The Joint Appointments Guide 2014: An updated guide to setting up, managing and maintaining joint appointments between health organisations and local government in Scotland

Introduction

Updated Scottish version of the Joint Appointments Guide

The Joint Appointments Guide was originally produced by OPM in 2001 for the Department of Health in England. In 2004 the Joint Future Human Resource Group (JFHRG), commissioned a version to provide a guide for practitioners in Scotland.

This is a second edition of the Scottish Guide, updated during 2013 to reflect the current legislative climate, in particular the Public Bodies (Joint Working) (Scotland) Bill which is progressing through Parliament at the time of writing.

The guide is based on research carried out in England for the Department of Health, and remains largely the same as the original published guide. The HR Working Group (HRWG) for Integration felt that much of this guide was still relevant and could be updated to reflect the current context and would still add value.

The changes to this version include an updated introduction describing the current policy context in Scotland, and some changes to the text to ensure the guide remains relevant to Scottish organisations and reflects the current Scottish policy context.

This guide is written in general terms to attempt to cover a range of joint appointments at various tiers. However, the terminology used and specific aspects of the guidance may not always be entirely appropriate to the governance arrangements which will apply to the post of chief officer, hence the status of this document as a guide.

What are joint appointments?

When separate organisations develop shared staffing arrangements to recruit someone to work for all the organisations, they have created a joint appointment. The purpose of joint appointments is usually to help organisations - sometimes those that are unused to working together - to work more collaboratively and achieve shared objectives. In the social care and health sectors, where joint appointments are now commonplace, joint appointments help deliver partnership working, integrated management and planning, and service integration.

In Scotland, the number of joint appointees is likely to increase significantly over the coming years, particularly in light of legislation. The roles of joint appointees can differ enormously depending on which organisation has recruited them and where they work in the organisations - at strategic, policy or service levels. In social care and health - where the majority of joint appointees are located - examples of joint appointments include project managers, those working for older people's teams and occupational therapists. Partner agencies to joint appointments may include organisations from the voluntary sector, as well as local authorities and health boards. In all cases the same principles for effective appointments apply.

The current policy context for joint appointments

In 2011, the Christie Commission on the Future Delivery of Public Services reported that Scotland's public services were in need of urgent and sustained reform to meet unprecedented challenges; to improve strategic coordination; and to ensure that services are designed with and for people and communities.

Later in 2011, and reflecting the findings of the Christie Commission, the Scottish Government announced its intention to move towards integration of adult health and social care (as a minimum) in order to improve the quality and consistency of care for older people. At this time, the Scottish Government made an overall commitment to creating the conditions for reform and set out the four pillars of its reform agenda:

• a shift towards prevention;
• greater integration of public services at a local level driven by better partnership, collaboration and effective local delivery;
• enhanced workforce and leadership development; and
• a sharp focus on improving performance, through greater transparency, innovation and use of digital technology.

Since 2011, the Scottish Government has been working closely with the main delivery partners involved in achieving this aim - Local Government and its partners for social care and NHSScotland for health services. Both Local Government (though the focus on National Outcomes and delivery of Single Outcome Agreements) and NHSScotland (through its 2020 Vision for Health & Social Care) have clearly established ambitions; to provide the high quality health and care services the people of Scotland expect and deserve into the future; to improve the support and services which are provided; and to build an engaged and empowered workforce.

Health and social care integration sits within a complex landscape where there has been significant progress in improving pathways of care in recent years. The Joint Futures policy, Community Health Partnerships and the work of the Joint Improvement Team have also contributed to development of partnership working across health and social care.

The introduction of a Dementia Strategy, continuing commitment to Free Personal and Nursing Care and the Reshaping Care for Older People programme, which is supported by the Change Fund for older people's services, all demonstrate determination to assure innovative, high quality care and support services that improve people's lives. The Scottish Government's Carers' Strategy supports unpaid carers, who are themselves essential providers of health and social care, and the Social Care (Self-directed Support) (Scotland) Act 2013 seeks to put greater control into the hands of individuals using care and support services.

The Healthcare Quality Strategy for NHSScotland, with its three priorities of person centered, safe and effective care, underpin the Scottish Government's commitment to deliver the highest quality healthcare services to people in Scotland. The 2020 Route Map (2013) sets out the priorities for achieving the 2020 Vision for Health and Social Care: it maintains the commitment to improving quality at scale across Scotland and among other things to engaging and empowering the workforce.

