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Health and care interests are mismatched

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Integration is now a buzzword. Integration is seen as the answer. The answer to what is not always clear, but nevertheless, it is ‘the answer’.

The problem is, it is much harder to do than might be imagined. At the highest level it often puts together different value systems. Health and social care do not work to the same principles.

For some in health, social care looks like a crazy, chaotic world, where decisions can be made without clinical evidence on what may seem a random basis. For some in social care, health can look like a world devoid of feeling, where decisions are driven by central regulators to hit targets that are financially motivated.

Then, the public can have altogether different desires and aspirations. We should also recognise that the vast proportion of social care takes place outside of statutory public bodies.

That isn’t to say that sometimes these differing perspectives don’t line up. When they do we can and do make real and at times quite rapid progress.

The problem comes when we differ. Without a common set of core principles – real, not simply published as slogans beneath our organisational titles – difference cannot be easily resolved. We are stuck at loggerheads.

Once you get past points of principle and into points of reality you bump into some pretty tough issues. Treating more people outside of acute settings may be good for those people and for people working in that sector. It isn’t good for the financial viability of acute trusts.

Sixty-five hospital trusts overspent their budgets last year, and the figure is rising year on year. History tells us they always get bailed out. Why would a hospital trust in a tight financial position engage fully in this work? Why not wait until 2015 and see how a new government views integration? Presumably few MPs will be standing on the ‘I’ll close your hospital’ ticket.

So where interests don’t naturally align it is hard to move forward. Everybody and nobody owns the problem.

The solution looks different depending on where you stand. This is a classic ‘systems leadership’ problem. Such problems are not resolved at the level of structures or policy or aligning pathways.

Those things are very necessary but can only be done once we have determined who the ‘we’ are who are going to resolve this (identity), what is the nature of our connection with each other (relationships) and what we are prepared to share in order to make this work (information).

Only then do we do the right work, the work that will move things forward in a positive and helpful manner. Until then we are just being busy.

John Atkinson, independent adviser on leadership, strategy and creativity


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