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HERTS AND MINDS - HEALTH AND SOCIAL SERVICES WORKING TOGETHER

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Joined-up working is becoming a reality in Hertfordshire as the barriers between health and social services are rem...
Joined-up working is becoming a reality in Hertfordshire as the barriers between health and social services are removed. LGC's Chris Mahony looks at how the new system will work

Speculation surrounding both the comprehensive spending review and last week's NHS Plan has centred on the possible transfer of services between the health service and social services departments.

In Hertfordshire, the county council and local health services have turned their backs on land-grabbing and agreed on a federalist approach, pooling sovereignty over specific services and then redistributing it. Each service has control over the delivery of care for specific client groups.

On the county side, members have approved a radical restructuring of personal services. Next April the children and families division of social services will merge with education.

Social services for adults will form a separate department but one whose budgets for each client group will be devolved down to a partnership board with a membership drawn from both county council and the NHS.

Caroline Tapster, the director designate of this adult care services department, says the restructuring is intended to cut down the barriers and reconcile the conflicting priorities of different services. ÒThe only way of dealing with some of the more difficult problems for any client group is getting rid of the boundaries between services.

'Most people we work with in adult services use both social services and health. We do not tend to have single-agency clients, but we organise ourselves like we do.'

The reorganisation is timed to coincide with a restructuring of NHS boundaries which will see just one mental heath NHS trust and the merger of the two health authorities serving the countyÕs population. Social services staff now working in community mental health teams will transfer to the single mental health trust. It will commission both health and social care.

This ceding of resources to the NHS is similar to the model already well established in Somerset. But Ms Tapster explains how her county and its NHS partners are taking the process one step further.

'We are talking about a building a community care and health commissioning arrangement. The health and local authorities will delegate their budgets for mental health down to this new partnership board. It will monitor what is happening and hold the trust to account.'

Given that the mental health service providers will now all be NHS workers, this could be seen as local government running up the white flag. Ms Tapster has a quick response to that. 'This is giving the local authority more power and control over elements of the NHS that we have not had - it is a trade-off.'

Meanwhile the county will take the lead role in the creation of community learning disability teams which will serve the county's large population of people with learning disabilities.

'Community nurses and psychiatrists have already been moving from hospitals into the community, helping these people into ordinary housing and the things that go with that. It seemed logical that the local authority should keep the lead with that.'

With the roles reversed in terms of staff reporting to a council management line, Ms Tapster says it is important the health authority continues to bear its share of responsibility through the partnership board.

The shape of the third adult client group, the elderly, remains less clear, not least because 10 primary care groups are due to merge into seven primary care trusts next year. But it will be multi-disciplinary and with social workers, social services and health managers and community nurses working alongside each other.

Social services staff will be aligned on a geographical basis with their health counterparts.

'We will be using the same principles as with the other client groups: a single budget, single assessment, you will only be asked once for your name and address. We don't know how all this is going to work out yet.

'Therefore we are aligning management arrangements - we will appoint a manager for elderly services on the same geographical basis as the primary care trust but won't go any further at this stage.'

Social workers are already attached to primary care groups, but the county believes joint working can be improved - over time. 'We can begin by aligning social workers alongside nurses so they start operating much more like community mental health trusts, but it will take a few years.'

Users, carers and staff have been closely involved in developments since the start, Ms Tapster says. For mental health workers particularly, she says, the changes may scarcely be noticeable.

She acknowledges that for social workers helping other client groups there could be more daunting challenges. 'Social workers are going to have to be much more accountable if they going to survive in the multi-disciplinary environment.'

As in all public services some of the biggest issues will involve money. Ms Tapster acknowledges the issue of charging will test the new arrangements. 'The agreements about how the resources are going to be divided up and what flexibility there is going to be will be quite important. It is a risk. We charge and the health service doesn't. Where it becomes difficult is if a package includes some things paid for by us and some by the health service.

'We already have several respite services that stop people going into hospital and rather than dance around on the head of a pin on how much is health care and how much is social care we put the respite care in short term for free. Once the package is in place the charging goes in. We can work through that, but it is a problem.'

Councillors used to transferring money between social services divisions to cope with unexpected pressures during the year may find their hands tied. A management agreement with the NHS will commit the council to ring-fencing a certain level of funding for each service.

Again Ms Tapster is upbeat, arguing some of the nasty surprises councillors are faced with during the year spring from NHS decisions. 'Some things the NHS does affect us and we will be able to influence that.'

Robert Ellis, Conservative leader of Hertfordshire, insists this plan is very much Hertfordshire's rather than a response to the government's demand for joined-up working. 'We have been thinking for some time this silo mentality was allowing people to slip through the net. A child is the same child whether it needs input from social services, education or health.'

He says that while members are both excited and nervous about the reorganisation, it enjoys all-party support. The charging issue will cause problems, but it is something the government will have to grapple with if it wants genuinely integrated care.

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