"I think what makes us different is that we're two organisations working as one," says Samih Kalakeche, director of health and adult social care at Liverpool city council.
"We share a vision and hopefully speak with one voice. We just pick up different parts of the agenda."
Kalakeche's team has an unusually close working relationship with the city's clinical commissioning group (CCG), which replaced the primary care trust (PCT) last April.
Integrating the two bodies – which between them commission Liverpool's primary care, public health and adult social services – makes sense at a time of rising need and falling budgets. But making it happen required political will and decisive leadership.
The fact that Kalakeche had led a small joint PCT and council commissioning team a few years previously did not hurt, but trust still had to build between him and CCG chief officer Katherine Sheerin.
"It was a different environment when we worked together before," says Kalakeche. "So I had to prove my leadership and learn how Katherine operates. We both have clear vision about where we're taking the city's health and social care, and that has helped our teams work much closer.
"There was some suspicion at the start – the CCG was a new body and people weren't sure how GP commissioning would work. The council too had a new administration take over in 2010. If we hadn't managed this properly our political leaders and teams would have lost trust."
Their journey began when the CCG – while still in shadow form – invited Kalakeche and his executive lead, Cllr Roz Gladden, to join its governing body. Together with hospitals and specialist health trusts, the CCG is also represented on Liverpool's quarterly health and wellbeing board, which is chaired by its elected mayor, Joe Anderson, and run by Kalakeche and Sheerin.
Both organisations are led by elected figures with deep roots in their communities – councillors and GP representatives on the CCG's governing body set the agenda. But officers put their ideas into action, manage expectations and keep them running day-to-day.
Sheerin – previously an associate director of the PCT – admits working with councillors was initially daunting. "I think they value the fact I go to all the select board meetings though," she says. "It's about consistency – you have to put in the time and not always be rushing off so they get to know you, otherwise there may be a bit of suspicion."
The pair meet several times a week, as do their deputies and finance teams. Professional politics have been sidelined – the focus instead is what is best for Liverpool, a city with high deprivation which is now facing deep financial cuts. Liverpool also has longstanding problems recruiting and retaining social workers – around 20 vacancies are currently being advertised.
Sheerin says: "Liverpool is the priority for our councillors and GPs, who have been working in their communities for many years and who are passionate about the city. They all have a real vested interest in getting things right for the long term.
"Samih and I may disagree on things but the main focus is on getting it right for Liverpool. This kind of relationship between the council and CCG doesn't exist in many places."
The innovative approach has seen the CCG put half a million pounds a year into running Citizens Advice Bureau sessions at GP surgeries – a direct response to the government's welfare reforms. This would not have happened without them understanding the impact of what is happening within the council, says Sheerin.
A major initiative has been the creation of 85 "step up, step down" beds suited largely to older patients who need short-term support on leaving hospital or when they are struggling to cope at home through illness.
The council invested £8.5m of capital funding to build the hubs and the CCG provides the revenue funding. The move has reduced the number of delayed discharges from hospital by 42% since April 2013.
Kalakeche says: "This couldn't have happened without trust and good working relationships between our organisations. The council is capital rich but not revenue rich so we had to work together to make this happen. It's a win-win – I can offer a placement for £650 a week when a single night in hospital can cost up to £300. Hospital is the last place we want to keep people when they needn't be there.
"It also means the patient can be assessed in a dignified manner by a social worker rather than when they are confused on a hospital ward. In the past we'd get people at the age of 55 being sent to institutional care because hospitals are not the place to assess people. No – get them physically well, move them out and get them into the community. It's better all round."
The organisations are now in the process of developing and aligning their two and five-year strategies. And they are visiting communities with a joint roadshow to communicate their shared vision and priorities.
Kalakeche says: "The aim is that we are becoming almost seamless – that if my team can't do something Katherine's team can do it, or vice versa. We have to move beyond this mentality of 'I am NHS' or 'I am local authority'."
Written by Ciara Leeming for the Guardian, to a brief agreed with Liverpool city council and Liverpool clinical commissioning group. Funded by Liverpool city council
