It is almost six months since the Government introduced new joint-working powers for local and health authorities. The response from the ground has been fairly slow so far, but the potential for new projects is enormous, and the Department of Health is keen for EHOs to get involved. Cathy Savage and Nick Warburton report on partnerships in progress

The thinking behind the powers set out in the Health Act 1999 is clear - no more overlaps, no more gaps, no more fuss about boundaries, no more cases where separate services struggle to respond to the same situation when they could combine forces to have a more meaningful impact. Instead of just talking the talk on joint-working, the Government wants to see proof that authorities are really getting down to business.

The aim is for flexible, co-operative services which can club together to achieve greater things, while appearing seamless and clearly co-ordinated to the end user. It sounds idealistic, but it is part of the Government's ongoing consumer-driven push for best value and it also offers great opportunities for authorities to think on a bigger, more strategic scale.
"People have been asking for years why they couldn't pool funds to work together," points out Carole Bell, policy manager at the Joint Unit at the Department of Health, "well, now they can."

Although take up has been slow so far - to date there are just 24 partnerships based on the Health Act criteria - Carole is enthusiastic about the future.
"We knew authorities didn't want a complicated application process so all we have is a simple notification process, and because the framework is so expansive, people are applying it in ways we hadn't even dreamed of," she says. "Basically what these powers offer is very straightforward, but in a way that was never possible before."
The majority of interest and examples so far have been based around health and social care - particularly in providing joined-up care packages for the elderly and disabled, who tend to have to deal with a multitude of different authorities, officers and budgets otherwise. But Carole has plenty of ideas for environmental health departments looking for partnership situations, and is very keen to see greater involvement on the preventive health side.
"If traffic accidents are pushing up accident and emergency bills at the local hospitals, maybe the health authority would like to club together with the local council for marked out cycle paths, or safe routes to school," she suggests.
"Or if food poisoning cases are a particular cause for concern, maybe authorities could collaborate on a public information campaign, or food hygiene education. If a council could demonstrate to a health authority that by funding multilingual food hygiene training to food outlets, the number of food poisoning patients would drop, they may well be convinced to come on board."
One of the partnerships already set up concerns accident prevention. A skateboard site had been opened for adolescents in a run-down area, but within months the local hospital had noticed a large influx of injured teenagers from the park. The health authority and local council clubbed together to put up signs about safe use of the skateboard park and everyone was pleased with the result.
Combining forces just makes sense in so many ways, Carole stresses. "It gives all those trying to tackle apparently insuperable problems more possibilities."

Powers that be
So how do the partnerships actually work? The framework was set out in section 31 of the Health Act 1999, which came into force this April. It sets out three forms of partnership:

Pooled funds: "Pooled funds are more about the way that organisations can make their budgets more effective," says Carole. This kind of partnership allows parties to bring money together in to a "discrete fund". Partners have to agree at the outset the range of health and local government services to be purchased and provided from the pooled fund. As the DoH website points out: "This will mean that the expenditure will be based on the needs of the users, and not on the level of contribution from each partner. This gives pooled budgets a unique flexibility, whilst being bounded by agreed aims and outcomes." This gets round the problem of spending beyond sectoral boundaries, something which has been a bone of contention for services with separate and constrained budgets in the past.

Lead commissioning: This is similar to joint commissioning, but allows delegation of a function/service from one agency to another. It "provides an opportunity to commission, at a strategic level, a range of services for a client group from a single point and therefore provide a level of co-ordination which improves services for users, and provides an effective and efficient means of commissioning", according to the DoH. At the outset, the partners must agree which functions will be delegated to the lead commissioner, who the lead commissioner will be, and what money to transfer to finance the services commissioned. For patients, the new partnership arrangements should clarify the standards and the services that will be provided. This should help to offer accountability in terms of best value. For the partners involved, the arrangement often builds on existing services and their combined knowledge should enable them to maximise efficiency in purchasing and to streamline commissioning.

Integrated provision: This offers an opportunity for partners "to resolve some of the difficulties experienced by users and, at the same time, to increase the quality of services by allowing different professionals to work within one management structure". The advantage of this flexibility is that by having a single management structure, a more co-ordinated approach is achieved.

Mounting pressure?
Partnerships should fulfil the objectives identified in the local health improvement programme - they do not need to be specifically identified but must be seen to underpin agreed priorities. Partners may start off with one form of partnership and progress to another.
Although the arrangements are discretionary, and partners just have to notify regional health authorities of their plans, Health Secretary Alan Milburn is keen to see other authorities to sign up. He was robust in condemning "sterile arguments about boundaries" in the 1998 Partnership in Action discussion document and if the first set of partnerships go well, there is likely to be increasing pressure for all authorities to get involved.
"Ministers are keen to see them used and be effective in producing better services," agrees Carole. "This has been a very joined-up document at their level too - endorsed by DoH, DETR and DfEE."
The partnerships are unusually democratic arrangements, as one of the conditions is consultation with appropriate stakeholders.
"We're re-empowering local people," explains Carole. "The real emphasis is on better services for people and improved outcomes."
The department's main aim now, is to encourage people to use the opportunities in every possible way.
"A partnership can come from virtually any starting point and develop into something," she says. "If you've got a good idea about why a partnership would help in your area there's no reason at all why you can't suggest a pooled fund, or whatever arrangement fits. I'm not saying it's easy, but ultimately it's about improving service and bringing together natural partners for common projects. It's something that authorities have said they wanted in the past, now it's up to them to seize the opportunity to make the most of it."

Further information
Information on the new powers was sent out to all local authorities, health authorities, NHS Trusts and primary care groups - council leaders, as well as leading officers need to "fly the flag" as well as officers. The DoH website carries the most up-to-date information about partnership arrangements, including detailed implementation guidelines. The site also has an information exchange which allows the partners to share problems and solutions. When local partners contact NHS regional offices about their partnership arrangements, they will be listed on the website so that others can contact them for help or information.

Visit the DoH website at: www.doh.gov.uk/jointunit/pship1.htm#purpose to find out more.