GOOD MANAGEMENT - Joint working between the NHS and local authorities is becoming increasingly important - but remains difficult to achieve. William Little looks at four key areas aiming to break this trend

Sharing back-office functions Cambridgeshire county council integrated its older people's services by transferring the budget and over 900 staff to the four primary care trusts in its area. The pooled budget is now over£110m.

The decision was based on the most effective way to achieve better outcomes - older people needed significant medical support in order to reach the threshold of social care services. To be genuinely seamless, the services had to be placed with the PCT, says council director of social services Eric Robertson.

This transfer has also resulted in the sharing of back-office functions, particularly in contract management.

This service remained with the council rather than being fragmented over the four PCTs.

The need and scale of commissioned arrangements for secondary care, such as old people's homes, however, is still commissioned by the PCT. But the contracts department at the council secures the provision. As there are a lot of small providers, it is much more efficient for the operation to be kept in one overall department.

Press and public relations functions are also being shared.

While the PCT and the council still have their own press operations, the lead on older people's social care at the council offers back-up support to the PCT press office. This has reduced the need to employ and train extra people at the PCTs.

Mr Robertson says other synergies were achieved to cut out duplication and improve services. In order to deliver a fully integrated health and social service of this magnitude, back-office support needed to be closer to where services were being delivered.

This has resulted in an improvement in performance management and collection of statistics. There is now only one person in post to manage both areas, rather than two.

The process, says Mr Robertson, means the PCT has not gone over budget once since the change-over, and have cut waiting times for assessment of older people by 350 per cent.

Joint posts Joint Southwark PCT chief executive and Southwark council director of social services Chris Bull says joint posts are only part of the strategy to create effective integrated working.

Joint posts only make a difference in the context of a joint commitment around service redesign, he says.

Southwark is combining health and social care for older people into one integrated service. In order to achieve this more effectively a number of joint management posts have been created to deliver the new agenda.

He says these posts are not just symbolic, but strategic positions to get the best results.

The appointment 18 months ago of a joint head of older people's physical disability services, for example, has achieved an integrated service because it provides common leadership across the system and sends a message that services are being designed around the needs of users rather than organisations.

He says the best way to get the most out of a joint post is by creating a good partnership structure with shared commitment and objectives.

Bolton PCT and Bolton council joint director of public health Jan Hutchinson agrees that the underlying strategy has to be in place for the joint post to work.

However, she also says that a joint post can iron out cultural differences between the two organisations, one of the key barriers to better joint working.

It is important to be seen to be working for both agencies equally, she says. This has helped create a shared vision and objectives over tackling health inequalities. It has meant that the local strategic partnership agreement that was formerly the role of local authorities is now seen as a joint objective.

Crime and the fear of crime, for example, has now been identified as a reason why some people are less physically active - they are too scared to leave their homes. PCTs can now work with the council to reduce this perception and help improve the health of the area.

Shared public health information Rochdale PCT and the local council have set up a website that contains all the public health information that can help local services target health inequalities.

Public health information manager Richard Pinkney says the site has become an information warehouse that agencies can use to produce their own maps of where services are needed most.

Census, crime, employment, life expectancy, public health targets and education information is included on the site.

The council and other partners in the area, including the PCT, attend a quarterly information group to work out the best ways of sharing information and exchanging ideas.

This is where the idea for a website with public access was born.

Each partner analyses their own information, but the council collates it on to the website.

As pointed out by Jan Hutchinson in Bolton, the most effective way to share information is to work towards common borders - it makes data more relevant, easier to collect and helps target resources effectively.

The PCT and council have a joint information team that collates information. This joint working has been effective in sharing housing data, for example, that the PCT would not usually have access to.

They have been able to map PCT data about older people's deaths caused by cold weather against council data regarding the quality of housing stock and where older people might be living. This has helped them to target services at those vulnerable during the winter.

Appealing to local jobs markets Manchester's joint health unit is in the process of setting up a scheme to target a recruitment drive at local disadvantaged groups. The project has been formed following the setting up of a steering committee involving all local players, including the local council and Jobcentre Plus, to share best practice and ideas.

The scheme follows an already successful programme in the local council, says lead programme coordinator Stephanie Banks.

She says the council waits until a number of low-level entry jobs become available, such as in administration and childcare, and then they are ring-fenced and not advertised externally.

The jobs are marketed - through Jobcentre Plus and community teams - to Manchester residents who have been unemployed for six months. Those who are interested are put on an initial two-week training scheme in secretarial and administration skills, for example.

They are allowed to apply for as many positions as they wish.

The interview is relaxed and supportive and, because they are only competing against others on the scheme, the success rate is high.

The jobs are primarily marketed at lone parents, the disabled, the over50s and black and ethnic minorities as well as to the priority wards in Manchester - some of the most deprived in the country.

Manchester Joint Health Unit programme manager for employment and health Neil Perris says the health scheme will run in a similar way, targeting the same groups and working in unison with the council.

The scheme will also help to meet joint targets in the local strategic partnership and public sector agreement aimed at reducing health inequalities, improving the local economy and reducing unemployment.

The scheme, says Mr Perris, shows how, by sharing best practice and skills, the NHS can learn from the past achievements of the local council.