joint appointments

RICHARD HUMPHRIES He lapses into the vernacular as he recalls being approached to take on two of the top public service jobs in Herefordshire. 'I initially thought it sounded very heavy, ' he says. 'But I also thought it was very exciting. It is the sort of offer you can't refuse and it would have been a bit feeble to say, 'well, It is a great offer but really it is too much work'. '

Richard Humphries was director of health, housing and social care when he was approached to take on the job of chief executive of Herefordshire health authority last November. There was a lot of interest in the appointment and a number of national papers and magazines picked up on it. 'I had generally been surprised at the national reaction to it, because locally it was a very obvious and sensible way to proceed. '

Mr Humphries says the area has seen its share of structural change recently. The former Hereford and Worcester county council split in 1998. 'There was a tradition of joint working from the previous council, so when the new council was formed there was already a solid base to build on to create stronger partnerships with other organisations. '

Mr Humphries has a varied background in social work. When he trained as a psychiatric social worker in 1977, he worked alongside doctors and in multidisciplinary teams, an 'invaluable' experience.

He worked in Wolverhampton, Warwickshire and Dudley in posts as diverse as dealing with children with disabilities; residential work; commissioning and planning; and performance review. Though he relocated from Birmingham in 1998, he has strong links in Herefordshire. 'My family has lived here for many years, my father was a local clergyman in rural south Herefordshire and my parents retired here about 12 years ago, ' he says.

Mr Humphries oversees an HA budget of£117m and 50 care staff, plus a social services budget of£28m and 1,200 staff. He highlights two areas as the biggest challenges so far to merging service delivery.

'The national policy differences between health and social care, particularly around funding issues and charging polices, make it very hard to get the two funding streams together because the time scales are all different, ' he says. 'The council's budget-setting process is also different to health.

The NHS process is more predictable - but it is very centrally driven and top-down. In local government I think there is a lot more discretion in deciding where the money goes. That reflects the fundamental difference between the NHS and local government - the NHS is a nationally managed and directed service and that does place certain limits on its room for local manoeuvre. '

Success will also depend on 'winning the hearts and minds of staff ', he says. 'You have to spell out the benefits of joint working for service users - because overall social workers and health service professionals are committed to the people they are working with. 'However, he warns this is 'not going to happen overnight' and 'evolution not revolution' is central to changing processes.

A single executive management team of six people for health, housing and social care has been set up to take a strategic view across service boundaries.

Mr Humphries is unfazed by the recent debate about potential NHS dominance in care trusts. 'It is important that care trusts are seen as a local choice, ' he says. 'Although I think it is a useful option, It is not the only one. We have become far too obsessed with the structure of organisations, rather than with the service that gets delivered. The debate is really about how to we move the furniture around.

'We are keeping an open mind. But if we do [go for a care trust], it will be because we think it will help us to deliver better services, not because we think It is the latest fad or fashion. '

While this joint appointment has a number of benefits there is also potential for conflict between the interests of the health trusts and council leaders.

Herefordshire has seen rows over health service funding in the past few years: and a new private finance initiative hospital generated controversy.

Leaving nothing to chance, Mr Humphries says a dispute protocol has been drawn up in consultation with NHS Executive and Herefordshire council to ensure his position will not be compromised by either side.

But it is not all 'heavy' politicking. Mr Humphries plans to roll up his sleeves and drive the mobile health centre minibus for a day around local villages. 'I am really looking forward to that, ' he says with his eyes lighting up. 'Sometimes I do miss not being in the frontline service. '

JULIA ROSS She has experienced the kind of pressures that families have to cope with. And Julia Ross says she was 'inspired' by the developments in Herefordshire when she applied for the post of chief executive of the new Barking and Dagenham primary care trust.

As Barking and Dagenham London borough council director of social services, she was already talking to Barking and Havering HA on building stronger partnerships when the post came up.

'I applied. . . but in my interview and on my application I made a strong point of saying that I believed a merged way of managing health and social care was the right way forward.

'When I was offered the job, I accepted on the basis that it would be a merged post. I prepared a risk assessment and asked them to consider it. 'Ms Ross took on both posts in April and now has a mammoth task. Under the joint governance arrangements she is responsible for a PCT budget of£87m and 600 staff. Where possible, she will pool its resources with the social services budget of£60m and 1,200 staff.

Ms Ross may be uniquely placed to manage the challenge. She is both a qualified nurse and qualified social worker with experience on the front line and in management, strategic and policy making positions. She also relishes challenges. After 20 years in Scotland and a stint at Hillingdon LBC she joined Barking and Dagenham LBC in 1998 as an interim director of social services after the authority was put on special measures. She was appointed permanent director the following year.

The borough came off special measures in March.

But Ms Ross worked part-time for several years to juggle work and family commitments, and says she did not get her first 'serious'management job until after 40. 'If you are going to put a lifetime career into difficult areas like health and social care It is going to go sideways sometimes, ' she says. 'I do not feel I have been banging hard at it and become burnt out. '

She also has first-hand experience of the kind of pressures that families have to cope with. 'I was in the middle of writing a book called When People Die for children to cope with bereavement - and right in the middle of that my husband died suddenly. I had to stop writing the book, it was a quite poignant and tough time, ' she recalls.

As with many London boroughs, Barking and Dagenham has a concentration of social issues that guarantee any type of heath and social care job will be seriously demanding. Ms Ross says it is the exact reason why health and social care need to operate under one strategic body. 'We have a huge commitment from the political and corporate leadership - it would be impossible to do without this. Being on special measures meant the council modernised itself quite dramatically and has leapt forward to a dynamic structure. It now has an executive that meets weekly and a health, social care and housing portfolio. '

Four priorities have been earmarked. 'Improving access to health services is crucial, ' says Ms Ross.

'Currently people's ability to get the services they need is quite tough. GPs are great. They have been around for a long time but their services really need development - some are still operating from a front room and that has to change. '

Reducing the high rate of coronary heart disease, dramatically reducing teenage pregnancy rates - one of the highest in the country - and improving the health of refugees will also take centre stage.

Ms Ross is pulling together a management team from both sectors to merge the planning of services on a strategic level. Although she currently operates simultaneously in both roles, accountable to council leaders and the NHS Executive, she envisages a future where operations are more merged.

Ms Ross concedes that the final model may well be a care trust, but is not 'obsessed with structures'. She says: 'I am interested in finding the best way to achieve dual governance and joint accountability to provide relevant services, if you can do that under current arrangements then a care trust is not needed. '

But she cautions: 'In any arrangement It is important to give both sectors an equal platform.

Unless you are joint and equal partners there is always a feeling of take over from one or another. '