Dated assumptions about the public and private sectors are preventing effective partnerships in health and social care, says Victor Adebowale
Health and social care are intrinsic elements of an equal society. In order to fix them we need to foster collaborative thought and practice.
We’ve set up Collaborate to do just that. Based at London South Bank University, Collaborate is a “do tank”, not a thinktank. The aim is to fill a gap in thinking, practice and leadership of public service − or services to the public, as I prefer to call them.
‘Collaboration must aim to provide public services that offer better value. Otherwise there’s no point’
If we are serious about tackling long-term conditions, about keeping people out of hospital, about community services and integration, then we must understand we’re only going to achieve this through collaborative practices. The number of collaborative partnerships is growing between the not-for-dividend sector and the private sector. But the problem is we’re not very good at these partnerships.
We don’t give enough thought to what collaboration means or the skills and leadership needed to collaborate properly; or even ask ourselves when are collaborative partnerships appropriate.
Alignment of views
In my professional experience, the not-for-dividend sector has three modes of operation. There’s the naive assumption the private sector has all the skills, and these skills will seep into you somehow without any effort if you partner with them. The result is you devalue both what you bring to that process and what you want to get out.
Then there are partnerships based seemingly on sound values and joined-up leadership working towards a shared endpoint. The reality is, in these cases, there has not been enough understanding of culture and value differences, so the partnership starts to unravel.
Finally, you get a genuine alignment of views, values and outcomes while keeping your own identity. These relationships are successful because people understand there’s a purpose behind the collaboration.
Collaboration must be with the intention of providing public services that offer better value. Otherwise there’s no point.
We’re interested in supporting organisations which want to collaborate across boundaries, for example the private sector with the not-for-profit sector. Good practice and training will develop from what we learn from each “intervention”.
We’re also interested in collaboration within organisations and addressing the fact people don’t collaborate across departments. This can be the case in the civil service and large bureaucracies.
Ease of transition
Another issue is how people move across professional boundaries. There’s quite a lot of movement at the top from the public sector to the private sector. It gets less the lower you go down. If you’re a management consultancy and a high percentage of your income is derived from government contracts then recruiting an ex-senior civil servant seems a wise idea.
People also make transitions from the private to the public sector. However, the public sector shouldn’t be the place you come to at the end of your working life to “do good”. I remember a former high-flyer in retail finance who’d gone to the voluntary sector complaining that “it’s just like being at work!”
‘Public services can’t be allowed to remain preserved in aspic’
There’s also this assumption that, if you go from the public sector to the private sector, it’s about money and that there are no values involved. These assumptions prevent collaboration and finding the best people.
Governments do it all the time. For instance, seeking expert guidance from high-ranking individuals in banking or business on social issues. The assumption is that if they want the best thinking about social issues they’d go straight to someone who has made a lot of money, not necessarily someone who had developed their skills within the social care field. But it should be all about the skills needed to deliver services to the public regardless of where you’ve obtained them.
Our “do tank” also isn’t an excuse for another discussion on outsourcing to the private sector. There’s outsourcing that produces value, and there’s outsourcing that doesn’t.
I believe you can have collaborative outsourcing that benefits society. The key issue though is around risk transfer and Collaborate will be looking at how we can share risk collaboratively. There are obligations for delivery of services to the public.
If Tesco had 40 per cent of the grocery market the company could’t be allowed to fail or people would starve. If we’re going to outsource a chunk of public services to a collaborative structure then there are obligations both ways. Public services can’t be allowed to remain preserved in aspic.
A better deal
It’s about engaging with the organisation that wants to collaborate, working with them to design the best way of doing that then evaluating the outcome. Training is also part of this process. Collaborate will certainly be looking to work with all sectors: public, not-for-profit and private. They’re all deliberately represented on the advisory board.
‘Collaboration is a complex process we don’t know a lot about and it is often done by accident rather than intent’
Everything I do starts with: “How can we help those at the sharp end of the inverse care law?” Because if we can help those people then everyone gets a better deal. It’s not even a moral question, it’s common sense.
At this moment in time there’s a desire to do things differently and collaboration is one of the pillars of how we move public services forward. Public services are not associated with choice, flexibility and a personal approach. This needs to change.
When we talk about services to the public, we need to talk about ones that are wider ranging than, say, just healthcare and education. We need to include banking if you’re going to improve society. It’s hard to escape the poverty trap if you can’t get a bank account.
We want people to be involved in Collaborate’s mission in the form of supporters, funders and investors. Our research programme will be focusing on improving society, not just producing research for research’s sake.
Collaborate is not politically biased: it needs to be fully accepted that the future of public services does not lie in the dominance of any one sector, but we need to know when to collaborate, how to do it and how to collaborate better. One area we’ve started looking at is how government departments collaborate.
Although we have a clear programme, we’re open to it being developed and shaped with other organisations and interested individuals. We need to ask: what’s the best way of structuring that generates maximum social and public values? The answer shouldn’t just be that if it’s not done by the public sector it has to be done by the private sector and that the voluntary sector’s role is to volunteer humbly.
Collaboration is a complex process that we don’t know a lot about and it is often done by accident rather than intent. The whole point of Collaborate is to make it a more conscious process that’s well led, well managed, thoroughly understood and which produces services the public can genuinely value.
Find out more
Lord Adebowale is a board director at Collaborate and chief executive of Turning Point