Intersectoral problem solving by interdepartmental units and committees

Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.18 | No.4 | 2012 11 INTERSECTORAL PROBLEM SOLVING BY INTERDEPARTMENTAL UNITS AND COMMITTEES By: Scott Greer and Anna Maresso Summary: Interdepartmental committees and units can expect to have different degrees of success in providing potential solutions to coordinating government policies and operating intersectorally. There is variable scope for them to contribute to a range of governance outcomes, including evidence, coordination, advocacy, monitoring, guidance development and implementation. The appeal of interdepartmental committees and units is that they work within the government bureaucracy, do not require significant costs or reorganisation, can work with departments over time, and can apply sustained pressure. They can work in multiple situations but are less useful in resolving political conflict. Keywords: Interdepartmental Committees, Interdepartmental Units, Intersectoral Governance, Health in All Policies Scott Greer is Associate Professor, School of Public Health, University of Michigan, Ann Arbor, USA. Anna Maresso is Research Officer, European Observatory on Health Systems and Policies and LSE Health, the London School of Economics and Political Science, London, UK. Email: slgreer@umich.edu Introduction Both interdepartmental committees and interdepartmental units are intersectoral governance structures that try to reorient existing government ministries around a shared, intersectoral priority. Both of these mechanisms operate within the bureaucracy and their fundamental justification is that they can move the bureaucracy to engage in such intersectoral priorities. Their vigour, though, depends on their ability to persuade other bureaucrats to engage with them, which is much more likely if they have strong political backing. The role of interdepartmental committees and units Interdepartmental committees are made up of representatives from the civil service (or possibly political appointee) level of departments. They might shadow a ministerial committee or be serviced by an interdepartmental unit. Such committees appear throughout the history of modern public health. Today, there are many examples of interdepartmental committees within European administrations, such as the Public Health National Committee in France (designed to improve coordination and information among the main ministries whose policies may have a health impact, particularly prevention and health security); the Traffic Safety Committee in Slovakia (whose narrower remit and detailed tools have contributed to a dramatic decrease in road fatalities); the Interdepartmental Public Health Committee in Hungary (which assisted the implementation of the National Public Health Programme) and several permanent Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.18 | No.4 | 2012 12 inter-ministerial committees coordinated by the Finnish Ministry of Social Affairs and Health that focus on aspects of health promotion such as occupational health, rehabilitation, gender equality and child and adolescent health. 1 Moreover, nearly every European Union (EU) Member State has some kind of committee structure responsible for coordinating EU policy. The virtue of interdepartmental committees is that representatives of the different relevant units use them as a forum for problem solving. Committees lower the costs of a decision by maximising the relevant information made available, and lower the costs of implementation by involving the affected interests (departments) in the decision. Regular committee meeting schedules can also be a stimulus to action: they allow participants to review new information, actions and progress, which thereby creates deadlines capable of forcing some information provision, action, and progress. The weakness of interdepartmental committees is that they may fall prey to a number of pitfalls. One is depleted energy: the committee ceases to meet or high-ranking members send low-ranking deputies and thus its mission is forgotten. A second is irrelevance: departments might send representatives but do not actually feel committed to the agenda or its implementation. A third is sabotage: departments may use the committee solely as a way to spy on people who might ask them to do things that they dislike. Interdepartmental units are groups of civil servants, deployed and organised specifically to pursue a particular policy issue or agenda. They are typically delegates of somebody (ministerial committee or a central government minister) and they differ from agencies in that they are not responsible for delivering any services. Rather, they are creatures of the need to coordinate policy rather than autonomously deliver a service as agencies are generally created to do. 2 Such units also often attract scholars, consultants and policy entrepreneurs as outsiders who can provide new ways of thinking. In the UK, most attention recently has gone to units such as the Prime Minister’s Delivery Unit (charged with monitoring delivery on a broad range of key goals such as shorter elective surgery waiting times) 3 and the Performance and Innovation Unit (responsible for identifying ways in which the government could organise itself to deliver better services. 