Rob Whiteman, Chief Executive of CIPFA (Chartered Institute of Public Finance and Accountancy) talks about how the NHS can work more closely with local authorities and other partners.
This presentation was recorded at our Integrated Care Summit on 11 October 2016.
The policy context around integration is clear. Of course, all of that policy framework and the interventions that have been made, really does lead to some rather simple questions about, well, which partners are we talking about? What is it that we are going to prioritise and how can we make it happen? And I always think that the simple questions about what are we trying to achieve, are always much more powerful than the complex questions. And if we can’t answer these simple questions, then we are probably getting something wrong.
There are big differences between some of the partners involved, within the NHS, within local government and indeed within wider integration. And actually, what we have got to do, is learn to work across boundaries for a whole system, rather than think that we simply have to create an organisational form to represent the system. Of course, there are many different ways that we see this. Through devolution such as Devo Manc, through placed based working, through the better care funds, through STPs. And through the different financial challenges that are faced by the players involved. There are different accountabilities. Local government has some direct tax raising powers and that’s interesting. Will a mayor of Manchester, one day argue that he or she will put the council tax up because they want to fund health? And of course, a difficulty in local government is, social care is important, but competing with other possible priorities too, not least children’s social care or other politically charged areas.
Public health is clearly a common ground between the two sectors. In a CIPFA publication we looked at the barriers to integration based on the thirteen round tables that we held. And, on the whole, we found barriers around organisations based thinking, government being unclear, the appetites for risk not matched, great difficulties around IT and data protection issues and often a lack of mutual understanding. We have to take more time, maybe, to share goals and understand these barriers. To look for the advantages of joint working rather than the barriers. Work on an assets model rather than a problems model. Always agree principles up front about what it is that we’re trying to achieve before individual pieces of work, the tactical work. And also, to consider the overall resources available to a region.
I’m on my fourth chief ex job. I have made lots of mistakes in my career, as I always say, I, you know, make mistakes for a living. The one thing that I have always tried to get right and I would commend it, is that I never ever, ever, criticise a partner body at my management board or to my staff. Because all I’m doing is I’m training my organisation not to trust that body. They’re trying to do us over, they’re trying to get more money. If I give those messages to my organisation, then indeed, I am training my organisation not to think about the system as an opportunity, but to view it as a threat. I get quite sad seeing rows between commissioners and providers at times, that in my mind, forget who’s the enemy. The enemy is needs, the enemy are people with poor health outcomes. I really would say that the culture, the way by which we work, is as important as anything that we put in a plan. And in terms of plans, the content of it is more important than meeting the deadline.
And also, I think accountants have a role here. I represent a profession that can often say – ooh – that’s a bit risky. That doesn’t fit our own organisation. Of course, the risk is that we do nothing. And the risk of doing nothing is a greater risk and what we have to do is to assess risk, system wide. I think difference is good, because I think that more localised solutions by horizontal working between partners isn’t always scalable elsewhere. Sometimes it is, but we mustn't think that it’s only good if it’s scalable. Because the truth is that all communities and their needs are wholly different. We do live in a very top down, vertical country and if we can get used to the idea that devolution isn’t only about what goes to local government. Devolution is about the ability of all bodies in health and policing, to be able to work horizontally, then actually I think that’s a very good thing.
Thank you very much.