Can the silos be broken? Cross-government working for public health

 

By Dr Jack Newman, School for Policy Studies, University of Bristol.

This blog first appeared for the Bath Institute for Policy Research on February 27 2024

 

There is growing recognition that tackling complex social problems, like climate change and health inequalities, can only happen by building strong interconnections across policy jurisdictions and sectors. As part of the TRUUD project (‘Tackling the root causes upstream of unhealthy urban development’), we examine how a wide range of policymakers can and must work together to co-create healthy urban development.

 

For many decades the siloed departmentalism of Whitehall has been a constraint on cross-government working. The silos are perhaps most apparent from the perspective of local government, which sees Whitehall as a disjointed monster, a complex labyrinth of incompatible systems. In turn, Whitehall sees local services through a kaleidoscopic perspective, with each department delivering largely separate policy interventions, reflected in its multitude of incommensurate policy geographies.

 

In the latest attempts to overcome Whitehall siloes, it is possible to distinguish three strategies:

• Firstly, there are the reforms from within, modifying existing practices and maximising opportunities for cross-departmental working. A new report from the Public Accounts Committee champions this approach.
• Secondly, there are proposals for redesigning the architecture of Whitehall, reforming the so-called ‘machinery of government’. This is outlined in Labour’s ‘mission-driven’ approach.
• Finally, there are proposals for significantly scaling back the functions of Whitehall through a radical decentralisation of power. This is advocated by an increasing array of policy commentators.

Bridging the silos

 

Last week, the Public Accounts Committee (PAC) published its report on Cross-Government Working. It focused on the government’s existing initiatives to bridge departmental activity, including HM Treasury’s ‘six approaches’ to working across departments. These include collaborating on policy development, sharing expertise, developing shared programmes, and transferring budgets. However, as the PAC report highlights, there is currently a lack of knowledge in the system about how (and whether) these approaches actually work in practice.

 

There is perhaps greater promise in the government’s flagship policy for cross-government working. The ‘Shared Outcomes Fund’ has provided £600m over the last five years for cross-departmental pilot projects. TRUUD analysis of the 60 project funded shows that DHSC (Department of Health and Social Care) and DLUHC (Department for Levelling Up, Housing, and Communities) are the most involved in cross-government working. These two departments are also the most frequent collaborators, working together on 17 of the 60 projects. Given that these are just pilot projects, this points to the significant potential for further integration of health and levelling up policies across Whitehall.

 

As the PAC report rightly argues, it is now time to learn the lessons from these pilots and scale up the successful projects, situating them within a transparent framework of cross-cutting departmental outcomes.

 

Redesigning the silos

 

History shows us that attempts to bridge Whitehall silos are only ever part of the solution. Kavanagh and Richards trace the long and repetitive post-war history of initiatives for ‘joined-up government’, going back to Winston Churchill’s system of ‘overlords’, in which members of the House of Lords acted as cross-departmental convenors. In the decades since, numerous subsequent initiatives have come and gone,each emphasising strategic direction and each ultimately increasing the centralisation of government.

 

The latest plan can be found in Labour’s proposals for “mission-driven government”. With familiar critiques that “government still largely operates in silos”, which “inhibits our ability to address complex problems”, Labour proposes to orientate government around a series of cross-cutting missions. To deliver its proposed ‘prevention–first revolution’in public health, Labour plans to create a ‘national framework’ that embeds the wider determinants of health across government and public services. This will be overseen by a new ‘mission delivery board’ to bring together all the departments that have an influence on the wider determinants of health.

 

Such proposals are very welcome, though there are ambiguities here, to the extent that “mission-driven government” could represent a seismic shift in the UK’sgovernance landscape or merely another transient rebrandingthat leaves existing departmental structures largely unaffected. If, as implied, a public health mission delivery board replicates the functions of the Climate Change Committee, its role would be to advise and monitor government performance, rather than coordinate the activities of government departments. If, as Labour has proposed elsewhere, it replaces existing cabinet committees, it could have a more fundamental role in changing departmental priorities.However, as the Institute for government has argued, reorganising the Whitehall machinery is an expensive and disruptive business

 

Decentralisation

 

Bridging and redesigning are important strategies for realising cross-government working, but they cannot be the solution on their own. In the academic literature, many argue that the best place to achieve joined up working, or a systems approach, is at the local level. The Government’s recent Levelling Up White Paper indicates that the local level is the best spatial scale to join up and engage affected communities in the co-design of place-based initiatives. This is particularly important in the delivery of a preventative public health agenda, in which decisions around transport, housing, and planning have significant impacts on the long-term health of urban populations. This in turn requires cross-government working nationally to provide the right structures and incentives to enable local actors to join up their activities.

 

The emerging devolution model in England holds a great deal of potential for bringing together a range of policy actors around cross-cutting missions. Initiatives like the Frome Gateway in Bristol and the Streets for All project in Greater Manchester are positive indications that, at the local level,public health can be embedded across various policy sectors. There remain, however, some big unanswered questions on English devolution around funding mechanisms, institutional capacity, policy powers, accountability, and geographical footprint. To meet the pressing challenges around public health and other complex social problems, these questions will need answers.

 

To realise cross-government working, it is of course important to build bridges across Whitehall departments and to fine-tune the machinery of government, but this must be done in tandem with a major decentralisation of policymaking and an agenda for realising the potential in the emerging devolution model.