On 1 October 2015, three major health organisations in North East Lincolnshire covering community services, mental health and acute (hospital) services entered into a Co-operation Agreement.
“So what’, you might say. “What’s the news in that? Haven’t public service bodies been entering into partnership arrangements and collaboration agreements and co-operating with each other for years? Aren’t many of them under statutory duties to co-operate, and to promote integration? Shouldn’t they all be pulling in the same direction anyway?”
Well yes, that’s all true; but the underlying reality can often be rather different. For many senior managers, ensuring the successful performance of their own organisation is the key priority; that is essentially what they are judged by. They may like the idea of partnership and co-operation, but they need to succeed to survive. They may genuinely believe that high quality services to citizens are best secured by their own organisation’s success; but they would be less than human if maintaining stability and the status quo, preserving jobs, and their own career prospects didn’t encourage them to be more focused on achieving that success rather than on the wider public interest.
Added to that, payment by results and other such financial and performance drivers create incentives which inevitably make organisational success the objective, rather than quality of service. The result can be that, at the point of access by citizens, it doesn’t feel very joined up or co-operative. The organisational boundaries can create frustrations for those caring on the frontline, and an obviously impaired service to those being cared for. Indeed, from that point of view, it might look (and probably is) positively disorganised and inefficient. In today’s economic climate, that is simply unacceptable.
Last October, NHS England’s Chief Executive Simon Stevens launched a crucial policy document titled the Five Year Forward View. There is much in this which the co-operative and mutual sector should find encouraging, but it is the emphasis on breaking down barriers which has particular resonance; barriers between family doctors and hospitals, between physical and mental health, between health and social care which are “set almost in stone”. These divides go back to 1948 and the very creation of the welfare state, and they are deeply engrained through different cultures, different practices, often different terms and conditions of employment – but also through having different and separate organisations.
Calling for people to work through organisational boundaries obviously makes sense – staff want it, citizens want it, and ministers want it. But how do you do that when the very organisational arrangements seem to get in the way? “Conflict of interest” within the public sector has become a subject of daily concern; having to compete for contracts inevitably results in rivalry and works against co-operation; competition law itself creates pitfalls for those who just want to cut through it all and do things together. This is where events in North East Lincolnshire have significance.
Three years ago, the chief executives of Care Plus Group (community health), Navigo (mental health) and North Lincolnshire and Goole NHS Foundation Trust (hospital) started to meet together regularly; every week, on a Wednesday. Often the chief executives of other local health providers attended: the hospice; the GP federation. Sometimes they had joint board meetings. As a result, they started working in a very different way; they started co-operating at a radically new level.
There is a real sense that there is one community needing services, and that the organisations are totally focused on providing what is best for that community, such that organisational egos don’t count. When recently one of the three parties to the Co-operation Agreement brought to the weekly meeting the news that his organisation’s funding had just been cut by £1m, the others said: no it hasn’t; OUR funding has been cut by £1m.
This is no ordinary level of co-operation. Each one acknowledges the need for the others to exist. Crucially, each corporate entity also exists for a public or community purpose: one is a community benefit society, one is a community interest company and the third is a public benefit corporation (the legal name for an NHS foundation trust). So they all share a common purpose – namely the public benefit. So fundamentally there is a harmony of interest, not a conflict.
Putting the underlying public interest before your own organisation’s interest takes leadership of a particular nature – a real personal commitment to co-operation and a humility to see and support the bigger picture. It also requires the buy-in of your own board, senior managers and staff. It is a culturally different approach.
Creating appropriate legal arrangements for this also requires thought and care. Directors need to be comfortable that the decision-making is robust, sensible and realistic, and crucially that they are fulfilling their own legal duties.
So the Co-operation Agreement is far from cosmetic. It involves entering into some serious co-operative commitments – to an overarching community interest; acknowledging some limits to their own corporate interest; and committing to working together co-operatively beyond those limits. At an organisational level, this is genuine mutual support, exactly in the way that individuals support each other at grass roots level when co-operating: seeing and meeting their own needs in the context of the collective need. You might call this co-operating for the public benefit.
On the one hand, this may not sound like significant news. In reality, it is big stuff. These three care organisations have broken new ground, and it is no surprise that others are queueing up to join.
What is interesting is that this started, as all co-operative initiatives do, by people co-operating. The verb comes first. The adjective comes next, when the behaviour becomes second nature. The noun comes last, and hopefully helps it to continue.
In this article
- care plus
- Cliff Mills
- community services
- Forward View
- national health service
- NHS England
- NHS foundation trust
- NHS Scotland
- North East Lincolnshire
- North Lincolnshire
- Simon Stevens
- The Co-operative brand
- United Kingdom
- Top Stories