Everyone Matters: 2020 Workforce Vision (published 2013) reflects the voices of over 10,000 people involved in the extensive engagement exercise: 'We will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations. We will continue to modernise the way we work and embrace technology. We will do this in a way that lives up to our core values. Together we will create a great place to work and deliver a high quality healthcare service which is among the best in the world.'

Everyone Matters captures the values that are shared across Scotland's Health Service:

• care and compassion;
• dignity and respect;
• openness, honesty and responsibility;
• quality and teamwork.

These values reflect the views of NHS staff and it is likely that they would be recognised by all those working in health and social care - aligning with the Practice Governance Framework for Social Work Practice, the Codes of Practice for social care workers and their employers developed by the Scottish Social Services Council on behalf of Scottish Ministers and the workforce policies developed by the range of organisations delivering social care in Scotland in the public, voluntary and independent sectors.

While a great deal has been achieved over the last few years there is widespread recognition across Scotland that reform needs to go further and the plans for integration are intended to deliver the change needed. Effective approaches to joint appointments will undoubtedly play a key part in enabling achievement of the outcomes required from integration.

The Public Bodies (Joint Working) (Scotland) Bill

The Public Bodies (Joint Working) (Scotland) Bill was introduced in the Scottish Parliament on 28 May 2013. At the time of writing its journey through Parliament is under way, and is likely to come into force in April 2015.

The Bill seeks to improve outcomes for people by providing consistency in the quality of services, ensuring people are not unnecessarily delayed in hospital, and maintaining independence by creating services that allow people to stay safely at home for longer. It will do this by integrating adult health and social care services.

What is meant by this is that services should be planned and delivered seamlessly from the perspective of the patient, service user or carer, and that systems for managing services should actively support such seamlessness.

Joint appointments are an important element of the delivery of the integration agenda and can play a significant role in helping health and local government agencies work together.

The role of joint appointments in helping to develop shared and complementary policies and plans, bring different professionals together and strengthen lines of communication between different organisations is seen as particularly valuable. However, joint appointments can fail to deliver the intended benefits when the post is poorly designed or the wrong person is recruited or is not supported adequately.

The purpose of this guide

This guide provides evidence-based guidance to help people involved in setting up joint appointments, and joint appointees themselves, to develop good practices and ensure that conditions are favourable for the new arrangement to work. It will help you to:

• set up and maintain a new joint appointment;
• review an existing joint appointment;
• troubleshoot within an existing joint appointment; and
• set up learning and development programmes, for instance to establish management competencies, in local government or health organisations.

Who is this guide for?

This guide is for:

• people involved in setting up joint appointment arrangements between health and social care organisations, including directors/heads of human resources, and staff organisations' representatives;
• people already managing or working with joint appointments; and
• joint appointees themselves.

The research behind this guide focused on joint appointments for health improvement between health organisations and local government. However, the recommendations, guidance, hints and tips within it will also be useful for developing joint appointments involving other organisations.

The guide's credentials

This guide is based on the initial findings of research funded by the Department of Health, commissioned by the South East Regional Public Health department and carried out by OPM. The aim of the research was to produce practice-based evidence about how best to manage the complex process of setting up and maintaining a joint appointment, focusing specifically on joint health improvement posts between health organisations and local government.

The research included a literature review, an examination of government policy drivers and contemporary analysis of joint working, specifically joint appointments. In addition, a survey was undertaken, supplemented by twelve in-depth case studies, to develop an insight into the wide range of joint appointments between health organisations and local government and to identify factors that can make joint appointments a success.

More recently, the guide has been updated to reflect the current context under the oversight of the HRWG. This group comprises membership from NHS Boards, SOLACE, ADSW, SPDS, COSLA, Trade Unions and Scottish Government. It is chaired by Shirley Rogers, Scottish Government.

How to use this guide

One of the main challenges of joint appointments, and indeed of partnership working in general, is making sure that the joint appointment is part of the mainstream activity of partner organisations.

The OPM research showed that in joint appointments which were experiencing difficulties, becoming detached from the mainstream was a major factor. This manifested in everything from poor strategic thinking about the purpose of the joint appointment to the absence of standard line management systems.

The key message of the research is that in joint appointments we need to apply everything we already know about good management practice in appointing a person to any organisation, and add new approaches to support the partnership dimension of the appointment. A joint appointment requires flexibility from organisations, but this should not amount to a suspension of effective management practice. This guide aims to help managers to identify the more complex needs and challenges of a joint appointment, but it also revisits and emphasises the more elementary processes of good human resource practice.

The guide begins at the start of a joint appointment process and has been written in a way that allows users to access the parts they need. The diagram opposite will help you to define the starting point for yourself.

Determining your starting point