What service integration looks like from Melbourne

Posted on Wednesday 8th January 2014

ViewPoint@HSMC

Nicola Battle, University of Melbourne

If you don’t give people the room to surprise you, they will invariably become the boring people that you expect them to be. This month I learned that the same can be said of cities. Indeed when I first told people that I was travelling to Birmingham to undertake a five-day intensive public management subject as part of my master’s degree, I encountered an inordinate amount of skepticism from both Aussies and Brits alike. “Why would you want to do that? It will be cold, the food’s rubbish and there is nothing to see. Wouldn’t you rather go to London?”

Never one to be easily deterred, I did make the somewhat arduous 33-hour trek from my home in Melbourne’s outer west to the University of Birmingham. Once there I was joined by nine student colleagues and two academic staff from the University of Melbourne. Over the course of the week, we were incredibly fortunate to hear from an amazing array of guest speakers from the Health Services Management Centre and the Institute of Local Government Studies at the University of Birmingham, and Birmingham City Council. The sessions largely focused on local government in the UK, as well as the monolithic-like properties of the NHS. Particular emphasis was afforded to recent innovations in service integration and personalised care.

As someone who works as a social planner for local government in Melbourne, the course certainly did provide an extraordinary opportunity to draw some interesting comparisons between the UK and Australia. First lesson - do not try to compare local government in the UK to local government in Australia. To quote one of my student colleagues, it is like trying to compare baseball to cricket. Both involve bats, both involve balls, but the playing field and the rules are completely different. Fundamentally, the role of local government in the UK appears to be much more comprehensive than in Australia. Its areas of responsibility are extremely broad, whilst in Australia these functions tend to be spread across the three tiers of government (i.e. municipal, state and federal).

Similarly, whilst Australia does provide a level of universal health care for its citizens, our public health system is nowhere near as extensive as the NHS. Many ‘non-essential’ services are not covered, out-of-pocket expenses are common, and fiscal pressure is applied to people once they reach a particular income bracket to purchase private health insurance. I think that all of us were amazed to learn that the British Prime Minister would typically access the same NHS services as any other citizen.

Of particular interest to me, were the speakers who spoke about service integration and personalised care. Both of these innovations have recently found a home within Australian public management, although it would appear that we are not as far down the path as our British counterparts. Certainly in the case of service integration, best practice in Australia is currently sitting somewhere between communication and collaboration. Indeed without a major shift in organisational culture, it is unlikely that we will achieve full service integration in Australia within the foreseeable future.

Overall all of the speakers were extremely forthright about many of the challenges that currently face both the NHS and local government, especially in relation to the City of Birmingham and the potential impact on local people. The underlying message was clear. Local government and the NHS are both incredibly complex service systems that are under increasing pressure to do more with less. Equally apparent, however, was the passion shared by each of the speakers and their steely determination to improve the efficiency and effectiveness of the system, particularly as it pertains to some of the city’s most vulnerable residents.

MarketChristmasDespite its current challenges, it is clear that Birmingham is a city that cares about people. From the woman in the canteen who prided herself on her ability to learn everybody’s name, to the group of locals in the pub who insisted that I join them because “nobody should sit by themselves”. I think that all of us also appreciated the total willingness of complete strangers to give directions and/or to share local knowledge as we navigated our way around the city. And whilst Birmingham does potentially lack the large-scale tourist attractions of other more popular destination cities, there is a vibrancy within its streets. This could be seen in any number of different ways, including the thousands of people who braved sub-zero temperatures to amble around the German Christmas Market and to share a mulled cider with friends; the pop-up cinema at the base of the Mailbox; the extremely well-utilised meeting rooms and other ‘bump-spaces’ within Birmingham’s beautiful new library. These are the foundations on which meaningful social capital is built.

So yes, it was cold and the food was pretty rubbish, but in just a few short days the city of Brum was able to find a place in my heart, in a way that few other cities around the world have been able to achieve.