Partnerships and service integration – is it all just hot air?

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Axel Kaehne

Since the 1990s, policy makers and academics have had a pet project in public service reform. Over time, they have called it differently but always meant essentially the same: public services collaborating with each other to improve service quality. At some point, it was called partnerships (remember the Partnership Agenda under Tony Blair’s government?), then it was service integration, a term particularly popular amongst health care professionals.

But what drives this collaborative agenda and where should it lead? Have we achieved anything over the last decades or was this all just hot air?

Academics have pointed out for a long time that there is a glaring gap in the partnership and integration project – evidence. We know from studies that working together does make a difference to professionals. This would be good if the main objective was to overcome service fragmentation per se, yet what drives much of the public policy announcements are intentions to improve service quality for users and patients.

Conceptualising service collaboration has been a well tilled field. Personalisation of services, where public services are shaped around the needs of the user is one way of thinking about improving public service delivery. Direct payments are a powerful instrument to re-orientate public services by putting the user in control. Yet, direct payments have been met with fierce resistance from some corners of the professional establishment, whilst the Welsh Government actively discouraged local authorities to use them until recently. Consequently, the take up of direct payments has been low.

In addition, producing evidence of the effects of service collaboration has proved to be the proverbial ‘holy grail’. The main stumbling block to it has been to establish a robust link between organisational changes and service improvements. As services improve their collaborative practices, the interface between users and professionals may often be largely unaffected. Organisational changes may not be noticeable for users. My paper on multi-agency protocols shows that even where the evidential link between changes and outcome is well defined, effects may be marginal and introspective at best.

Another reason is that service improvements are most urgent when users or patients draw on support from many different professionals because of the complexity of their needs. In the field of children’s services it is not uncommon to have families dealing with fifteen different professionals or more at a time.

The complexity of service delivery impacts on how organisational changes are perceived by the users and how they are affected by them. Key working may be a useful example. Potentially, key workers were supposed to reduce the number of professionals working with a service user, yet there is little evidence that they have had this desirable effect. More often than not, key workers joined the long list of professionals without reducing the need to be in contact with others. In other words, they turned into another layer of service delivery on top of the already existing ones.

So, why is it so difficult to improve service delivery in collaborative contexts? The answer lies in the discrepancy between policy objectives and the levers for change we have available. Policy makers constantly profess a desire to improve services by urging professionals to work together. Yet, there is only one player in this game who really knows what would constitute better services: the user. As long as professionals are in the driving seat, users will be a polite afterthought to their practice. Whether you call it partnership or service integration, collaborative practice grows from user demand. Better public services for users with complex needs should not be a product of professional generosity but an outcome of user demand. Until the user is in control of the service they get, service collaboration will remain little more than hot air.

Axel’s article, ‘Multi-Agency Protocols as a Mechanism to Improve Partnerships in Public Services’, is published in Local Government Studies.

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Dr. Axel Kaehne is currently Chair of GORWEL, the Welsh Foundation for Innovation in Public Affairs and a Senior Research Fellow at the Faculty for Health and Social Care, Edge Hill University. He is also Senior Research Fellow at the Alder Hey Children’s Hospital NHS Trust in Liverpool.

The Big Society lasted 1000 days. Will we ever see ideas of its like again?

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Stephen Jeffares

The FT’s Chris Giles recently wrote:

“Mark Carney Bank of England governor, has signalled that his policy of linking interest rates to the unemployment rate [Forward Guidance] will be buried less than six months after its birth…his big idea for monetary policy has bitten the dust” (FT, 24 January 2014).

This is not the first time in the last year we have heard reports of “big ideas” “biting the dust”.  The same has been levelled at Cameron’s purported big idea in politics: The Big Society.  How funny that sounds just a few months after thousands of policy actors were deliberately inserting Big Society terminology into their strategies, job descriptions and articles. A friend who recently attended a meeting at CLG told me that the last remnants of the Big Society team have now left their posts; organisationally, at least, the Big Society is dead.

