news focus: The latest bunch of recruits to primary care trusts are showing that the old divisions between social services and the NHS are starting to break down, says Paul Smith

Published: 11/4/2002, Volume II2, No. 5800 Page 13 14

One good thing about shakeups is that you can often add a bit extra to the mix. Take Shifting the Balance and the resulting 'new' NHS, finally made flesh last week. The structural makeover has meant big-time job-hopping, with senior managers from health authorities descending on the new primary care trusts like a wave of Nordic invaders. It has also meant an opportunity to bring in staff from outside the NHS - crucially, managers from local government.

Demolition of - or at least giving a heft shove to - the so-called Berlin Wall between health and social care is one of the main drivers behind the PCT concept. Not only has the idea of a 'seamless service' been doing the rounds for some time, in recent years an understanding of the symbiotic relationship between the pressures on social services and the NHS has resulted in everlouder calls to close the funding gaps between the two. It is an issue expected to be central to chancellor Gordon Brown's Budget next week.

It is perhaps refreshing, then, that the need for action is being reflected in the higher echelons of senior management. April has seen a small number of managers - probably no more than 10 according to the Association of Directors of Social Services - bred within the cut and thrust of local government take up of chief executive positions in some of the 138 new trusts.

Two stepping into the breach for the first time are Colin Morris - former director of social services at Darlington borough council and now chief executive of Darlington PCT - and Durham county council's former deputy director of social services Nigel Porter - now chief executive of Sedgefield PCT. Both have been senior social service managers.

What attracted Mr Porter to the role? 'The reason I made the move was that I was excited about the opportunities opened up by Shifting the Balance. It is about looking to the future, and I think I've got the general management skills to make it work.'

Although their appointments could make their PCTs contenders to go for future care trust status, both believe the flexibilities in the Health and Social Care Act already provide sufficient scope for effective joint working.

Mr Morris says that developing a culture of working relationships between social and health service is more important.

Continued from page 13 They share concerns, however, about the disparities in pay and conditions between them, with NHS staff, in the main, on higher pay. Differences for managers working within the learning disabilities services can be as high as£4,000 in Mr Morris's experience.

He adds: 'It is an important issue and it is one that effects both sides.And yes, it certainly needs to be addressed quickly, but I do not believe that It is beyond the wit of man to overcome it.'

Crossing the boundaries from local government is not uncharted territory. Julia Ross landed in the chief executive hot seat at Barking and Dagenham PCT while director of social services at Barking and Dagenham London borough council.

Under joint governance arrangements, she has become responsible for the PCT budget and, where possible, has been pooling its resources with social services.

The inspiration behind Ms Ross's decision - and perhaps those PCT boards which have brought in social service experience - is Richard Humphries.

A social worker by profession, he ended up assistant director of Dudley social services and then director of Herefordshire social services before making the switch to chief executive of Herefordshire HA.

It has been that zig-zag career path which now sees him at the Department of Health in charge of the health and social care change agents team, and now stands as perhaps the most highprofile manager to have bloodied himself on both sides of the Berlin Wall. He is an enthusiast for local government managers: 'The management skills in local government are transferable, and there should be more movement into the NHS. Over the past 10 years there has been substantial involvement in local government with commissioning services from the independent sector.

With the number of partnerships developing between the independent sector and the NHS, those skills will be invaluable.'

Perhaps the rarest animal in the public sector management jungle is David Panter - a man who took the virtually untrodden path from the health service, as chief executive of Hillingdon PCT, to local government as chief executive of Brighton and Hove city council.

Widely regarded as one of the NHS's high-flyers, he made the move just over six months ago - a move that the ADSS wants to see happen more often.

'I think I am only one of a handful of people who have moved to a chief executive position in local government from the NHS over the NHS's 50-year history, ' Mr Panter says. 'The most exciting thing about my current role is that you can see ways of improving health through education and environmental services, through transport policy - levers over which you have little control in the NHS.

'The problem is that in general local government has very little understanding of social services and I think my background at Hillingdon has been extremely useful. I understand something about the upheavals taking place in the NHS and that is going to help in dealing with that, help ease integration.'

He says the levels of management talent across both organisations is high, but praises the high standard of general management skills in the NHS - among the best in the public sector. On care trusts, he says his thinking has 'hardened' since leaving the NHS.

Again, he says the flexibilities under the Health and Social Care Act are already there. Though it may be different for adult services, he fears that care trust status would result in the medicalisation of children's services - a step he is reluctant to take.

'When I was at Hillingdon, I felt that there was no point moving to care trust status before the cultural changes had been made - it is about getting health visitors, GPs, nurses, social workers and the other professional groups working together first. Any reforms have got to centre on improving patient care first.'

And for NHS managers thinking of making the leap into local government, Mr Panter said they should not fear the voters or their council representatives.

Though it came as a culture shock, Mr Panter said democratic accountability running through local government is a huge plus.

'You have to convince councillors on certain issues, but once they agree you have got their full backing and it can give you huge strength when dealing with government departments. You have got autonomy, which within the NHS - with its chain of command running from the health secretary - you often do not have.'

The only problem: 'Initially, I had difficult coming to terms with the fact that as chief executive I had to keep my mouth shut in council meetings.'