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Crossing boundaries

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A lot has been said in the last 12 months in this column about what integration is, what it could achieve, why/where it is or isn’t happening, and where duties and obligations rest or arise.  

But there is a time for soul-searching and asking questions, and there is a time for getting on and doing. What is important right now is that every council, health organisation, housing body – any publicly-funded organisation working to achieve better lives for citizens – accepts responsibility for doing this in an integrated way.

All of us working in or for the public sector have a collective responsibility for delivering public benefit. That means getting the most out of every pound of public money, and that is only possible when we look at how all public money is spent on communities, groups of citizens, and individuals. When there is a problem it is all too easy to see it as someone else’s fault. We do not have responsibility for that awful decision or terrible action because it rests with somebody else. Well is that really the case? What have you contributed to the situation and what has been the consequence of the decisions that you have taken? Do we not all share responsibility when things go wrong, and for making sure that in future they go right?

How often do we hide behind our own organisation, its targets and achievements, and the area in which we are perceived as having primary responsibility?  How often do we look at risks, and managing risks, in terms of how they affect our council, our trust, our agency, rather than how they impact on citizens?

Nothing is achieved if it is generally accepted that collaboration and integration are needed, but are too difficult or impossible to deliver “because of the way things are”.  Much silo-thinking is based on and justified by the need to make responsible decisions for my organisation, even when that manifestly runs against the public interest and the best use of money.

At the recent Health and Care 2015 Conference at the Excel, Jeremy Hunt made the point completely and utterly clearly in saying that he was looking for full integration”, whatever that means, and that he is looking to the health and care system to achieve this. He absolutely underlined the need to think “prevention” and to approach the whole subject from a patient centred perspective.

“Full integration” means, for every person working in the public sector, being aware of and working collaboratively with every other person having responsibility in relation to the same citizen, or community, or neighbourhood. It means, for every person, looking right through the boundaries, between health and social care, between councils and NHS trusts, between one set of objectives and another, and working collaboratively for what is best in the public interest.

Of course this is easy to say, but much more difficult in practice.  Legal duties and responsibilities, to deliver services, to stay solvent, to take account of some things and not others make this very hard.  How often do we hear that concerns about conflict of interest get in the way, when in reality all working for the public good have a fundamental harmony of interest, which goes much deeper than their institution?

Although directors of course need to work in the best interests of their organisations, where those organisations have objectives which are geared towards the public or community benefit they have not just an ability but a duty to work in a way that does not simply consider what is in that organisation’s best interests; they must act in the best interests of the community and in such circumstances they can work across organisational boundaries.

A director might say that it is fine for Jeremy Hunt to make great speeches at important conferences but “we need to stay focussed on what is right for our organisation”. No problem with directors doing that, but perhaps those boards should read again their constitution or rules or other governance requirements and challenge themselves about what exactly their underlying purpose and objects are.  One of the things we can do as lawyers is to find a way of making it easier for organisations committed to the public or community benefit to work collaboratively together.  Some real innovation is needed here, and may be on the way.

A sea-change is needed in public services; but whether it occurs will depend on individuals within organisations, and whether by acting differently and taking some collective responsibility, they refuse to be constrained by organisational boundaries. We all have a responsibility, and it is only by accepting that responsibility in the first place and then working better together that we can change things.




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