Public service reform is the obsession of all governments but improvements appear to illusory. Too often the focus is on ownership. The Tories (and elements of new Labour) seem to believe that if everything is contracted out to the private sector somehow there is a superior management ethic which will sort everything out. With the NHS they think changing the framework for commissioning will solve some undefined problem.
In my professional role I have been looking at service improvement and it seems to me that the political class have been asking the wrong questions. The more I look at public services the more disfunctional they look, not because of the people working in them, a huge proportion of which are committed to providing quality services, not because of who runs them, although I’ll say later why privatisation is not going to improve things.
The problem I see is that public services have evolved in such a way that they don’t place the service user at forefront of their service. Instead services are designed around assessment systems, structures and processes which turns the user into subject of the system.
Listening to recent presentations from Total Somerset about their client centred approach just further reinforced my view. They have run a 6 month project which placed a small group of ‘high contact’ families at the centre of the processes which have largely failed to deal with their problems.
First they mapped all of their contacts with agencies over the last two years. People continually being asked the same questions as each organisation carried out its assessment. Some assistance which dealt with a small part of a problem and then disengagement.
The project liaised with the agencies but more importantly they placed the person at the centre of the process. Each family has an advocate who helped them navigate the agencies. Organisations unable to share data because of legislation could have it joined up and shared when they ceded that power to the people who the data related to. Now currently it is common for a range of bodies working with a person or family to hold case conferences. These rarely if ever involve the person they are talking about. While improved joint working is essential it is not on its own sufficient.
The experience of this project is that families took more control of their lives, started to deal with some of their problems and started needing intervention from the agencies a lot less. The estimated savings per family over the 6 month period was around £50,000 across all the agencies.
There has been some progress though, the personalised budgets for people with disabilities were long fought for and can put people in charge of their care but this initiative seems to have stalled.
Some on the right might say that market mechanisms and competition can sort all this out. However processes for commissioning public services only create a short term competition for the contract and the choice is vested in the commissioner and the legalities of the process and not citizens. The Work Programme contracts were supposed to demonstrate a new commitment to a ‘black box’ approach where contractors would be paid on the basis of what they achieved and not on their systems, processes or service models. This just meant that the contracts went to the lowest bidders as the black box effectively eliminated quality measures from the tender.
To make real change to public services we need to be able to join them up at the level of the citizen as well as at the strategic level.
Services need to wrap around the service users needs rather than strait-jacketed into procedures and organisational silos.
Yes in some instances services will need to be standardised – we don’t all need a personalised refuse collection service or sewage system. standardised services can run alongside personalised ones – e.g. taxis are still needed even if you have an excellent bus service.
We also need to give more control over our data held by a myriad of organisations. Give us the ability to log into our health records and other public sector contact and case management systems, how about even allowing us to update some of our own details.
We can have public services which more effectively serve the people.
Link: www.somerset.gov.uk/totalsomerset









