Herefordshire: a unique partnership

Herefordshire leads the UK in the way it brings health and local government together in a uniquely strong partnership to deliver improved public services for you.

Working as one

In early 2008, Herefordshire Council and NHS Herefordshire became the first local authority and primary care trust to form a new kind of partnership. It was based on a shared vision to work together and achieve efficient, excellent and value for money services to improve the life chances, quality of life and health and wellbeing of people in Herefordshire.

A single chief executive leads both organisations. We also have a joint management team and several joined up teams and services.

We work as one organisation to plan, purchase, design and deliver care around people's individual needs close to where they live. We also have one set of agreed values that puts people at the heart of everything we do.

We have a single corporate plan with shared targets, and we have new systems and new ways of working to achieve improved performance across the council and the primary care trust. We work to agree joint policies wherever possible, including a new joint environment policy, and we have a joint disability equality scheme. 

We operate out of a single corporate headquarters and we are bringing around 1600 council and primary care trust staff together in one building to create a single working environment, enabling still more integration, improving services and cutting administration costs. The move means we can sell many old premises that are not fit-for-purpose and expensive to maintain and instead, the funds will be used to improve essential services.

We have invested in new systems to drive improvements in how social care cases are managed, as well as new systems to share information across several areas of operation and bring together human resources, payroll, finance and procurement systems to make them more efficient.

Moving forward, Herefordshire Council, NHS Herefordshire and Hereford Hospitals NHS Trust are discussing how they could save many millions of pounds a year through sharing several central functions and investing the savings back into protecting essential services for the most vulnerable members of the community.

Improving customer care

Several health and local authority services have been transferred to our award-winning customer service centres in our market towns and the city. The aim is to improve customer care and make our administration more efficient and effective. Our Info by Phone centre has speeded up responses across a wide range of services, with most queries now answered at first contact. A single Customer Insight Team oversees customer care and complaints across council and health services to ensure we learn from customer experiences.

Our info centres bring health and local government service information together in one place, and some go much further. Our centre in Bromyard also contains the town's library, a sports centre, tourist information, internet access and a range of community services.

Herefordshire was the first in the UK to provide information technology, systems and support across a local authority, primary care trust, hospital trust, schools, mental health services, GP practices and voluntary sector organisations. The benefit to Herefordshire is the streamlining of information flow and systems across most of the public sector, which makes more efficient use of staff with specialist expertise and skills, and means that you do not have to keep giving the same information every time you contact us.

Public services across the council, the primary care trust, the voluntary sector and the police and fire services now work more closely together to better meet your needs. We produced a unique guide for residents that arranges information about services around the important events in your life - such as starting a family, moving into the area, becoming a carer or bereavement. This makes services easier to understand, locate and access for everyone.  

Better health for everyone

Herefordshire people generally enjoy better health than the average for the rest of the country - and can also expect to live longer. The council and the primary care trust are working to challenge the links between high social deprivation and poor health, with emphasis on promoting healthy lifestyles and designing 'packages of care' for older people and children.

By working closely together, our local NHS and the council can tackle early on the deep-rooted causes of ill health - including poverty, education, housing, upbringing and the choices people make about smoking, alcohol, diet, sexual behaviour and exercise. By taking a preventative approach we reduce people's risk of developing serious and long-term illnesses such as stroke, heart attack, diabetes and cancer.

The recent opening of a walk-in health centre in Hereford has been well received. It means you can see a GP or a nurse without an appointment any time between 8am and 8pm seven days a week. We are working to make sure that people have more choice, greater convenience and can access responsive services that fit in with today's busy lifestyles.

Partnership working has resulted in local people being able to choose and book appointments with specialists - at a clinic or hospital at a time to suit you - or even use county libraries or info centres to book appointments.

We have involved the whole of the local NHS and the council's adult social care services in reviewing how services could be better shaped, focused and provided around the needs of individuals.

Looking after older people

Numbers of older people continue to grow more rapidly in Herefordshire than nationally. Increasingly, services are joined up to support them to live independent and fulfilled lives.

The Care Quality Commission, the independent regulator of health and social care, has reported that we are 'performing well' and we are looking after older and more vulnerable people better than ever before.

We have pooled budgets for managing adaptations and equipment to help people to live independently at home after they have come out of hospital, or to support disabled children at school. Accessed by district nurses, occupational therapists and social workers, the service enables faster and efficient use of equipment across the county, providing improved health and social care. Most equipment is now delivered and fitted in two days of the original request. And there are significant savings on management costs, and from joint purchasing of equipment.

We joined forces to provide 24-hour care services for older people with mental health problems in their own homes. This gives them the choice of living at home, prevents unnecessary hospital admissions, reduces long-term residential or nursing care admissions and improves support for family carers.

Services include homecare, a roving night service and using technology like smart phones and fall sensors. We offer a 24-hour telephone link to give people confidence that we are on hand to help as needed.

Hundreds of people are now choosing their own social care with their own budgets, and saying this is enabling them to be independent and to lead fuller lives, and we are piloting individual budgets for some health services. 

We jointly fund village wardens, who are local people in remote rural parishes who give practical support to older people, helping them to feel safe, healthy and in touch. They collect essential medication, help complete forms, do their shopping, join in with activities and support them in emergency situations.

Supporting children and families

Services for children are 'performing well' according to an annual performance rating, published by Ofsted, and children receive a good start to their care and education in early years childcare and nursery settings. Two thirds of primary schools and secondary schools in the county are rated good or better.

We have developed a multi-agency approach to services for children and families on behalf of Herefordshire's Children's Trust (which brings together all agencies working with children). The result is a programme to create teams of professionals in locations closer to communities, providing a mix of services such as family support, health and social care, education welfare and youth services in each location working with local communities.

There is better support and training for family carers through the Carers' Hub, which was established in 2009. And a network of children's centres has been set up to bring together health, family support services, employment and training opportunities for young families.

Helping the most vulnerable

Public services and the voluntary sector work together to look after the more vulnerable members of the community through a groundbreaking 'signposting' service. For example if a district nurse visits an older person, who does not have a smoke alarm, then the district nurse will make sure the fire and rescue service gets in touch to put that right. Or if a social worker thinks a resident is not getting all the benefits they should, then they will get in touch with our welfare benefits service to ensure they do.

To keep communities safe, the partnership works together to identify areas of anti-social activity, and explore how we can safeguard vulnerable individuals. Our needle and syringe programme at community pharmacies helped cut the spread of Hepatitis, HIV and bacterial infections and promote the health and welfare of injecting drug users. It is highlighted nationally as best practice by the Department of Health.

The council and the primary care trust now has a single emergency planning service, which means we can work more effectively in responding to the challenges of extreme weather, flooding or health threats, such as pandemic flu, to ensure residents are protected.

Leading the way

Where Herefordshire leads, others are following. London is planning to bring together several borough councils and their local primary care trusts in order to improve services. And in Greater Manchester, local authorities and primary care trusts are also investigating enhanced partnerships.

The experience in Herefordshire is that instead of public service agencies working alone, they can, by sharing more services and working in true partnership, make much stronger progress on issues that residents feel are most important, such as quality of life, health and wellbeing.