Panacea for all ills, or waste of time?

Don’t be fooled that more joined-up health and social services will save government money

Collaboration between health sector organisations has been a theme of many columns I have written for New Zealand Doctor Rata Aotearoa in the past four years.

Depending on the people you ask and what you read, interorganisational collaboration is either the panacea for our health system’s ills, as implied by the Pae Ora (Healthy Futures) Bill, or a waste of time, as hinted at by the Final Report of the Health and Disability System Review.

In this light, a new report issued by the Productivity Commission earlier this month makes for fascinating reading. Together alone (no, not the Crowded House album) assesses the state of play of collaborative initiatives in the social sector.

Collaborative initiatives exemplify a much broader trend in policy. Perhaps the central policy debate of the 20th century revolved around the role and size of government vis-à-vis non-government.

The pendulum swung towards a larger role and size in the middle of the century but, by the end of the 1990s, the advocates for smaller government were in the ascendancy. Social and health services – between which there is a very blurry line – were at the forefront of these swings in policy fashion.

While that debate has not gone away entirely, a striking development since the 1990s has been the blurring distinction between government and non-government. Some political theorists have gone as far as to say this distinction hardly matters any more. What matters instead is “governance”.

In this context, this refers to the collective efforts of a range of participants – public sector, private sector, non-profits, communities – in responding to policy problems.

Social sector collaborative initiatives come in many shapes and sizes and can be initiated by any type of organisation. Some involve coordination between government agencies, others are initiated by non-government, community-based social service providers.

By far the largest example is Whānau Ora, instigated in 2010 by Dame Tariana Turia, then associate health minister. Whānau Ora is an infrastructure that covers a broad range of collaborative initiatives, which all share the kaupapa of being whānau-centred rather than provider-centred. This involves an integrated approach to whānau needs and aspirations, in contrast to the “five cars up the driveway” approach that has traditionally characterised social services provision.

Whānau Ora is also a flagship for a new type of entity in public policy that is neither government nor nongovernment, but has a status defined more in terms of Te Tiriti o Waitangi. (The Māori Health Authority will be another space to watch here.)

Other examples of collaborative initiatives include primary care provider South Seas Healthcare, as well as a number of initiatives aimed at combating family violence. What they have in common is that multiple organisations and communities, with different but potentially complementary resources and remits, pool their resources, strengths and capabilities to address problems and meet needs that cannot be addressed by single organisations.