4 Another experiment was a unit to deal with the homeless living on the streets that focused on the joining up of relevant aspects of local government, housing, social work and health services, 5 as well as drug harm reduction programmes. The virtue of interdepartmental units, above all else, is that they have staff which can dedicate their time and energies to intersectoral work, a task that often takes place outside the rhythms of established bureaucracies and the frenzies of daily politics, which can redirect government activity and the focus of ministers. A unit can continue to carry out the political mission of intersectoral governance when the politicians have been called away to other tasks, acting as a delegate for a minister who can be distracted by politics or sucked into administration. The potential weakness of interdepartmental units is that they may be side-lined as being too intellectual, too impractical or too distant from the preoccupations of the bureaucracy. Three broad kinds of responses can meet this challenge. One is that political will ultimately does matter and that a unit has a chance of being effective if it is known that it ‘belongs’ to a senior minister who will advocate and defend it if necessary. The second is that personnel matters, making it imperative that the unit be staffed to combine technical competence, energy and a sense of the relevant bureaucratic and political issues. The third is strategy, whereby the unit makes itself a credible ally for at least some of the interests within affected sectors, rather than being solely an in-house critic alienating departments and their ministers. ‘‘ a forum for problem solvingProblem solvingIntersectoral governance often must face coordination problems that have a political rather than simply a bureaucratic source; that is, the government does not agree within itself. There are four quite common situations which highlight the nature and extent of this problem, both in terms of the level of conflict between ministries and the political importance of the issue that needs coordinated action. Consequently, interdepartmental committees and units can expect to have different degrees of success as the potential solution to the coordination problem. The four situations are: Table 1: Conflict, salience and coordination challenges High Political Importance Low Political Importance High conflict Situation 1. Interdepartmental committees and units might clarify issues but resolution depends on political will. Situation 2. An interdepartmental committee or unit with strong political support could impose a solution. Risk of departmental sabotage. Low conflict Situation 4. Optimal for interdepartmental committees and units – strong political backing and few political conflicts. Situation 3. Interdepartmental committees and units very useful – committees can clarify problems and solutions while units can add missing energy to the issue. Source: 5 . Note: A high conflict situation is one in which there is little or no basic agreement. Political importance is the extent to which an issue matters to the government, especially its senior politicians. Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.18 | No.4 | 2012 13 1. Two ministries refuse to agree because their ministers refuse to agree. A common example would be conflict between the ministries of health and finance over tobacco control. 2. Two ministries refuse to agree about some minor problem and no senior official or minister thinks the issue is a priority. An example here would be disputes over the role and cost of health care in schools or prisons. 3. Two ministries do not have particular disagreements but need to iron out the details and do not necessarily get around to fixing the problem. An example here might be implementing a policy that allows home care visitors to older people to carry out multiple tasks such as health visiting, checking smoke detectors, and helping with official paperwork, which in practice is difficult to coordinate. 4. Two ministries basically agree on the need to cooperate because it is an important government agenda item, they do not disagree much, and senior ministers want cooperation. For example, this was the case with the English task force on helping the homeless sleeping on the streets, mentioned above. Based on a framework by Page, 5 Table 1 presents these four situations in a grid, along with the potential role of interdepartmental committees and units. In general, the worst situation for a unit or committee is Situation 1 when they are as likely to be damaged in a conflict between top politicians as to be effective in mediating high-level political conflicts. This was basically the situation of the New Zealand Public Health Commission, which managed to offend so many high-level politicians and affected interests that it was abolished only three years after it was created. Situation 4 is the best scenario for units and committees as they can bring their respective advantages to bear on an intersectoral task that the government supports and that does not involve too many interdepartmental conflicts. Governance outcomes Using the map of situations outlined in Table 1 one can see the scope for interdepartmental committees and units to contribute to a variety of