Review: The barriers to service local integration are well known, and case studies of ‘best practice’ will not overcome them, says Institute for Government
Anyone who has sat through a conference consisting of glib case studies of revolutions in public services but been given only five minutes to ask questions will cheer at a new attempt to raise the quality of debate.
In the latest publication from its Local Public Service Reform programme, the Institute of Government looks at why public services struggle to learn from the successes - and failures - of repeated attempts to join up services. The answers may not be surprising, but they need spelling out.
The study’s starting point is the depressing realisation that countless attempts to integrate local services “have not translated into significant improvements on the ground”. What it calls the “perennial barriers” are well known, and can be summarised as: short term policy and funding cycles; unaligned geographical boundaries; cultural differences between professions; barriers to data sharing, and the absence of a culture of learning lessons from outside.
The paper tackles the fifth of these issues and finds a lack of mechanisms to support the cross-fertilisation of ideas.
“A review of organisations and programmes designed to support learning in local areas found over 100 examples – of which 90 are in use today – with great variety in what they do and who funds, leads and delivers them," the authors say.
"Despite the broad range of support on offer, the majority of initiatives focus on learning in specific sectors such as education, health or crime and therefore reinforce silos rather than support collaboration. We found fewer than 10 programmes designed specifically to support learning around integrating public services, such as between health and social care.”
Of course opportunities abound to hear from case studies of integration - especially those that can be presented as successes.
“Time and again, the criticism we heard is that online case studies, large conferences and national guidance based on ‘best practice’ are all about showcasing success and promoting particular places, programmes or individuals. They do not provide the space to have frank discussions about what didn’t work, including the mistakes, pitfalls and difficulties that people faced along the way.”
Rather, people need opportunities to dig deeper into the “messy reality of implementation”, the authors say.
“The best way to do this is through face-to-face conversations that allow people to break out of organisational and professional silos. Connecting people virtually, or uploading case studies online, does not provide opportunities to get into the detail of a programme, reflect on what is working and not working, and build up the relationships that are needed to make cross-sector and organisational collaboration a reality.”
The report concludes that local leaders of public services should:
- Create open, outward looking organisational cultures where staff at all levels are encouraged to share concerns and learn on the go with their peers – especially those they are working with to integrate local services.
- Encourage staff to take part in cross-sector secondments, mentoring schemes or events that encourage cross-fertilisation between local organisations; for example, between local authorities, clinical commissioning groups, general practitioners, employment services, care homes, the police and other local services in an area.
- Incentivise cross-sector learning by setting an expectation that working across different local organisations and maintaining a diverse professional network is essential to career progression.
So far, so good - but the report notes that incentives in the wider system can actively discourage organisations and individuals from making the most of informal learning opportunities. A focus on delivering specific statutory duties, in a particular way, inhibits a “more open, experimental culture that is willing to learn from others”.
Moreover, individuals are rarely rewarded for looking beyond organisational boundaries. Local politics can also disincentivise people from actively seeking out learning from places with a different political make-up, with elected members naturally keen to circulate good news stories about their local area.
These barriers sound just as formidable as any other aspect of integration in public services, which raises the question of where to start the process of dismantling. The institute is scathing about directives from Whitehall – however well intentioned, they are invariably interpreted as meddling resource management – and pins its hopes on peer to peer initiatives.
There are even case studies: the Devon Care Kite Mark developed by 80 residential care providers in the county; and the Employability Practitioners’ Network set up in the London borough of Islington. However, any messy realities of implementation are left to the reader to discover.