Joined-up working, shared priorities, joint financing – was there ever a time when the Audit Commission, governments and countless other watchdogs and public bodies were not urging services to be more ‘joined up’?
For many, the buzzwords ‘joint working’ lost their pizzazz a long time ago. But whatever joint working means, the mantra ‘partnerships are good’ probably still rings loudly for public sector leaders.
Of course, the Audit Commission has repeatedly championed the potential of partnerships. Councils working with nearby health services is one example, but this has to have meaning and common purpose. And it has to have finance.
In these times, public services need to achieve more, but with less money. It’s possible that joint working, and specifically the joint financing of services, can ease the pain for finance directors and care providers.
There is evidence that pooled funds can improve services, but the Audit Commission’s new report, Means to an end: joint financing across health and social care, is sceptical about offering blanket reassurances. No two places are identical, so different approaches will work in different areas. But generally, councils and NHS bodies are not clear about what they want to achieve from joint financing, even where it’s happening. So it’s hard to say whether their projects are successes or not. The message here is loud and clear: know what outcomes you want when you set up joint financing agreements.
If a pooled fund is created by a council and a primary care trust aiming to lower the rate of teenage pregnancies in an area, they must have a target in mind. And they must review their progress towards it. Too often our research finds that when health and social care providers put pen to paper for an agreement, it’s the agreement itself that takes all the energy. Part of the problem is that the actual financial agreements can seem complex to arrange – getting pen to paper becomes the achievement.
Ticking the joint financing box might be a milestone, but that sort of tick-box mentality has to go. It needn’t be as difficult as many complain about. We know the Department of Health has tackled a stumbling block by moving the finance cycle so that the NHS and councils are potentially in tandem. And the commission’s report includes examples of successes.
Joint financing can work from the top down and it needs support from within the organisation. In Torbay, integrated health and social care teams can commission bespoke care for people, while the London Borough of Hammersmith & Fulham has a joint chief executive with one management team that combines health with all council services.
At the very least, all councils and the NHS must ask what they might achieve through joint financing to improve life for people in greatest need. Some councils might have worked naturally with their health service counterparts for decades, with well established relationships at the top or in the frontline care services. Provided the benefits of this are clear, that’s a good thing. But organisations don’t need to work together just for the sake of it.
Improving services has to be the main reason for joint financing. Getting a grip on potential savings and better value for money also has to be a priority. Pooling resources can help to achieve that. But it isn’t enough on its own. It’s the outcomes from doing it that matter and on which all organisations should judge themselves.
In December, the new Comprehensive Area Assessment, under the name Oneplace, will emphasise the importance of results. It’s likely that some of the better outcomes for people with health and social care needs will have been achieved through joint financing, proving that this is more than a financial agreement and much more than a tick-box exercise.
Michael O’Higgins is chair of the Audit Commission
