Adult Care Services in Hertfordshire – Integrating Services and Pooling Budgets
Key contacts: Sarah Pickup
Address: Hertfordshire County Council, County Hall, Pegs Lane, Hertford, SG13 8DQ
Telephone: 01992 556 301
Email: Sarah Pickup
In a nutshell
Since 2000, we - Hertfordshire County Council and Hertfordshire Partnership NHS Trust - have been developing innovative approaches to working together. Our aim is to ensure better, more accessible social care services for our users. We now have partnership arrangements in place for a number of service areas including:
• mental health
• learning disability
• drugs and alcohol
• child and adolescent mental health.
We have focused on bringing together social care services previously provided in isolation by the Council or the NHS. We have pooled our budgets and introduced a Joint Commissioning Board to support this.
The issues
We both felt that we had to develop a new approach to deliver better social care services in the County. Existing provision was very complex for our service users. For example, an individual with a social care issue had to speak with different professionals working in separate organisations - and actually go to different places to meet them.
For many service users it was hard to separate their health and social care issues and understand which professional they needed to visit. We agreed that we had to address this by developing a more person centred approach to our service provision.
How we got started
In England, Section 31 of the Health Act 1999 allowed us to establish a range of formal partnership arrangements. This included the ability to pool budgets and transfer staff from one organisation to another. We agreed to use this power as the basis for a new partnership approach.
We started by running staff workshops. At the workshops we discussed how we might deliver more person centred services. The workshops were encouraging. Staff were very committed to focusing more on individuals rather than organisational structures. These workshops were also helpful for identifying practical issues and challenges – and thinking about how to address these.
We set up a core group was set up to take forward our new partnership approach. This group involved staff involved in delivering services, human resources, finance, and Union representatives from each organisation. This group developed a structured work plan for taking forward joint working.
What we did
We have set up shared staffing arrangements, with the aim of streamlining and co-ordinating service delivery.
In some cases, we have transferred staff from one organisation to another. For example, Community Learning Disability Teams have been established within the Council. As part of this change 40 community nurses and other staff transferred from the NHS Trust into the Council.
We knew that staff changes of this kind needed to be carefully managed. Because of this we allowed staff to transfer on a temporary basis to begin with.
We have also co-ordinated services at a strategic level. Service Directors from the Council are represented in senior decision making structures of the NHS Trust, and vice versa. Regular meetings between senior decision makers also ensure that important issues are discussed and addressed.
We have also developed joint commissioning arrangements. This means that we both contribute to a 'pooled commissioning budget' which covers spending for the whole County on mental health, drugs and alcohol, learning disability and child & adolescent mental health services.
Spending decisions are taken by the Joint Commissioning Partnership Board. This Board is made up of County Councillors and Directors or Chairs from both partner organisations. We also have four co-opted members and some formal observers from the voluntary sector.
The Board is supported by a Joint Commissioning Team. The Council hosts this team, and manages the budget administratively.
Our outcomes
Our approach has had an impact both organisationally, and for service users:
• We have improved outcomes for service users. Access to professional advice and support is now easier because people can go to one place and get the help they need.
• Professionals operating in the new teams are able to develop a better awareness of other disciplines. They have more opportunity to share information and work closely to support individuals. This ultimately benefits service users, as well as professionals.
• There have been organisational benefits as well. There is less duplication in what is provided. Because the provision is more appropriate, we are making better use of resources.
• The people involved in establishing the partnership arrangements have learned a lot from this experience. We are using this knowledge to establish similar partnerships in other areas.
One great thing – the impact on our service users
The best thing about our partnership approach is the impact on the individuals that access our services. Our focus has been how to improve services for the individual, meaning that we can question and redesign which organisation takes responsibility for service delivery. This has meant changing our structures and governance, but services are now more accessible and appropriate for the people we work with.
Lessons learnt
We have learnt a lot from this experience, which will help us to expand the approach and develop new ways of working together.
• Don't assume other organisations work in the same way yours does. Cultures and governance structures are often very different. It is important to talk with people in the other organisation to find out how they really operate.
• Be prepared for the fact that things change. During the time we have been working in this way there have been radical changes to the NHS in England. We have had to adapt to these changes and in some cases change our structures and governance arrangements in response.
• Be resolute about what you can deliver. When problems arise, don't see these as blockages. You need to find ways to overcome them and be determined about what you can achieve.
• Develop a formal partnership agreement or constitution. Our constitution provides a good, solid foundation for working through challenges as they arise. It meant a lot of initial discussion about potential problems and issues – but was worth investing time in.
What next?
We are now adapting this approach for other areas of service delivery in Hertfordshire. We are also working together to develop joint arrangements for a new care home using pooled budgets and joint commissioning.