As the title suggests,  and in a new book, I argue that Big Society lasted around a 1,000 days.  That is rather neat, I admit.  Wayne Parsons has argued that you need a sensitive measuring device to understand the death and termination of public policies, but as a starting point you can think about newspaper citations.  Although a crude measure, this reveals the date when a policy idea first entered the public realm, the peak of discussion, and the point after which it is never uttered again.

It reminds me of Frazer’s description of how Saharan Tuareg tribes would up camp when somebody died, and never mention the deceased’s name ever again. Although government actors do not quite up camp, they shuffle around, renaming units and amending job titles, renewing websites and pulping documents.  As for the newspapers, for a while they write of the policy’s death, of u-turns, and discuss hints of decline (as in the article above); more important is to focus on the point where they stop mentioning it – that is when the idea is dead.  It is also a point in time seldom acknowledged.

So where does my 1,000 days come from?  Well, counting citations in British Broadsheet newspapers (see Figure 2.1) you can see that in 2008 there were no mentions of the Big Society, a few hundred in 2009, great excitement by 2011, and just over one mention a day in 2013.

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My prediction is that at some point in 2014 we will not speak of Big Society again – it will be the end.

But will we see anything on the scale of Big Society ever again? If Forward Guidance is anything to go by, it is quicker and easier than ever to discuss, endorse, but also critique and deride policy ideas. But it is also quicker and easier to coin and foster them too.

Some critics of the Big Society pointed to how many times it was relaunched, but like iPhones or Apps, we are in an age where we can release beta versions, test things out, get feedback and quickly offer updated bug fixes or new versions. We cannot measure the longevity of a policy idea by expectation alone – no, we can speculate about decline but it is not until the tribe up-sticks and moves to a new part of the desert, vowing never to mention its name again, that we can be sure that it is truly dead.

An earlier version of this blog appeared here 27 January 2014.

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Stephen Jeffares is a Lecturer based in INLOGOV. His fellowship focuses on the role of ideas in the policy process and implications for methods.  He is a specialist in Q methodology and other innovative methods to inform policy analysis. Stephen’s book, Interpreting Hashtag Politics: policy ideas in an era of social media, will be published by Palgrave in April 2014.  Preorder or follow @srjeffares

Who is in control of the sandbags?

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Philip Whiteman and Ian Briggs

The recent news that the Minister for the Environment, Owen Patterson, has visited flood torn Somerset and the Environment Agency, has had a bit of a tough time in the media. It has started to open up a few interesting questions and issues around who is actually accountable and who is responsible for flood response. Undoubtedly facing persistent flooding problems is deeply distressing for those affected and it is far from unreasonable to expect the response from the State to be swift, appropriate and well managed.

But who should respond and who has a say over what the local priorities are is perhaps a more complex question to answer. On further investigation it would appear that our system of local public administration has a few dark corners that are somewhat enlightening to explore.

One slightly dark corner that the media seems to have paid little attention to is the Local ‘Internal Drainage Board’ (IDB). What may come as a surprise to many, especially if you do not operate in a particularly high risk area, is that these IDBs are actually part of the complex firmament of democratically elected local bodies.

Internal Drainage Boards as local public organisations are specifically charged by legislation to supervise matters of water level management.  Whilst current powers are determined by the Land Drainage Acts of 1991 and its precursor of 1930, the antecedents of these curious bodies can be traced back to Henry II in 1297.   Not surprisingly, their boundaries are not coterminous with principal local authorities, but instead with water courses.

The 121 IDBs are distributed across the low lying areas of England and Wales, such as the Somerset Levels, Fens or Romney Marshes. Board members are elected by the IDB ratepayers and may sit alongside appointees.  Herein lies another oddity: each elector, usually an agricultural land holder, is awarded a number of votes related to the size of land holding or occupation – something rather reminiscent of voting rights pre- the 1832 Great Reform Act!  Whilst local authority members may sit as appointees, it is not remarkable to comment that control of IDBs holds little interest to political parties.

