Sense of authority

When public appointments commissioner Sir Len Peach cleared Frank Dobson of loading NHS boards with Labour councillors, he remarked: 'The secretary of state will surely argue that he has tapped a previously neglected source of candidates.'

And, since the first round of appointments following the election, there has been plenty of evidence that local authorities are proving to be a fertile recruitment ground. Many trust boards now have councillors with social services backgrounds.

Such appointments could also help achieve another of Mr Dobson's ambitions - to break down barriers between health and social services. But are there also hidden dangers?

Toby Harris, director of the Association of Community Health Councils for England and Wales, and himself a council leader, thinks there could be.

He sees 'huge virtue' in the cross-fertilisation between trusts and social services that these board appointments can produce. But he warns that there could be conflicts of interest.

'The classic one would be about discharge of a patient into residential care,' he says. 'If you have sitting on the board of a trust, or chairing a trust, someone who also has direct responsibility for social services, it could end up with people having arguments with themselves.'

It is not seen as a problem by Arthur Keefe, chair of Bristol social services and newly appointed chair of the local Phoenix trust.

'If I stood to make money out of the actions of one of the organisations I chair, or advance my political career, or in some way derive a benefit from it, there might be a problem,' he says.

But he sees no ethical or political difficulty in helping public sector organisations to manage their services effectively.

A qualified social worker, Mr Keefe became a social policy lecturer 26 years ago because he wanted to change attitudes which held 'that professionals know best' and viewed people 'as supplicants rather than citizens'.

As the lead local politician on social services in Bristol since 1989, he knows many of the senior players in the health service, and has been active in pulling health and social services together after a long period of stand-off over services for people with learning disabilities and mental health.

Does this make him the kind of chap to bang heads together, as Mr Dobson was threatening last summer? 'I am not a bully,' he says with a smile.

The aggressive competition that accompanied the market-driven model of welfare has gone, he says. 'The language of competition was dropping away very quickly even before the election.

'People who have been arguing and secretive are now talking openly to each other about co-operation on joint projects. There is a very different atmosphere within the NHS.'

Which does not mean that Mr Keefe is not bringing his own agenda to the Phoenix trust, nor that there have not been reservations about his appointment as chair. There is a strong view locally that a specialist learning disabilities trust is the most appropriate body to provide the full range of services needed. He disagrees.

'I don't believe the NHS is the appropriate vehicle to provide effective social care services,' he says bluntly.

He acknowledges that the trust is 'quite well signed up' to community care, and supports its strategy of closing long-stay hospitals and providing holistic services by multi-professional teams who don't ask where the social care boundary lies.

But he fundamentally disagrees with the notion that a separate service can meet all the needs of people with learning disabilities.

He sees his role as ensuring 'fairly strong leadership on both sides of the relationship. I can draw people together in a way that hasn't happened before'. But he will insist on a common strategy and the managerial and organisational arrangements to achieve it. He knows that managing service developments in Bristol will be a very sensitive job, particularly because of the need to retain staff with the scarce and valuable skills needed to look after people with learning disabilities.

He does not think trust boards are going to be changed by the number of local government appointments, but believes it is important for that voice to be heard.

'The key thing is a significant local connection,' he says.

Phoenix trust chief executive David Selway has the advantage of knowing his new chair quite well - he was a student of Mr Keefe and was a planning officer at Avon county council when Mr Keefe was chair of social services.

'Certainly, any organisation which resists input from other fields is going to die. You can't survive by being insular,' Mr Selway says.

'Especially in the field of community services and learning disability, we have to work closely with social services for the sake of the people we are serving.'

Mr Selway is unconcerned about conflicts of interest.

Mee Ling Ng is baffled by the suggestion. As deputy leader of Lewisham council, she is responsible for its relationships with external bodies, which has given her broad experience of the way the health service, the private sector, the police and other public agencies operate.

She is intimately involved in developing 'strong, constructive, tangible ways of working as partners', which she thinks will also be useful in her new role as a non-executive director of Lewisham and Guy's Mental Health trust.

She believes that trusts and social services are in tune with each other over vexed issues such as bed blocking, because if one does not pick up responsibility it passes to the other.

'I can't honestly see any difficult issues of conflict arising from my coming from local government and being on the social services committee,' she says. 'The trust and the local authority are working closely together and we are in an era of joint working and being allies, rather than of conflict.'

Ms Ng is a full-time consultant on disability, employment and management issues and is the author of a book on creating work opportunities for people with mental health problems.

She takes her new role very seriously and thinks it may mean she will have to give up some of her current work.

She went to the trust's annual meeting last year and was impressed by the fact that it gave a presentational slot to a mental health service user. Since joining the trust in December, she has joined the audit committee, serious incidents and complaints committee, and the appeals panel. Each requires training 'before we are allowed loose on them'.

'It is definitely more than a two-day a month job,' she says.

Dennis Reed, one of three new non-executive directors at Barnet Healthcare trust, believes it is 'extremely constructive' to have local government people on NHS boards.

'People like myself bring quite an intimate knowledge of the local community as well as of social services, because I have been a councillor, because I have lived in Barnet for donkey's years, and because I am plugged into local networks, which often see HAs and trusts as distant bodies.'

Mr Reed is director of the research body, the Local Government Information Unit, a former Labour social services spokesman on Barnet council, and now a co-opted member of its social services committee.

He says the local situation is improving, with more co-operation and collaboration. A good local agreement was reached on how to spend the winter pressures money, despite the previous 'somewhat prickly relationship' between health services and the council.

That atmosphere, says Mr Reed, meant that development plans have been produced in a vacuum with the HA feeling no ownership of Barnet's community care plan.

He says there is a 'huge overlap' of services provided by Barnet Healthcare trust and the council, so he is delighted at the prospect of providing a link between the two. He is impressed by the way his first board meeting was conducted. It was not just open to the public, but included a public question and answer session.

'We live in a complex society. Throughout my career there have been numerous occasions when I have had to juggle various hats, and I see no reason why these roles can't be interchanged,' he says.

'You have to be conscious of not letting personal views colour what you are doing in terms of the function you are performing.

'If there is a clear interest, you need to declare that. I see no problem, as long as you are open about it.'

See News Focus, page 16.