All change please?

I had an intensive week last week, speaking at two conferences. I find that sometimes doing a lot in a short period has its benefits. In this case having to prepare two presentations on engagement in two very different areas; healthcare and local planning made me think about what the similarities and differences are.

The Economist recently referred to the coalition government as the most radical regime in the Western World. This is certainly true for both Health and Planning.

The first event I spoke at was the OPM/Involve Seminar on ‘The Big Society: Patient and Public Engagement in Health’
Recordings of the event will eventually appear here.

Healthcare is seeing some radical changes. Primary Care Trusts (which have already been reformed, merged and restructured numerous times) are being abolished and their commissioning function is being taken over by Consortia of GP practices. Local Involvement Networks are to be reformed into ‘Local Healthwatch’. These are big changes and once again the NHS enters uncharted waters

It was a great pleasure to hear where some leading experts, including Kieran Mullan from the Patients Association and Brian Fisher from the NHS Alliance, think the field is headed. Brian Fisher mentioned some work he has done to measure the long term benefits and value of community development. He was able to show some very impressive health improvements in areas where targeted community support was provided.

This is an area which I feel very strongly about. In 2005 Involve produced a report on measuring the costs and benefits of engagement. Back then there was little interest but in the current climate making the case for engagement has never been more important. The benefits and long term societal gains that Brian Fisher has identified risk being destroyed by short term cuts.

I’m pleased that Involve and Sciencewise will be co-hosting a small expert seminar on the costs and benefits of engagement and that we will also be launching a paper on the issue later on. Keep an eye on this blog for future updates.

The second conference I spoke at was ‘A New Era for Local Planning’ run by LGC and the NLGN.
Planning is an area which is also experiencing a lot of change. The detail won’t be revealed until the Localism Bill is unveiled in November but the government have made it clear that they mean to make massive changes in how planning happens at the local level. These changes include abolishing regional structures and moving decision making powers to local councils, and providing local communities with rights to bid to run public services and allowing local groups to bypass planning applications through referenda.
The irony is that I’m actually advising the State Planning Organisation in Turkey on the governance of their RDAs that they are establishing; the very structures that the UK is in the process of abolishing!

This apparent paradox has helped me to identify a challenge with these wide ranging reforms. We appear to be obsessed about finding the right structure.

Both planning and health are contentious areas with conflicting needs and trade-offs. In both areas there is not one ideal level of decision making; some decisions are best made locally others regionally or centrally. I’d argue that organisational culture matters as much as structures, if not more.

Over the past decade the NHS in England has seen Community Health Councils, PPI Forums and LINks come and go. How long will Healthwatch last before a hyperactive civil servant or minister decides that “This isn’t working, let’s start again”? What if the problem isn’t so much the structure, but the time it takes for changes to bed in? If so the latest round of restructuring might be the last thing the NHS needs.

Don’t get me wrong, I think that England is over-centralised and that changes need to happen. However when faced with massive cuts some semblance of continuity may be important. If we set up new structures, abolish old ones but leave the organisational culture which caused the problems in the first place intact we may have created chaos in the public sector with very little to show for it.  

In a situation where new structures are rarely given time to bed in the long term benefits that Brian Fisher identified will struggle to materialise, either in the NHS or planning. Culture change is not free; if government is serious about changing public services for the better reforms need resources and time to make them a success. 

Perhaps David Cameron said it best: “We shouldn't be naïve enough to think that if the government rolls back and does less, then miraculously society will spring up and do more. The truth is that we need a government that actually helps to build up the Big Society. This means a whole new approach to government and governing.”

 

Edward Andersson