Feature

The dream team

Penny Abraham gives a councillor’s eye-view of the highs and lows of joint working by an inner London local authority and primary care trust

Dreaming and believing are an essential part of tackling health inequality and ensuring integrated services for our communities. Sounds wacky? Not at all: joint working by local authorities and primary care trusts represents the best chance we have ever had to make a real difference to residents’ health.

We made our first faltering steps toward working with health partners in 1998-99, when we invited an officer and a non-executive director from the then Camden & Islington health authority to join our community care subcommittee.

Around the same time I was unexpectedly elected as chair of the joint consultative committee, which oversaw jointly funded projects. I found myself in a parallel universe where my local authority expectations did not seem to have much meaning — the attitude to budgets, the way reports were written, the way meetings were conducted was utterly different. But it was a good training ground, and I learnt a lot.

At the end of the 1990s, we went on to set up two partnership boards: one to oversee the health action zone, and one to oversee our newly integrated mental health services. A councillor chaired the HAZ board, and the mental health board by a non-executive director from the community health services trust.

My strongest memory from that time — and subsequently — was the constant plea for diagrams of what the structures were; who was doing what, where and why were perennial questions. I also remember a quite serious disagreement between health authority colleagues and local authority councillors around whether four former care homes, where ex-patients from Friern Hospital had lived, should be sold for affordable housing or to the highest bidder. This issue encapsulated the differing imperatives in the two cultures.

Throughout this time, I was vice-chair of the social services committee. I attempted to act as a catalyst behind the scenes, and one initiative was to invite the Democratic Health Network to do a series of ‘bridge-building’ training sessions with health and local authority partners.

The intention was to help people understand other points of view, and the results were startlingly positive. A turning point for me was when I heard a health authority colleague speak passionately about how the pursuit of equity in health provision was her main intention as a commissioner. She had similar values to mine after all.

A few years later, in April 2002, saw the arrival of further integrated services with Camden primary care trust, Camden and Islington mental health and social care trust, and the local health partnership. By now Camden had had to adopt the new constitutional arrangements, so much depended upon the activity of the executive member for social services and health — me again. The backbenchers who had been involved in the earlier work were crucial to the success of the next stage — including acting as councillor non-executive directors on the newly formed mental health and social care trust.

Consolidation of the local health partnership was a fascinating task. I chaired it during its first year — 2002 — and had the job of trying to engage some ‘big hitters’ from prominent London teaching hospitals, as well as the primary care trust, the mental health and social care trust and the voluntary sector.

Without all partners at the table, the local health partnership would have been a white elephant, but thankfully it got itself together quickly by the exercise of careful inclusiveness and tackled four important priorities:

• suicide prevention (Camden has the highest levels of suicide in the country)
• ‘claiming the health dividend’ through local jobs for local people
• income maximisation
• physical activity.

Those four priorities were chosen for their genuine cross-cutting potential, and there is excitement about the possibilities open to us now that health and local authority are drawing closer together.

Last month, we worked closely with our public health partners on a planning appeal against 24- hour/seven days a week work on the channel tunnel rail link, which would have affected one of our most deprived communities.

The planning inspector stated: ‘I do not think one can put a price on potential disbenefits such as ill-health through sleep deprivation, or the risk of harming people’s educational achievement or employment prospects.’

A test case of the safeguarding power of health impact assessment in planning matters.

Some of what I have described might be dismissed as process, process, process. However, a preoccupation with process was necessary as we moved from the polarised position of local authority in one corner and health authority in the other to an integrated position where we work together for the better service of our communities.

Now we are free to look to our dreams and beliefs to take our vision forward. The motto I quoted at the start is the one I think we should live by — or as Oscar Wilde put it: ‘We are all in the gutter, but some of us are looking at the stars.’