Joint working in Knowsley

With local government and NHS responsibilities increasingly overlapping in the areas of public health and social care, integrated working is becoming more important. Knowsley Metropolitan Borough Council and Knowsley Primary Care Trust (PCT) have developed a pioneering approach to this issue. They have set up a series of joint teams and effectively combined their workforces.

Key learnings for other councils

• Create joint governance arrangements.
• Joint posts are needed, but most staff can retain their contracts with one employer.
• Establish HR frameworks to set out how managers deal with staff from different organisations.
• Be prepared to take 'creative risks'.

Background

Knowsley has a population of 150,000 and is the eighth most deprived district in England. It has lung cancer and heart disease rates significantly higher than the national average, while life expectancy for both men and women is lower.

There is also a high proportion of people on incapacity benefit and a large number of carers as a result.

These problems place demands on both the NHS and local government.

What was done?

The need for closer integration was identified at the time of the creation of the PCT (now known as NHS Knowsley) in 2002. Once the trust was established, its workforce of 1,300 began combining with Knowsley Metropolitan Borough Council’s social services teams, which includes 900 staff.

Within two years, the arrangement was strengthened with the signing of a section 31 (now section 75) partnership agreement. This allowed the two bodies to pool budgets, establish integrated teams and merge functions.

Since then, the integrated approach has gone from strength to strength. A high number of teams operate on an integrated basis covering areas such as:

• HR
• communications
• the community older people’s service
• intermediate care.

It has also meant some staff and services are co-located.

Two years ago, the partnership expanded even further after the alignment of leisure and cultural services with the directorate of health and social care to become the directorate of wellbeing services. From this point, the partnership took the name Knowsley Health and Wellbeing.

The move has led to even more joint working, particularly around encouraging people into sporting activities. One example is Activity for Life, an initiative that enables GPs to refer patients to an exercise programme. The programme has been particularly successful with 84 per cent of participants showing improvement across 14 health measures after 12 weeks.

However, despite the close working, the two bodies still remain separate statutory organisations with contracts for most staff held by one or the other. The exceptions are a number of joint senior posts, such as Anita Marsland, the Chief Executive of NHS Knowsley and Executive Director for Wellbeing Services.

The joint working has required a number of measures from a workforce management point of view. There is an HR protocol setting a framework for how managers should be handling staff from different organisations. This includes arrangements for how secondments across the two are managed.

Meanwhile, Knowsley has taken a flexible approach to recruitment – advertising for posts without insisting on which organisation an individual has to work for.

Jane Raven, the partnership’s human resources and organisational development director, says:

“It means that we have two pools of people to recruit from. If we get someone with an NHS background they can be employed by the PCT, so they keep their pension entitlements, but are then seconded straight out to a predominantly council team if need be or vice versa.”

The benefits of joint working can be seen on a number of levels. It has led to a financial saving in areas. For example, Knowsley saves £230,000 a year through joint strategic planning and commissioning of services.

Meanwhile, staff report there have been benefits for both employees and the public. Michelle Murphy, an occupational therapist in the community older person’s team, which includes workers from the council, NHS and voluntary sector, says:

“Communication is undoubtedly better. I am employed by NHS Knowsley. But being able to work closely with my counterparts from Wellbeing Services means communication is better and the service for patients is more joined-up.”

Key personnel and resources

The partnership’s strategic direction is overseen by a board composed of senior councillors and non-executive members of NHS Knowsley. Meanwhile, the commissioning of services, budget setting and overall coordination is done by the integrated executive leadership team.

Workforce planning and key HR issues are managed across the partnership in an integrated way. The combined budget stands at more than £398 million.

How could it have been done better?

Joint working had been underway for nearly two years until the section 31 agreement was in place. This meant that at the start staff had to take a ‘leap of faith’ when working for integrated teams. For example, they had to trust that their contractual and pension arrangements would remain the same. Ms Raven says:

“In Knowsley we have a culture of creative risk taking and our staff have been positive in working differently because they believed in what we were doing. There is strong leadership in Knowsley that has sent out a compelling vision for integration as a means to improving people’s lives. This has driven our approach rather than having a focus on governance arrangements.”

Next steps

With the partnership firmly established, the council and PCT is now looking at how it can increase the accessibility of services. This includes not only developing integrated services and care pathways but also co-locating NHS and council services.

One example of this already established is the Halewood Centre, an integrated public service building which was opened a year ago. It houses GP surgeries, dentists, a council one-stop shop and post office, giving local residents access to a range of services all under one roof. And next year a new leisure centre will open in Huyton which will also house services such as a disability day centre.

In terms of the HR and organisational development agenda, the next 12 months will see the development of a single workforce strategy for health and wellbeing. This will be informed by the results of the first integrated staff survey across the whole workforce using the NHS staff survey methodology.

Further information

Jane Raven
Human Resources Director
Knowsley Health and Wellbeing
email: jane.raven@knowsley.nhs.uk

Case study published May 2007, revised May 2010.