Dagenham, as plans to become the first locality in the UK where social
services and health care are led by the same manager, are unveiled.
When it launched the NHS Plan last year, the Government set out its vision
for far reaching and fundamental changes to the way that patient centred
care would be provided in future. A key part of the Plan was the call for
health and social services to overcome their traditional divisions and to
work effectively as partners in care to provide a seamless service for
patients tailored to their particular needs.
Following the appointment of Cllr Ray Parkin as chair of the Primary Care
Trust Board, the current Director of Social Services, Julia Ross, has been
made Chief Executive, to establish this innovative model between the Primary
Care Trust (PCT) and the Local Authority.
This means that Julia Ross would be effectively managing a combined
operation, serving both Social Services and the PCT, subject to the
Secretary of State's approval.
The Health Authority and Local Authority have recently made significant
progress in partnership working and this new model of integrated care is
seen as a further extension of this good work and an opportunity to build on
the partnership success.
This unique step will lead to much closer relationships between health
services and the Council, consequently
leading to better and improved services for residents in the Borough.
The new Barking and Dagenham PCT, which starts on April 1, has the potential
to make real improvements for patients, making the health and social care
system easier to understand, simpler to access and more convenient to use.
New Chair of Barking and Dagenham PCT, Ray Parkin, believes it is just a
matter of time and that the best way to catch up is to join primary and
community health and social care services as much as possible.
He said: 'I have always wanted to see health and social care being brought
closer together. I want to see people's health and well being improved and I'm more
interested in setting that right than who does what. This will make my
vision a reality.'
Mrs Ross joined Barking and Dagenham Council as interim Director in November
1998 and was appointed as permanent Director in June 1999. Julia comes from a nursing and social work background.
Mrs Ross said: 'This really will make a real difference. We'll be able to
drive through all the improvements people want to see simply by working
together to a common purpose more closely.This model makes it easier to
focus on peoples' needs rather than service boundaries.'
She added: 'This makes perfect sense for GP's and primary care teams, social
workers and nurses. But even more important, it makes sense for people
needing health and social care.'
Sue Osborn/Susan Williams, Joint Chief Executive of the Health Authority,
said: 'We are extremely pleased that Julia Ross has been appointed as Chief
Executive of Barkingand Dagenham Primary Care Trust.
Building on partnership success of the past by strengthening partnership in
Delivering the vision for integrated health and social care
The Health and Social Care Bill which is currently going through Parliament
proposes the possibility of a new integrated Care Trust.
In Barking and Dagenham the local authority and health authority have taken
that message to heart and are planning to establish an innovative merged model of management across health and social care between the newly created Primary Care Trust (PCT) and the local authority. Effectively, that will mean the posts of Chief Executive of the Barking and Dagenham PCT and Director of Social Services for the London Borough of Barking and Dagenham are to be combined.
How it will work
This model falls short of a full Care Trust, as suggested in the NHS Plan,
at this stage but will have dual accountabilities and joint governance arrangements at a local level and provides the potential for all the benefits for the patient/ user of integrated health and social care. It will also build upon the already
existing partnership success between Barking & Havering Health Authority and
Barking and Dagenham Council.
This new model will help bring about a radical redesign of the whole care
system with social services being delivered in new settings, such as GP
surgeries. It will also enable social care staff and health care staff in
primary care teams such as GPs, health visitors and primary care nurses, to
work alongside each other as part of a local care network. A key test of
these closer-working arrangements will be how well they deliver improved
The new Barking and Dagenham PCT, which commences on 1st April 2001, and the
Local Authority's Social Services department have the advantage of
co-terminus boundaries and share a Borough with high levels of
deprivation - the 7th most deprived London Borough. The new model of
integrated care will help provide enormous benefits to the people of the
Borough and will combine a significant pooling of resources with the PCT
having a budget of£87m, 600 staff and involving 75 local GPs; whilst Social
Services has a budget of£60m and 1,200 staff.
Further improving partnership arrangements
The Health Authority and Local Authority have recently made significant
strides forward in their understanding and capacity for partnership working
and through the creation of a local Partnership Development Steering Group,
have managed to bring all Primary Care Groups, NHS Trusts and Social
Services partners together to plan and deliver local services.
Many partnerships are developing between health and social care and the
Government is urging the introduction of more pooled budgets to achieve
greater integration. However, the desire for truly seamless services for
those needing health and social care is yet to be achieved. This would mean, in
time, joint planning, provision and purchasing of all primary community
based health and social care and there will be certain services which are
not appropriate for joint purchasing and provision.
The views of stakeholders in health have indicated support for exploring
this particular model of integrated care further and the Council also see real benefits not only for integrated health and social care but for the development of a more integrated policy across Social Services, Education, Housing and the Environment. It will also help deliver the community leadership role of the Council in developing the 'power of wellbeing.'
The principles of the merged model
Delivering the model with pooled budgets will involve a number of principles
- commissioning and care provision will be combined - although mental health
services will be provided by a separate integrated Mental Health Trust
- joint leadership on all care groups
- integrated care pathways
- joint budgets/ shared economy
- models adapted to fit different local circumstances
- local flexibilities to fit local need
- joint governance
- dual accountabilities
The challenges of delivering the new model will be around achieving a focus
on primary care and social service performance; building staff capacity; tackling the financial pressures;
achieving joint governance and dual local accountabilities and managing the
new culture and change process.
The benefits that could be realised
The benefits that could be realised for local people are substantial:
GPs, through their primary care team will be able to see how they can
directly commission and influence the type of services they want to provide
- there would be integrated assessment of need and locality planning
- it will assist the creation of integrated care pathways and seamless
- it will provide a vehicle for leading on community/ user based services
- it will maximise resources and avoid unnecessary and costly duplication
- it will provide a stronger base for challenging obstacles to greater
effectiveness in the total health community
- pooled budgets will help create a total health and social care economy
- it will reinforce 'primary care' rather than medical and social care
models of intervention
- it will keep commissioning close to the user and make it more seamless
- it will enable directly provided services to be reshaped to meet changing
need without lengthy bureaucratic process
- Best Value regimes can be timely, cross-cutting and put into place
- It will provide single accountability to the patient/users point of view
but still achieve the benefit of dual accountability through the NHS and Local Authority to the Department of Health
The 'Must do's'
To achieve the benefits of the new model it will be essential to pay
attention to the development of the new PCT and build on the success of the
Primary Care Groups and maintain recent progress in Social Services. It will
also be vital to understand that the success of the model will mean ensuring
that professional groups recognise that they all have an important
contribution to make and that some organisational development work will be
necessary. Having transparent systems for budget control and financial management will also help alleviate fears around money being moved out of the system and costs
being shunted around.
This model represents a unique and innovative way of providing health and
social care services in the future across Barking and Dagenham and will go
some way to delivering more improved and more seamless services for the
future. It builds on existing and strong partnership working and will
deliver a number of benefits. There are also some important challenges to
overcome to achieve and deliver the model and it will be important to ensure
that the model is properly evaluated so that we can learn from it and adapt
it if needed to ensure that it becomes the success we believe it will be.