The very existence of the IDBs offers some interesting avenues to explore. One question that presents itself is around Government’s intention to respect that it is often the local community that holds local knowledge and solutions to problems existing within communities. Now, one can see that the Environment Agency itself has a few problems to deal with – it has not escaped media attention that the Agency is facing cuts at a time when the headline news is demonstrating that many local people are living with persistent flooding. Clearly one significant advantage of a large scale Agency is that it learns lessons from previous practice and can then make judgments as to the best way of dealing with problems. It can lay down standard operating processes and procedures and is in a position to balance a wide range of competing issues such as general environmental and ecological sustainability, whilst at the same time responding to social need.

However, if the flooding problems in the Somerset levels are allegedly a direct product of the failure to dredge rivers (and here we are not offering any opinion on that matter), should the decision be one that is taken locally or should it be one that conforms to a standard operating process? We have on one hand a body open to public scrutiny that is made up of local people and elected representatives who are resourced through a local precept taxation system and a national body that is answerable to citizens through national government. In this type of situation, very complex inter relationships develop between the principals and their agents!  This complexity is furthered by the addition of principal councils and DEFRA – who also have an interest in flood prevention policy and measures.

If, as we have seen through the introduction of locally elected Police and Crime Commissioners, government has an appetite for bringing public institutions closer to the people, then it may seem more than a little strange that in some of our most sensitive localities this argument over prioritisation is between Ministers, local people and a government agency. Perhaps we should look to promote a more visible role for the Local Drainage Board.

They are clearly important to local people in high risk areas, but with increasing pressure on local authorities to absorb ever increasing numbers of new houses and reports that new homes are being constructed on flood risk zones, we may need to think more deeply about how we manage this tension between control at a local level and the advantages of having a national response to such emergencies.

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Philip Whiteman is a Lecturer at the Institute of Local Government Studies.  He has research interests in the impact of central government and regulators on the role, service delivery and performance of local government and other local bodies.  He is currently looking at developing a case for researching how guidance is an important instrument for steering local government over and above legislative instruments.

 

briggsIan Briggs is a Senior Fellow at INLOGOV, and sits on a rural Parish Council in Warwickshire. He has research interests in the development and assessment of leadership, performance coaching, organisational development and change, and the establishment of shared service provision.

When will they ever learn?

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Catherine Staite

The news of the death of Pete Seeger has reminded me again of his old song ‘Where have all the flowers gone?’ The line ‘oh when will they ever learn?’ has been running through my head since I saw an item on the local news about police officers and mental health professionals working together to prevent people with mental health problems ending up in police cells for want of the right support. ‘Good stuff!’ you might think.  Indeed it is  – but it is also profoundly depressing to hear such a venture being reported as ‘new’.

In 1993 I led a multi-agency, multi-disciplinary team, which diverted people with mental health problems and learning disabilities from custody.  The team included all the right skills and necessary statutory powers – a specialist social worker, two community psychiatric nurses, a senior probation officer and a police inspector.  We had the backing of all the chief officers and the team went wherever they were needed, the police station, the bridewell below the magistrates court and the remand and hospital wings of the local prison.

The approach was simple but effective. By bringing the right skills into the system at the right time, we were often able to help get the right decisions and find the right services. Within a year, the prison hospital wing was no longer full of prisoners with mental illness and learning disabilities. This was a time when the local mental hospital was being run down for closure, so it was no small feat. Of course, some of our clients were very disturbed and a small number were dangerous, or had committed very serious offences so they had to stay in prison or be moved to a secure hospital but at least we knew who they were and where they were.  We advocated for them. They were not dumped and forgotten.

We shared our learning and even wrote a book about our approach which was replicated and adapted all over the country. It was cheap and effective because it made better collective use of existing individual professional skills, capacity and powers and partner agencies’ budgets.  It was about reducing demand, reducing costs and reducing re-offending – but most of all it was about reducing risk and suffering.

