County discusses consolidation of health, social services departments
With several hours spent in discussion and brainstorming during a special-called meeting last week, the Haywood County Health Department and Department of Social Services are one step closer to the possibility of merging the two agencies.
No decision has been made yet, but the meeting, facilitated by the University of North Carolina School of Government, highlighted the desire of both agencies to increase efficiency and reduce costs. Present at the meeting were representatives from the health department and DSS boards as well as Mark Swanger, Mike Sorrells and Kevin Ensley from the Haywood County Board of Commissioners, DSS Director Ira Dove and Health Department Director Carmine Rocco.
The informational meeting led to a discussion about what the options are in a possible integration of the two agencies and the pros and cons of each option.
“We want you to have the information so you can make the best decision for your community,” said Aimee Wall with the N.C. School of Government.
Changes in state legislation now allow for all counties to establish a Consolidated Human Services Agency (CHSA) in place of several separate agencies — Haywood County’s current system. While DSS and the health department already physically consolidated last year when both departments moved into the newly renovated building on Paragon Parkway in Clyde, the agencies still operate independently with their own separate governing boards.
Consolidation could be a positive move for the county, but Swanger emphasized the need for more information gathering and studies of other counties, including Buncombe, that have begun to consolidate, or have already implemented the consolidation process.
“I’m not absolutely convinced one way or another,” he said, adding that DSS and the health department have established a task force to gather this information.
“Will consolidation show actual benefits to the county?” Sorrells asked.
If a CHSA were established in the county, it would mean changes in how the agency is governed.
Currently each agency has its own board that makes recommendations on policies and procedures to the county commissioners. The one exception is that those serving on the health board and the social service board are responsible for hiring their respective department directors.
In a CHSA, a Consolidated Human Services Board would need to be appointed or the county commissioners would serve as the board with an advisory committee.
A consolidated CHS board consists of four consumers of human services (those provided by the agencies), eight professionals, including a psychologist, pharmacist, engineer, dentist, optometrist, veterinarian, social worker and nurse, two physicians (one must be a psychiatrist), a county commissioner and other public members. The board can consist of up to 25 members.
The other option is for the commissioners to serve as the human services board for one or both agencies. To do so, the county would have to give a 30-day notice of a public hearing on assuming the board(s) powers and duties, after which, the board can pass a resolution. If this option is taken, the commissioners would have to appoint an advisory committee on health services, and they may appoint other advisory committees, although there is no law saying they must also have an advisory committee for social services.
As things stand now, much of the final decision-making powers already reside with the county board of commissioners, which wouldn’t make for much of a change if that option is taken under the possible consolidation.
“We understand what the ramifications would be is that there would be very few additional duties thrust on the board of county commissioners,” Swanger said, explaining that right now the buck stops with the commissioners anyway.
“If I’m going to be accountable for something, I want to have some authority to affect it,” he added.
However, others expressed concern that if the commissioners entirely took over governing responsibility, the experts would lose control over agency decisions and the process could become more political.
“We really feel we’re doing a service to the county,” said Robert Knoedler, board of health chairman. “When we send something to the county commissioners, it’s with a lot of thought. We don’t want the board to feel that their input is not important.”
Swanger said if it were decided that the commissioners would take over the governing of the consolidated agencies, it wouldn’t be very different from how things work now, which includes input from both boards.
“To suggest we would take that advice less seriously is just not true. You don’t go out on a limb as a commissioner and make uninformed decisions, and you’ll pay for it if you do,” he said, adding, “We’re the ones that are most accountable to the public.”
Sorrells said the commissioners need the expertise of the boards to make good decisions, and he doesn’t see that changing whatever the arrangement might be.
“I’m going to rely on their expertise because we don’t have that expertise,” he said.
Degrees of consolidation
As to whether the agencies would maintain separate boards or if one large consolidated board would be created, the group came up with positives and negatives for each scenario.
One large board would mean representation from a broad spectrum of the community and allow everyone across agencies to “work strategically and focus our efforts,” Rocco said.
However, the downside would be that such a large group could be unwieldy and because of different confidentiality laws for the different departments, it could get confusing. Maintaining separate boards could mean better logistics, but overall cohesiveness, understanding of each agencies issues and strategic planning capabilities might be lost.
A possible solution incorporating the best of both options would be to have one large CHS board with several sub-committees focusing on more specific issues, Dove suggested.
“It’s more working differently,” Dove added. “We could have sub-committees meet more often on a focused agenda. I don’t see a huge downside to having one board. (The board) will have more superficial knowledge on a broad spectrum but will have expertise from sub-committees.”
Although a decision on the governing of the potential CHSA would have to be made before the agencies’ integration, the focus of the meeting soon shifted to a discussion about whether consolidation would even be beneficial for the county and the public.
“It just makes sense to have it all under one umbrella,” said County Manager Marty Stamey, who said he believes a CHSA would be more efficient and convenient for everyone.
Stamey used the example of a client trying to sign up for food and nutrition services. He said they would sign up at DSS, but since the health department has the nutritionist on staff, they would have to make an appointment with the other agency, too.
Consolidation would greatly streamline a variety of processes, he said.
Sorrells pointed out that the county is already seeing some savings by having multiple service agencies under one roof, but at this time, not enough is known about the likely outcomes of consolidation to make a decision.
“If you’re going to do this right, it may cost up front,” Dove said, but he added that so far the information from the task force is showing that consolidation can slow the growth of agencies, meaning lower administrative costs.
Swanger said on that note, the county has been ahead of the curve, cutting staff from about 550 employees to 500. The positive side of those cuts is that consolidation probably wouldn’t result in more cuts being made, but could “slow growth by finding more efficiencies.”
If staff were further reduced, however, layoffs would be unlikely, Ensley said.
“Reductions so far have mostly been through attrition or retirement,” he said. “That would be the preferred way we’d handle it. We’re in lean times and government needs to run lean.”
Dove agreed and added, “There’s not a lot of excess staff, so I don’t think there would be a big reduction.”
Even though there probably wouldn’t be much in savings for the county up front, Swanger said slowing growth could mean big cost savings in the long run.
“The benefits would probably be over time,” he said.
Originally, the health department and DSS boards wanted to have a recommendation for the county by Jan. 1 of 2013, but a decision might take longer than anticipated. The next steps will be to put the gathered information together and review the research from the task force, and then the decision-making process can begin.