The Role as Director Social Services with Pembrokeshire County Council and County Director for Pembrokeshire with the Hywel Dda Health Board.
Jon Skone, October 2010 Director of Social Services/ County Director Pembrokeshire, Pembrokeshire County Council/ Hywel Dda Health Board
This article is based upon the brief notes used for a 15 minute presentation made at this years Association of Directors of Social Services Cymru conference at the end of June on the topic of integration with the health service. The reason for my involvement is that since March of this year I have held the posts of Director of Social Services with Pembrokeshire County Council and County Director for Pembrokeshire with the Hywel Dda Health Board.
This all came about with the arrival in West Wales of Trevor Purt as the new Chief Executive of the Health Board. Trevor had a vision of decentralising the organisation based upon the three counties of Carmarthenshire, Ceredigion and Pembrokeshire each managed by a County Director one of whom would come from an acute background, one from a community background and one, he hoped, being a Director of Social Services.
Just before the Christmas break last year I received a telephone call from a friend and colleague, who is an executive director with the Board asking how I would feel if Trevor approached my Chief Executive, Bryn Parry-Jones, with a proposal that I take on the role of County Director. It is true to say that I didn't think twice about saying that I would be up for this because it would provide me with the golden opportunity to make some of what we had been talking about come to be. It would have been very difficult to have said no and four months on, although my wife thought that I had lost the plot (not quite the way she put it) I have not regretted the decision.
Rumour has it that Bryn and Trevor agreed the idea and a way forward in less than ½ hour. The whole arrangement consists of an exchange of letters stating that 50% of my time and that of my colleague, Angela Watwood (who became the Head of Community and Primary Care) would be purchased by the Health Board at an agreed cost for an initial period of 13 months, reviewable before December 2010, and that our activities on behalf of the Board would by covered by their insurance.
One of the advantages of linking the two organisations up at Director level is that because I am so used to working within a matrix of accountabilities the need for negotiated accountabilities and governance arrangements has not been required, although as time goes on we will need to do some work on this.
In order to free up my time my responsibilities for Housing and Community Safety were transferred to a colleague Director in Pembrokeshire County Council and in return, I may be the first Director of Social Services to be responsible for a District General Hospital.
It is very difficult to describe what it has been like but if you have ever seen the film Butch Cassidy and the Sundance Kid the feeling is abit like when they jumped off the cliff. It was there and Angela and I just went for it without really knowing when or if we would ever reach the bottom. At the present time we are still falling but it is in slow time and not threatening or scary.
The idea that these roles could be undertaken separately with a neat division of time, quickly went out of the window and as far as I am concerned I am doing one new job. I'm not working any more hours, indeed I rarely work weekends now because this was one of my wife's conditions, but when I am in work it is pretty relentless and in my face.
It has also forced me to view the world very differently. From talking and believing in partnerships and integration, I now live and breathe it and it is the necessary default position to keep my sanity. I no longer have any excuse or other person to blame or negotiate with. It is fair to say that I do have some strange conversations with myself.
Both Angela and I have found people very welcoming and accepting although we do find the management environment within the health service with its complex accountability structures and very hands on relationship with the Welsh Assembly Government, very different from managing within the local government context.
It is now very difficult to see any other way of operating and although we are currently concentrating on services for adults, we have already had discussions concerning services for children, particularly those concerned with safeguarding.
Working across both organisations does provide us with real opportunities for mutually riding out the approaching financial storm and driving the integration agenda without having to rely on section 33 agreements.
I now understand why people concentrate so much on the acute services. I look back with fondness at a time when I did not react to ambulances driving past or the air ambulance flying over. Now I am more inclined to worry about their impact on achieving my 4 hour Accident and Emergency Targets.
If I were to be pushed to give a personal vision of where this could lead I would say that possibilities could include either full integration or the creation of a new entity called something like Health and Social Care Pembrokeshire which is an arms length social enterprise sitting between, but owned by, both the local authority and the health board.
Director of Social Services/ County Director Pembrokeshire
Pembrokeshire County Council/ Hywel Dda Health Board