‘What’s not to like?’ you might ask and you’d be right but, somehow or other, twenty years later, police officers and mental health nurses are re-embarking on the same journey. Is it because mental health services are still the “Cinderella’ – and their budgets have been cut even when the rest of the NHS has had increases in funding? Is it because we are still so ignorant and fearful about mental illness? Or is it because innovation is generated by enthusiasts on short-term funding so it doesn’t get mainstreamed or embedded? Perhaps it is all of the above.

Whatever the reason, our collective inability to use the available evidence to guide our thinking and to take shared professional and organizational responsibility for public policy challenges means we are doomed to keep making the same mistakes.

When will we ever learn?

Catherine Staite

Catherine Staite is the Director of INLOGOV. She provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.

The prospects for a dramatically more representative Parliament post 2015 are bleak

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Catherine Durose, Liz Richardson, Ryan Combs, Francesca Gains and Christina Eason

Whilst the likely outcome of the next election maybe still far too close to call, one feature of the next Parliament is very predictable.  The 2015 Parliament is likely to remain as deeply unrepresentative of the make-up of the UK population as the current legislature.  Although the 2010 Parliament showed some improvements in diversity, while women represent 51% of the UK population they formed just 22% of MPs; and although the ethnic minority population is 8% the number of ethnic minority MPs is half that at 4%.  Representation by other underrepresented groups: for example people with disabilities or openly LGBT is also less than would be reflective of the makeup of society more generally although this is harder to count.

This poor representation is despite all three main party leaders stating their support for efforts to improve the diversity of representation in Parliament in evidence given at a specially convened Speakers Conference before the last election.  While Lord Hurd has argued recently that greater diversity in political representation is a ludicrously radical demand, the Conference argued that improved diversity would support better policy making as MPs would draw on a wider range of experiences, and could act to enhance the legitimacy of Parliament and encourage greater political engagement.

Our research for the Equalities and Human Rights Commission, conducted just after the election in 2010, set out to explore the barriers to representation from underrepresented groups and to examine the pathways to politics taken by successful politicians from those groups protected by the Equalities Act to see what lessons could be learned.  We gathered primary qualitative data from a purposive sample of 62 national politicians and candidates, some who had been successful, and some who had not managed to achieve selection and/or elected office.  We also heard from around 20 lobby groups for under-represented groups within and outside political parties, and other stakeholder organisations.

In some cases shocking examples of sexist and racist attitudes were reported.  One black candidate was asked whether she was ‘one of them happy-clappy churchgoers’. One candidate recounted the experience of a local party member ‘hitting me on the bottom and asking me what a nice girl like me is doing in the Labour Party.’  A female ethnic minority candidate expressed her perception of the “double whammy” of discrimination she faced.  This also ran the risk of reducing support for diverse candidates.  In one example, other women in a candidate’s party assumed that she would get support from ethnic minorities in the party, but the other minority members were: “reluctant to support me because I am female and they are all men”.  Other attitudes towards women were less overtly expressed but still exclusionary. Women in politics perceived themselves as facing heightened expectations to justify their presence in a way that men did not. Yet, women were not taken seriously or seen to have the gravitas of male politicians.

While possibly horrifying, these might be familiar complaints about lingering outmoded common-or-garden prejudice.  However, beyond this, our analysis, published in Parliamentary Affairs, identified a systemic and institutional problem with local party ‘selectorates’.  A key issue mentioned by those we spoke to was the critical veto role played by the local selectorates, the local party activists who are responsible for selecting candidates.   Women and ethnic minorities reported facing ‘selector hostility’ struggling to secure the nomination for winnable seats as local party elites look for so-called ‘archetypal’ candidates.  The archetypal candidate reflects selectors’ own characteristics, but more importantly, those of previously successful candidates.  It is partly based on assumptions about electoral risk, and who different parts of the electorate will be prepared to vote for.  Candidates and sitting politicians saw this attitude reflected in the suggestions put to them to ‘have a go’ in ‘unwinnable’ seats. Analysis by Maria Sobolewska at the University of Manchester  has shown that, pre 2010, the Liberal Democrats selected the overwhelming proportion of their minority candidates in highly ethnic diverse seats, most of which were unwinnable and the Conservatives selected more than half of their minority candidates into hopeless seats.  The Labour Party selected the highest proportion of ethnic minority candidates for safe and winnable seats.

