Working with the health service

Michael Laing, director of integrated community services, County Durham Care Partnership explains the collaboration between the NHS and
local authorities

The most moving celebrations of the Coronation weekend for me were those which took place in our supported housing. Our extra care schemes, residential and nursing homes and specialist accommodation are a valued part of their communities. Schools, volunteers and faith groups all made an extra effort to include the people we care for in our supported housing. NHS Community staff, social care teams and primary care colleagues were all invited to join in. Most of the care we give happens in someone’s home and is delivered by a team every day of the year not just on a special occasion such as the Coronation.

Relationships
The Coronation Service was full of messages about relationships, symbols and tradition. The long lasting of the success of the County Durham Care Partnership is built on the relationships between individuals at all levels developed over many years. The Chief Officers meet fortnightly. We talk informally about a range of work-related subjects but we also get to know and understand each other, share problems and find joint solutions. There is also some talk about favourite foods, holidays, dogs, horses and our families. This incidental chat is important. It shows that we are human and have interests beyond the formal work situation. It helps when we are facing pandemics, storms, floods and demand pressures to enhance and sustain our joint working. More importantly it helps us care for each other as unique individuals.
    
Many Coronation guests wore medals and the neck chains of the orders of chivalry. I’m told special permission is needed to wear the decorations of other nations. This may come from the time when the Earl of Leicester presumed to wear “foreign” symbols of office in front of Queen Elizabeth I. Her characteristic remark for all of the Court to hear was “My dogs wear my collars”. We are not quite so fussy in our Partnership. We give out our lanyard and badge pretty freely. We encourage people to wear it as an outward sign of being part of the Partnership. I always feel quietly proud when I see them being worn especially by people who are not members of the Partnership.
    
Durham Cathedral stands high above the River Wear and dominates the surrounding City especially when seen from the East Coast Mainline. It was illuminated red, white and blue for the Coronation. It began as a monastery in 995. One of the roles of the monks was to care for the sick. They were organised into groups of monasteries called provinces or congregations – similar to ICBs. Monasteries had infirmaries, dispensaries and alms-houses – not unlike acute hospitals. They also had parishes and “cells” outside of the Abbey caring for people in villages and towns – just like primary and community services. The monk’s health and care system is part of our tradition and perhaps our future.

Finance
Integrated care systems need more than relationships, symbols and traditions to be successful. They need structures, administration and money. In County Durham we are working with our ICB in the North East and North Cumbria to co-produce a Joint Committee. We have been operating as a Joint Executive for many years and have structures which work well, reach shared decisions and make the most of the skills of our workforce and get best value from every penny. The Joint Committee is the natural development for the County Durham Care Partnership – but it is “new territory” in terms of governance. We have some Government guidance from late 2022 but we are working through the details together drawing on the expertise of the ICB’s head of governance.

Goals
Our ambition is to co-produce a Joint Committee which has “everyone and everything” related to health and care in scope. We know that this will be achieved over time. This means the NHS, primary care, Public Health, Adult Care, Children and Young Peoples Services, the voluntary and independent sector and Community Services. There is also an important role for housing and economic development. We want to jointly exercise our decision making capacity to commission services to meet needs, innovate, sustain and improve outcomes and support each other when we are under pressure. Above all we want to make it easier for our people to experience and deliver health and care services.
 
Trust
“Put not your trust in money but put your money in trust” said Oliver Wendell Holmes. Money and trust go together in the County Durham Care Partnership. How we spend and account for our money is key to all of our relationships. We can demonstrate that trust in our Better Care Fund, in the way we decide together how to invest money from the Discharge Fund and how we commission. We respect the different  financial regimes of our partner organisations. However some of the important lessons from the Covid pandemic and austerity are about sharing our money to get better outcomes and supporting partners with financial troubles.
    
“While money can’t buy you happiness it certainly lets you choose your own form of misery” according to Groucho Marx. Agreeing the governance arrangements and culture for our money is essential in the development of the Joint Committee. We work on “open book” principles now and we want to keep them in the future. If we don’t get the governance and culture of the money right we will be at risk of choosing our own form of misery.

Children & young people
We often concentrate on adults when we integrate services. In County Durham, children and young people’s services are “front and centre” of our Partnership. We have appointed to some joint posts recently to lead our integration of children and young and turn our ambitions into operational changes and improved outcomes. The Association of Directors of Children’s Services (ADCS) President this year is John Pearce from Durham County Council. In his first speech as President he called for a Better Care Fund for children and young people and greater integration between health and care.
    
Joint posts across health and care have worked really well in County Durham. We have a Joint Head of Integrated Commissioning who is also our Director of Place. I am in a joint post between the Council and the Trust. We have joint posts in mental health and learning disabilities. Our aim is to have more joint posts in the future and more secondments between partners as recommended by the Hewitt and Messenger Reviews.
    
It seemed odd going to the North East and North Cumbria ICB “Winter De-brief” in bright spring sunshine. Our ICB is doing some great work in bringing us together and promoting good practice as well as listening to feedback from the “frontline”. They have put me in touch with North Cumbria who are doing some outstanding work on integration and our visit is already planned.
    
Going to visit customers in their homes with “frontline staff” is a great privilege. I’m often greeted with the line “Hello, where do you belong?” Which is a County Durham way of asking where I live. It emphasises the strong sense of “belonging” to a place felt by our customers and workforce. We will do well to remember that sense of place and belonging as we develop our Joint Committee.