Joint working between PCTs and local authorities means a two-pronged attack on health inequality

Better working with local government has been a policy aim for years: it was one of the drivers behind the 2006 primary care trust reorganisation. Since April this year, PCTs and local government must provide a joint strategic needs assessment.

Anita Marsland, executive director of health and social care for Knowsley council and chief executive of Knowsley PCT, says the PCT and council have worked together formally since 2002, using section 31 of the Health Act to form a partnership between council and PCT. "We recognised that to have an impact on health inequalities and quality of life, a range of council services had to be involved," she says.

"We've been able to pool resources since 2002, with joint appointments at various levels, but always kept a close eye on our mantra - single accountability to service users and patients, but dual governance arrangements," she explains. "All our teams of social workers, district nurses etc are co-located, so we hope users experience seamless service. We have no issues with continuing care, and don't have delayed discharges - in 2000-01, that was a problem.

"In social care, we were eighth worst in 2000," Ms Marsland adds. "For the last five years, we've been a three-star council, and the PCT side is better as well. Our biggest lesson was to integrate as many 'spine' services [finance, HR and resource functions] to be as efficient as possible."

Another joint appointment is Will Huxter, strategy and commissioning director for Islington housing and social services and Islington PCT. He says: "Joint working is the best way to address health inequalities and well-being. By agreeing what services we want to improve, the money arrangements fall out of those conversations, rather than starting off talking about who funds how much of what.

"We have jointly identified demographics and service changes. We think together about implementing and planning services like dementia care, work out the 'big stuff', and then approach pooling budgets."

Nigel Walker of the Department of Health's world class commissioning team says joined-up government is "essential to any success with the new agenda", but adds: "Local politics can get in the way, as can the government's arrangement for joint funding. Most local authorities don't enjoy giving up governance of money.

"How matters are configured can vary - some like Knowsley have completely integrated. Peterborough PCT merged its commissioning functions, and transferred all local governance commissioning staff into the PCT, in 2004-05".

Mr Walker concludes that "people need to agree where they should join up services and commissioning, and where they don't need to. And joining up requires investment - Luetz's five laws on joint working are relevant."

Luetz's five laws on joint working

  • You can integrate some of the commissioning all of the time and all of the commissioning some of the time, but you can't integrate all of the commissioning all of the time

  • Integration costs before it pays

  • Your integration is my fragmentation

  • You can't integrate a square peg and a round hole

  • If you integrate, you call the tune

Adapted by Nigel Walker

Find out more

  • Walter Luetz, 'Five laws for integrating medical and social services', Milbank Quarterly 1999.

  • Nigel Walker, 'Joining the dots', Journal of Care Services Management 2008.