As director of social services in Pembrokeshire and county director of health with the Hywel Dda Health Board, he looks after not just social services but also the area’s hospital, Withybush General.

    This makes him the first director of social services in Britain to be responsible for a district general hospital. It is a far cry from his first job as a frontline social worker in Neath.

    “Taking on a hospital is quite something,” he says. “I don’t think anyone who’s not worked in a hospital has any idea of what they are taking on. They are fascinating establishments because they operate almost in isolation from everything else. For somebody used to one reporting line there are several in health.”

    This has created a “top-heavy” management structure – one that he is “whittling” away at.

    The role came about when the chief executive of the health board, Trevor Purt, decentralised the organisation into the counties of Carmarthenshire, Ceredigion and Pembrokeshire.

    The idea was for each to be managed by a county director, one of whom would come from an acute health background, one from a community background and one from a social services background. Skone gained the latter role.

    Joint role

    Alongside him, Angela Watwood, Pembrokeshire’s head of community care commissioning, was appointed to the joint role of head of community and primary care last March.

    Skone says he was insistent that Watwood joined the health board because he felt it would enable true integration to take place.

    The agreement reached between the council and the health board was for 50% of the duo’s time to be purchased by the board at an agreed cost for an initial 13 months. However, to free up some of his time, Skone’s previous responsibilities for housing and community safety were transferred to a colleague at the county council.

    So far, says Skone, the joint role does not require him to put in extra hours, though he thinks that is because he is accustomed to dealing with various priorities at the same time. He says: “One advantage of linking the two organisations at director level is that, because I am so used to working within a matrix of accountabilities, the need for negotiated governance arrangements [between the council and health board] has not been required, although as time goes on we will need to do some work on this.”

    Skone has had a steep learning curve. The language of the health service is different from that of social services and there is intense political pressure from the Welsh government to meet health targets, including on waiting lists.

    Meeting targets

    For instance, Skone is worried about meeting the target for patients in accident and emergency to be seen, treated and admitted or discharged within four hours.

    This is not to say that pressure from local government is any less. Skone says it is a “different sort of intensity” at the local level.

    The thinking behind such a role is to secure savings. So far none has been secured, but Skone says the potential is there after the impact of health service reorganisation in Wales, introduced in October 2009, has been fully worked through.

    The new structure ended the internal market between purchasers (the health boards) and providers (hospital trusts) by creating integrated boards responsible for all local NHS services. At the same time, the number of boards was cut from 22 to seven.

    It is this reform that makes Skone’s role as a social services director with responsibility for a hospital possible, something that could not work in England where joint posts sit across councils and primary care trusts, which commission but do not provide acute care.

    Skone says savings will accrue from his ability to see what happens when people move through the health and social care system, identify where blockages occur, and examine the impact of pooled budgets.

    He is a strong advocate of integration as the only way forward: “Working across both organisations does provide us with real opportunities for mutually riding out the approaching financial storm and driving the integration agenda without having to rely on formal partnership agreements.”

    As a result Skone, who along with his team of six is based at Pembrokeshire County Hall rather than the hospital, sees potential for his role – still a “work in progress” – to become the norm across Wales.

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