Organisational barriers remain to public services integration, report finds

21 Sep 16

Attempts to better join up public services remain on the periphery of the system due to organisational and psychological barriers to reform, a review has found.

Social care organisation Turning Point, and the think tank Collaborate said that initiatives to promote greater integration in public services are failing, which is resulting in people in need being “passed from pillar to post”.

The Moving from the margins: The challenges of building integrated local services report called on joined-up services should be at the heart of social and public service reforms.  

Based on the views of a group of social sector experts, the report makes several recommendations, and highlights the work of existing integration programmes.

The review found that the integrated models do exist, they are at the periphery of the system. These include the West London Zone, which is an initiative working outside of the statutory system that provides a ‘cradle to college’ pathway for children.

To spread such schemes more widely, significant conceptual change is therefore needed in the minds of public servants and planners to overturn the top-down down approach, the report said.  

It argued that the current “paternalistic” approach to public services cannot create the reforms that will lead to better outcomes for citizens because it denies people on the front lines the power to effect change. Also, ‘negative narratives’ around austerity are blinding providers to what can be achieved with existing resources.  

The report referenced a recent Institute for Government report that drew similar conclusions, as it outlined the failure of successive government to cement integration between public services. It was crucial, today’s report said, that keystone reforms to public services, such the NHS Forward View, which acknowledge the importance of patient-centred care, do not fall on the same stumbling blocks.

Last month a group of councils in the South East of England called on the health secretary Jeremy Hunt to back a plan for greater social care integration, which included a proposal to re-design jobs to bridge organisational differences.

Lord Victor Adebowale, the chief executive of Turning Point, said that integrated systems across sectors, such as policing and mental health care, can provide people with the right support. But integration only exists on the fringes because of barriers to reform, he said.

“With public sector budgets shrinking and demand for services growing, change is required urgently and a shift in behaviour and culture is necessary to achieve this.”

“Achieving reform is a challenge, but if Theresa May is to meet her promise to tackle economic and social divides in this country then we must start by ensuring those who rely on public services get the support they both need and deserve.”

Sarah Billiald, managing director of Collaborate, highlighted the need for infrastructure to “pull services together rather than push them apart,” to reduce public sector inefficiency.

The report recommended an approach whereby local services are driven by, and developed around issues, not existing structures. The important shift is, it said, to begin with the social challenge, understand the drivers of the problem in a community, build the evidence base, and develop services from there.

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