At BDO we’re passionate about the potential for integrated services to improve quality and make savings. Yesterday we attended a dialogue session on the future of sharing outcomes, budgets and risks, hosted by the New Local Government Network (NLGN), the CBI, and Pinnacle PSG.
We’ve blogged previously on the barriers to integrating services at a local level – particularly those which stem from the way central government is organised. What was great about yesterday’s session was that it focussed on opportunities not constraints, and solutions which can be implemented locally in the future without reform at national level which may or may not happen.
The outcome of the session will be a new report from NLGN in the autumn. We can’t wait to read it. For now, we wanted to share our four headline thoughts following yesterday’s discussion.
Statutory services complicates the sharing of risks
Integrating services involves attempting to share the risks inherent in delivering those services. Yet in practice that proves difficult where there is a statutory requirement on either body to provide a particular service in a particular way. For example, if X local authority integrates with Y JobCentre to help long-term unemployed people into work, both are jointly responsible for the outcomes achieved but certain risks associated with the statutory duty of providing a basic job seeker service cannot be shifted from the Department for Work and Pensions. This can affect the depth of integration possible or the imagination with which it is pursued.
…Therefore managing demand is an ideal goal for a service integration project
If it is complicated to pinpoint where statutory responsibility lies when integrating services, a potential alternative is to focus on integrating preventative services which manage demand. Local authorities, NHS Trusts, Probation Trusts, Clinical Commissioning Groups and other potential partners for integration projects do not generally hold statutory responsibilities to stop something from happening – rather they are protecting themselves and their service users. Creating new preventative services that manage demand (and accrue savings) down the road can enable enthusiastic participation from a range of partners without cutting across their statutory duties.
Local government is best placed to coordinate local integration
There is no requirement for local authorities to hold the ring when it comes to developing and running an integrated services project. An NHS Trust or Clinical Commissioning Group or any other organisation could have the knowledge and commitment to do so. Yet when it comes to Whole Place Community Budgets (and associated Neighbourhood Community Budgets) these have been broadly local government led. There’s a clear reason. The advantage of local government in driving local integration is that it holds a democratic mandate to act, something which is not generally shared by their potential partners.
The focus of integration can be on ‘place’ or ‘outcome.’ Combining the two could be a powerful combination
The goals set by service integration projects so far, from Troubled Families to Neighbourhood Community Budgets, have tended to focus either on improving a range of services for a smaller local area, perhaps a specific neighbourhood, or achieving a particular outcome across a wider geography, troubled families living within an entire local authority boundary being a classic example. In short we have two types of combination: ‘specific outcome within broad geography’ or ‘broad outcome within specific geography.’ It would be fascinating to see more attempts to integrate services based on a ‘specific outcome, specific geography’ approach – for example helping people into work on just one estate within a local authority.
A thousand flowers blooming
A local authority, drawing on its democratic mandate and convening partners to achieve a discrete preventative outcome within a focussed geographical area offers huge potential as a model for service integration. But of course it’s not the only model. Whether it be as a result of central government backed schemes such as Community Budgets, Better Care or Troubled Families, or due to locally-sponsored efforts, Councils across the UK are acting as policy laboratories, experimenting with what works and what doesn’t. As the story continues, it’s vital that, from this ‘let a thousand flowers bloom’ approach, the best practice can be disseminated. Research, like the project being led by NLGN, will form a key part of that.