The ambition to join up services
No-one would argue that joining up services across the public sector is a bad idea which is why it’s been an ambition of successive governments for decades – either to improve services to customers or save money (or, more usually, both).
The recent spate of White Papers sets high expectations of Local Government, Social Housing providers and all the organisations and individuals who form the extraordinarily diverse ecosystem that provides Adult Social Care. As such, this constitutes a hugely ambitious and far-reaching programme of public sector reform and this against a backdrop where many of these organisations are grappling with staff burnout, Brexit, increased demand and a mounting cost-of-living crisis.
Keep it Local
There are particular opportunities and challenges in the recognition that local needs are best understood and met by local people. There are several examples, both in the UK and abroad, where small autonomous teams provide care and support to self-managing clients in their homes with the involvement of their formal and informal support networks.
The Buurtzorg model in the Netherlands[i] or Somerset’s micro-provider initiative[ii], for example, successfully tailor hyper-local services at a place, family and individual level. Early and proactive intervention of this sort not only provides much better outcomes but also saves money in the long run.
From Silo to Collaboration
Not all large organisations work well with themselves, let alone with each other, and the Government’s approach acknowledges many of the regulatory, financial, organisational and cultural barriers that we need to find answers to.
The systemic realignment of the way services are provided requires a significant cultural shift in organisations that may have become silo-based, not because they set out to be but because their activity has been traditionally focussed on specific statutory, fiduciary or target-driven outcomes. Public bodies including the newly constituted Integrated Care Boards, Local Authorities and Social Housing providers are expected to join forces to understand their customers at a granular and localised level.
A truly responsive and integrated approach means reaching out to the seldom-heard groups whose needs often mean that they are less well equipped to access services or express their views on them. While there will be a ‘single person accountable’ for local plans, these areas include hundreds of thousands of people for many Local Authorities and millions for most Integrated Care Systems. This makes it both important and difficult to ensure individual voices are heard if services are going to be tailored at a truly local level.
Transparency, Governance and Consistency
These new regimes also call for greater transparency in governance, reporting and accountability with increased powers for various Ombudsmen, the Regulator for Social Housing and the Quality Care Commission. Clarity and consistency are core components of equality and access – so it’s entirely proper for public services to be monitored and failures held up to public scrutiny.
Balancing National and Local
The risk for the organisations subject to this scrutiny lies in balancing national solutions for standards, data collection and performance with personalised local services that will vary from place to place by their very nature. Increased costs associated with monitoring and governance will be offset by better outcomes, but a prevailing fault line in previous efforts to join things up has been a mismatch between increased cost of delivery and compliance with savings realised for other organisations (or even for other bits of the same organisation).
There is therefore a pressing need for the forthcoming raft of carrots (funding and savings) and sticks (regulation and compliance) to be even-handed if we are going to overcome the traditional behavioural and organisational barriers to change.
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