On 22 September, I was one of the speakers at Capita’s conference on Integrating Health and Social Care, held at the Marriott Hotel in Cardiff.
The conference attracted delegates from across the NHS and local government in Wales, as well as from some third sector organisations. It was a good event, with stimulating speakers and some excellent discussion during the Q&A sessions.
Many of the points made by other speakers resonated with the messages in my speech. I was invited to take part in a panel discussion and focused on one key message: How we as auditors reconcile our potentially conflicting roles of providing assurance that public money is being spent wisely with promoting improvement in services and outcomes.
Better integrated services are a wise use of public money because they improve outcomes for service users and because they are more efficient. Many of the big issues the Auditor General has investigated in recent years revolve around the need to bring together those things that should work well together but are still operating as separate elements. And the outcomes of good integration are strongly linked in his reports to providing more equal and accessible services across Wales.
Local government and health services are particularly ripe for improved integration. Delayed transfer of care, and its impact on budgets and outcomes, is an obvious symptom of deficient integration.
In the information age, we forget at our peril that integrating our information systems, both within and across sectors, is a huge dependency before we can really integrate services. We have also reported on shifting the care of people with chronic conditions into supportive community settings. This kind of transformation is vital if we are to: minimise the acute demands on all agencies; save money; and, at the same time, help people lead lives that are as little disrupted as possible.
So far so good – through our work we can help to promote improved services and outcomes through integration. But, we have an equally strong message about the importance of good governance and clear accountability that can sometimes seem to run counter to the call to do things in new and different ways.
The Auditor General has not pulled his punches about the need to improve financial management – in Health Boards and many local councils this is a challenge only half-faced. But good financial planning is vital if the decisions taken today lead to sustainable solutions for future generations.
He has also exposed governance concerns – when the ward and Board become dislocated, or decisions are taken in what once would have been smoke-filled rooms.
Good governance cannot be compromised in the rush for integration.
So, how can these two messages be reconciled? The key lies in well-managed risk taking founded in a good understanding of the lessons already learned by others further down the track.
The Auditor General has committed to supporting well-managed risk taking and that means that even where well-thought through risks sometimes fail to pay off, the auditor will not be calling for heads to roll.
So if you think we are focusing too much on process and not enough on outcomes or that our audit approach is inhibiting your innovation, please talk to us – we want to help.
We also invested time and resource in capturing good practice we come across in our audit work, and from outside Wales too, through our Good Practice Exchange and shared learning events.
We recently ran two shared learning seminars on Leading Programmes and Projects and Re-shaping Services with the Public – both very relevant to improving or transforming services through integration. The materials and outputs from these seminars will be available on our Good Practice Exchange web pages
Integration may well be part of the solution to the challenges facing health and social care. It doesn’t have to consist of large scale reconfiguration, but it does depend on leaders creating a culture where innovation and well-managed risk taking can thrive and ‘safe-to-fail pilots’ really are safe to fail.
Better, and different, ways of working require us all to leave our fiefdoms behind and work together with energy, innovation and accountability…
… and that includes the auditor.
About the Author:
Alan Morris is the Sector Lead for Local Government and Criminal Justice with the WAO as well as being the strategic lead on fire and rescue services, national parks, education and the Good Practice Exchange. He has a particular interest in environmental services and sustainability. Away from work, Alan is heavily involved in athletics and is qualified as a Level 3 athletics field official.