governance outcomes: Evidence: An interdepartmental committee is a forum for aggregating information; this could include information from around government but as a structure for this purpose, it might be inefficient. A unit is more commonly found in this role, with tasks ranging from collecting existing information to commissioning or performing research, engaging in public debates or simply informing ministers. In principle, evidence is a function that a unit or committee could fulfil in any of the four situations, although higher conflict makes information harder to gather and creates more risk that evidence will be ignored or incur retribution. Coordination: This administrative ‘holy grail’ means having the processes necessary to promote intersectoral working, including allocating responsibilities and making sure that bureaucracies carry out their tasks. Also, coordination can resolve differences and even build trust, and ideally should be carried out by experts in bureaucracy. Therefore, a committee is the logical choice and it can carry out the task in low- conflict situations. An interdepartmental committee is only likely to coordinate in high-conflict situations, for example, if there is a very clear political demand to resolve the issue or if it is backing a ministerial committee or other political process designed to resolve the issue. Advocacy: The virtue of a unit is that it can add energy. Advocacy requires energy and a unit should be well suited to this role as long as it is either working on relatively non-contentious issues or has strong political support (or both). A unit in a high-conflict, politically salient situation probably needs the backing of the most senior politicians to survive, let alone win. A unit in low-salience situations can be particularly useful, particularly if energy is lacking from other quarters. Finally, a unit in a high-salience, low-conflict situation is likely to be very successful. Monitoring: Monitoring is best done by a unit, though in theory, a high- functioning committee could co-opt member departments’ resources. The UK Prime Minister’s Delivery Unit was a success in this regard because monitoring requires energy and it was able to deal with the conflict that monitoring engenders. It is more likely to work in low-conflict situations but can work in high-conflict ones. Guidance development: Done by a committee it can be reduce conflict but paradoxically this is more likely in situations where there are already low levels of conflict. Done by a unit, guidance development can reduce transaction costs in formulation but requires diplomacy and political support to be implemented. This means that it works best in situations 3 and 4 where the problem is technical rather than political. Implementation and management: While departments and agencies implement policies, the monitoring and evidence activities of interdepartmental committees and units may feed into implementation. While interdepartmental committees and units can achieve these goals, they should not distract from the fact that existing units and committees frequently are low-cost established mechanisms as well. Interdepartmental committees, in particular, do not capture all bureaucratic interdepartmental coordination within government; nor should we think that only those committees and units led by health specialists are of special interest to health policy. Service on committees and units led by other departments, and participation in their consultation mechanism, is ubiquitous and, if used well, a vital technique for intersectoral governance. Conclusion The appeal of interdepartmental committees and units is that they work within the government bureaucracy, do not require significant costs or reorganisation, can work with departments over time, and can apply sustained pressure. They can work in multiple situations but are less useful in resolving political conflict. There are two summary lessons. First, political support is helpful for committees and units to work best. Second, a combination Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.18 | No.4 | 2012 14 is a good idea – a unit to provide energy and a committee to resolve technical issues, as well as political leadership such as a ministerial committee to channel and contain political disputes. Such a combination should be powerful and effective. References 1 Greer S. Interdepartmental units and committees. In McQueen DV, Wismar M, Lin V, Jones CM, Davies M (Eds) Intersectoral governance for Health in All Policies. Structures, actions and experience. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, 2012. 2 Talbot C. The agency idea: sometimes old, sometimes new, sometimes borrowed, sometimes untrue. In Pollitt C, Talbot C (Eds) Unbundled government: a critical analysis of the global trend to agencies, quangos and contractualisation. Abingdon: Routledge, 2004. 3 Barber M. Instruction to deliver: Tony Blair, the public services, and the challenge of delivery. London: Politico’s, 2007. 4 Performance and Innovation Unit. Wiring it up: Whitehall’s management of cross-cutting policies and services. London: Cabinet Office, 2000. 5 Page EC. Joined-up government and the civil service. In Bogdanor V (Ed) Joined-up government. Oxford: Oxford University Press /Cabinet Office, 2005.