Friday, April 26, 2013

Why is 'joined-up' governance so difficult?

This example from the UK leads me to ask yet again: why is it so difficult to do 'joined-up' governance?  This report's recommendations seem relatively simple yet, based on past experience, we could have little confidence that their enactment was feasible or possible.

"Cold Enough: Excess winter deaths, Winter Fuel Payments and the UK's problem with the cold

 Twitter hashtag: #coldenough

Around 25,000 preventable 'excess winter deaths' occur each year, and the annual cost of cold-related illness to the NHS has been estimated at £1.36 billion.

This report from the Strategic Society Centre provides a full strategic review of the government's response to this ongoing public health scandal, and what it should be doing in future.
The report identifies four government departments with policies that touch upon these issues:
  • Department for Work and Pensions
  • Department of Health
  • Department for Energy and Climate Change
  • Department for Communities and Local Government
However, despite progress achieved via policies such as the Cold Weather Plan, Winter Fuel Payments and the Warm Home Discount scheme, the report concludes the government's policy response is still characterised by:
  • A fragmented, uncoordinated approach across different government departments.
  • The domination of the issue of ‘fuel poverty’ over the health effects of the cold, and an over-reliance on incomplete government means testing data; and,
  • The clear need to do better.
Recommendations of the report include:
  • Introduce an annual public health campaign linked to the Winter Fuel Payment to further influence cold-related behaviour.
  • Create a single national ‘at-risk’ register for the cold, integrating DWP, energy company, GP and local authority data.
  • Give clinical commissioning groups (CCGs) responsibilities for excess winter deaths.
  • Enable CCGs and Health and Wellbeing Boards to refer households for free home insulation under the government’s Energy Company Obligation (ECO).
  • Make excess winter deaths and cold-related illness a Ministerial priority.
Author: James Lloyd, Director, Strategic Society Centre"

1 comment:

Helen Wilding said...

Hi Ray
It's an interesting one this. There are ongoing debates about the 'causes' of excess winter deaths.
There are a lot of focus on houses (bricks and mortar) - but some people die because of complications from, for example, falling on a pavement. In addition, being alone and isolated increases in winter months - there is growing evidence that loneliness can affect life expectancy almost as much as smoking.
In addition, there is something more structural. In Scandinavian countries - arguably colder - there isn't such a marked effect. It could be that they have been 'better' all these years at building insulated buildings but also it could be that there is more resilience being a more equal society.
So definitely, a case for joined up governance but I am not sure how helpful it is to take this particular facet of poor wellbeing and health and tackle it in isolation of all the other dimensions.