Consolidated health department under discussion in Jackson

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Consolidated health department under discussion in Jackson

The Jackson County Commissioners got some food for thought during a meeting last week exploring the possibility of consolidating some of the county’s health and human resources services into a single department.

“Things have gone well in a lot of counties, so if there’s a way to potentially improve services for the citizens of Jackson County, I think we owe it to the citizens to at least investigate it,” said Commissioner Ron Mau, who suggested discussing the change during the board’s first work session after his election last November. “This is the start of the conversation, is the way I’m looking at it.”

A state law passed in 2012 giving counties more freedom to consolidate departments than they’d previously had, allowing them to combine the health department with one or more human services departments. So far, 22 counties — including Haywood, Swain and Buncombe — have formed a consolidated department.

Following Mau’s suggestion, the board invited Jill Moore, public law and government associate professor with the University of North Carolina School of Government, to give an informational presentation on the options available. Margaret Henderson, a public administration lecturer with the School of Government, also came to facilitate a group discussion among members of the commissioner, health and social services boards. The county paid a $2,000 facilitation fee, plus travel expenses, for the visit.

Pros and Cons

The meeting opened with a quick poll of its participants to see what about consolidation had their interest and what they liked about the current set-up. The resulting discussion revealed overwhelming support for the work the boards are currently doing and hesitation about trying to fix what many said wasn’t broken.

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“At this point I have to say I feel like we have two exceptionally well-run public bodies and both of those deliver exceptional service to our citizens,” said Commission Chairman Brian McMahan. “I don’t see any need to change the way we do things now, but I’m open to the conversation here at the table.”

Three of the five commissioners — Mau, Mickey Luker and Charles Elders, all of whom are Republican — said that while the board might ultimately decide to change nothing, it made sense to at least have a conversation.

“I think anytime that we can look at and investigate a potential to improve any services for the citizens of our county, then it’s worth a conversation,” Luker said. “Whether we do it or not is a decision down the road, but I think you’ve got to start somewhere.”

Counties that have undergone consolidation have had varied reasons for doing so, Moore said. Some wanted to improve service delivery or change the relationship between the county commissioners and the departments. Others wanted to create a unified personnel system, as consolidation gives counties the ability to put under county policies employees who previously were required to be under state personnel policies. And still others wanted to save money by identifying efficiencies.

However, Moore said, there have been some lessons learned in the process. Consolidation sometimes saves money, but it doesn’t always. And it doesn’t necessarily make communication seamless between departments, because legal restrictions on how and with whom some types of information can be shared — such as information regarding child welfare cases, for example — don’t change.

Some of the goals motivating consolidation can be achieved without consolidating at all.

“Honestly, consolidation in or out, it’s co-location that I envision has efficiencies,” said Health Department Director Shelley Carraway. “More collaboration, more hallway light bulb moments.”

Existing logistical challenges are driving Commissioner Elders’ interest in consolidation. Builders, for example, have to deal with three different departments with three different offices in two different buildings — planning, permitting and health. Similarly, the health and social services departments often deal with the same people, and those departments are about as far away from each other as it’s possible to be in a town as small as Sylva. The health department is on Scotts Creek Road, and social services is off of N.C. 116 near Webster.

“We had a lot of people complaining about running so many places to get questions answered,” Elders said. “I’m very concerned about how we might consolidate some of those and be better servants to our builders and whoever needs this service.”

Longtime health board member Doug Homolka agreed that “it could drive a drunk to sobriety to try and get all those things done,” but cautioned against “throwing the baby out with the bath.”

“Maybe a better conversation between the directors of those particular areas (is to) put it into a one-stop shop situation and put it to someone who’s consistently answerable so you don’t get a different answer every time you go there,” he said.

Haywood’s experience

Haywood County was an early adopter of the consolidated health department model, launching a study of the concept almost as soon as the law was passed and debuting its consolidated department in January 2014.

“It’s been great, honestly,” said Stoney Blevins, director of the Haywood County Department of Health and Human Services. “I really can’t think of any downsides.”

Blevins had experienced a consolidated department before arriving in Haywood County in December 2014, working with the Wake County department that gained state permission to consolidate before the newer, broader law passed in 2012. He says the model allows more efficient use of resources and creative service options.

“Anytime we have a vacancy, we look at it and ask ourselves where is the best place it could work across the whole agency,” Blevins said. “That’s kept us from having to add positions over the last several years.”

He said the 19-member governing board is “dynamic” and that while big transitions are always difficult, the county’s original goal of improving service to citizens is being achieved.

However, he said, the calculation is different for each county. Jackson County has a reputation for wonderful service delivery already, so it’s possible that the investment involved with consolidation wouldn’t be worth the potential return. And the fact that Jackson’s health and social services offices are so far apart also poses a problem. Haywood County’s departments were already co-located when consolidation took place.

“If they’re in a county where they’re across town it’s a little harder,” Blevins said. “It can be like getting married and still living in two houses. You’d be married, but you wouldn’t be working as closely together.”

Jackson’s social services building is still fairly new — it’s been around for roughly a decade — but commissioners are currently discussing the future of the health department’s location. The department needs more, better-configured space, and the board will soon decide whether to renovate the existing building or pursue new construction. In February, commissioners voted to pay $424,350 for a 3.9-acre property that’s on Skyland Drive next to an existing county building and just down the road from the current health department building — that land could be used to house a new health department, and the consensus surrounding consolidation could be a piece of the puzzle.

“I think every county should ask themselves that question,” Blevins said. “We have this available to us. Should we do it or not? The answer might be no.”

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