Crowd puller

Education, education, education - not just prime minister Tony Blair's favourite soundbite, but a list of the NHS's partners.

Social services, winter pressures and elderly people are the headline areas of joint working between health and local authorities - with NHS-social services partnerships made compulsory in the NHS plan.

But your local authority may be slightly huffy at being characterised as a social services department with some vaguely health-related bits - public health, sheltered housing and cleaning up the rubbish - tacked on.

So it may come as a shock to find that while 98 per cent of councils with social services departments are working in partnership with health, so are a whopping 93 per cent of education authorities.

The findings come from a Local Government Association survey of more than 75 per cent of English and Welsh local authorities. In addition, 86 per cent of respondents said housing departments were working with health, 67 per cent cited environmental services, and a perhaps surprising 57 per cent said 'cultural services' were involved.

LGA health policy officer Jeni Bremner says joint work with education is about more than the odd smoking cessation project in schools. 'Some of it is about children with special needs, some about psychology services, ' she says. And she points out: 'Schools have a lot of contact with health services about individual children.'

The government's Quality Protects childcare strategy also contains a requirement for all children in care to have health checks. Ms Bremner says: 'It's not just at the front line, it's at a strategic level as well.'

NHS Confederation policy manager Janice Miles agrees. 'The variety of joint working is something our members increasingly recognise. They are working more and more with other areas, like housing, as well as social services.'

One area in which NHS organisations are becoming more involved is in 'best value' - the system of reviewing services, which local authorities have just begun to implement.

A striking 43 per cent of local authorities surveyed said they had involved health partners in the reviews. The figure plummets to 26 per cent of district councils - which have no social services departments - and it is true that 50 per cent of the joint best value work involved social services. But what about the half that was not?

The reviews use 'the four Cs' - challenging the status quo, consultation, comparison with other services and competition - and Ms Bremner says consultation and 'challenge' are key areas for health service managers and clinicians.

NHS involvement may be linked to joint services or areas where 'health is a legitimate player'. Challenging services, Ms Bremner says, involves 'thinking about why a service is delivered the way it is, whether it should be there at all, is it delivering best practice, does it fit with a trend, or is it done that way just because it always has been?'

As an example, she says this is the chance for NHS partners to say, 'Actually when you do it like this it's really awkward for us. . .

It's an opportunity for dialogue.'

A total of 71 per cent of the local authorities had joint arrangements with health to commission or provide services, and 22 per cent of the 144 authorities that described their arrangements cited joint services for elderly people, while 42 per cent mentioned mental health and 33 per cent learning difficulties.

But 15 per cent of respondents cited areas as varied as exercise sessions by GP prescription, energy efficiency schemes and accident prevention. Joint funding of public health posts or projects was mentioned by 19 per cent while 14 per cent reported joint work 'via a strategic overview or planning group'.

'Social services has often been a bridge into joint work and understanding the different cultures of health and local authorities, ' says Ms Bremner.

'But the number of district councils doing joint work suggests it's not the only bridge.'

Of course, the survey does include lots of number crunching about use of the Health Act flexibilities - pooled budgets, lead commissioning of services and integrated provision. Nearly three-fifths (59 per cent) of local authorities reported that they already had some new powers in place, or that work to take advantage of them was in progress. Only 12 per cent had no plans to use the powers.

Ms Bremner says this is more significant than the relatively small number of Health Act schemes so far given Department of Health approval.

It is not that health and social services have dragged their feet - more the reverse. Partners with good joint-working arrangements already in place took a 'considered' approach.

'Rather than just transferring existing models, they are working to develop them further, 'Ms Bremner says.

It is not all happy news.

Funding problems - more acute in local government than the NHS - are cited by 35 per cent of those surveyed as a hindrance to joint-working. And lack of understanding of each other's systems, roles and cultures was frequently mentioned.

The NHS Confederation's Janice Miles says: 'Our members have reported this, too. 'A series of regional 'listening events' is planned by the two organisations for the spring to address this, she says. If all the education chiefs, housing directors and cultural services managers turn up, it could be quite a crowd.