In our research, we argue that where candidates from under-represented groups have been successful, this is often because they were ‘acceptably different’ and shared particular ‘pathways’ into national politics which mitigated against the perceived electoral disadvantages of being from an underrepresented or  minority group.  One younger, male, ethnic minority politician highlighted how other aspects of his identity were able to make his ethnicity ‘acceptable ‘I think my age and colour ticked certain boxes and ex-military, public school boy ticked others’.  For women, this could take the form of being ‘one of the boys’, as explained by one respondent: “It’s how you fit in so they don’t think you’re a girl […] Once one of my colleagues described me as one of the boys, I think he meant it as a compliment but I’m not sure that it is.”  Such candidates are also likely to follow a pathway into politics which emphasises university education and a ‘politics facilitating’ or an increasingly  prominent ‘professional politics’ route.  Many of the new female or ethnic minority MPs elected in 2010 had experience in national politics as advisers, or lobbyists.  Of the 27 ethnic minority MPs, at least ten have legal backgrounds (37%).

Whilst this new type of pathway into politics can help to overcome selector hostility if candidates are filtered both through local selectorates and through professional pathways, then a key policy question in increasing diversity in representation becomes how to open up politics.  One of our interviewees said “When I was trying to become a Parliamentary candidate I was asked on more than one occasion what my qualifications were and they meant academic qualifications. One woman even said it was a real shame because one of the other candidates was a lawyer and another one had a PhD and although I seemed like a really nice woman I wasn’t really [of] their calibre”.

Although the Labour Party is persisting with the unpopular but effective policy of making 50% of its target seats selected from all women shortlists, this willingness for the party elites and the party machinery to work with local selectorates to overcome selector hostility is not found elsewhere.  Although David Cameron is clearly committed to wider diversity, Conservative members are deeply resistant to either interference from the national party or equality measures, as highlighted by recent media reports, and supported by other research by Sarah Childs and Paul Webb. And the Liberal Democrats are also struggling to take any positive measures, with the ongoing furore over sexual harassment claims still making headlines.

Without tougher efforts by all parties to address their own openness, attitudes and ‘selectorates’, the portents for the 2015 Parliament being radically more representative than 2010 do not look good.

This blog first appeared on Democratic Audit, http://www.democraticaudit.com/?p=2540 27 January 2014

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Dr Catherine Durose is Senior Lecturer and Director of Research in the Institute of Local Government Studies at the University of Birmingham and works with the Public Services Academy.

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Dr Liz Richardson is a Senior Lecturer in Politics at the University of Manchester, and a Visiting Fellow in the Centre for Analysis of Social Exclusion (CASE) at  London School of Economics and Political Science (LSE).  Her previous roles include Co-ordinator of LSE Housing at the LSE. Liz is co-editor of the journal, Local Government Studies.  She is also a Director of a community charity, the National Communities Resource Centre.

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Ryan Combs is a Research Associate at Centre for Primary Care, Institute of Population Health at the University of Manchester.

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Francesca Gains is a Professor of Public Policy at the University of Manchester. Before entering academia she worked in local government and the probation service, and has both government funded and Parliamentary research experience. Her research agenda explores the relationship between political management arrangements and policy outcomes.

Christina Eason has a PhD from the University of Manchester’s School of Social Sciences and has research interests in British politics, gender, women, representation, and institutions.