Services need to be joined up at the level of the citizen not just at the provider level
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
Ok I’m now going to say what might sound like sacrilege to a politician, but why not actually just concentrate on core values instead of changing policy every five minutes on a political whim? I’ve also found that these systems in the end only benefit the management team running them and like the governments current changing to GP consortiums, the staff and users get it in the neck.
If anything the private sector seems less disfunctional because they run from a set of core values. Take Tesco, Starbucks, McDonalds, Marks and Spencer ect, you can go into any of these and you’ll know you’ll get the same service if you visit a Bristol store as if you visit a London or perhaps even New York store. No what we really need to do is put the National back into our national services and not come up with some hair brain scheme every five minutes.
Chris surely the most basic principle for public services is that they should serve the public. This approach requires no restructuring no privatisation just an understanding that key services should be built around the needs of the citizen.
I also believe in an evidence based approach to providing services and the evidence is that this works especially for the most vulnerable
Yes Paul they should serve the public but first they should get the basics right. Unfortunately any changes in the public sector requires consultation and ends up costing a fortune. It’s like the joke how many politicians does it take to change a lightbulb? The majority to form a committee and the 1 to state due to costs the lightbulb is now being made redundant. The only exception to the rule is change driven by legal necessity than political will. I can’t remember the latest case but some of the things you mention like joined up services has already come about due to child protection cases.
This seems too much like icing on the cake, when what should be focused on first is the cake. Then there’s the social enterprise aspect and the voluntary sector, seems a bit too much Big Society for my tastes and we all known what that means privatisation by the back door and lumping the governments troubles onto the voluntary sector.
As for control over data that is a interesting problem which falls into three camps. The first is that a lot of data still only exists in paper format and is going to have to be converted to digital format before a national system could exist.
The second is that the public might not like what they see in their notes. On the politically incorrect side patients might wonder why they’ve been labelled CRAPPY (Chronically Re-Appearing Patient) or even DPS (Dumb Parent Syndrome). Then again more seriously doctors might run checks just to confirm that a child isn’t being abused or that a symptom isn’t cancer. This might lead to undue stress in the parent or patient.
Finally there’s the problem with data security, exposing this data will of course expand the possibility of it falling into the wrong hands and end up being used for identify fraud.
The point about the public sector’s management and control of information is a good one. I’ve lost count of the times that I’ve been told that information is confidential that plainly isn’t. The public sector seems to be in the grip of paranoia and urban myth when it comes to the provision to the public of information and data.
A recent case in point is the scandal over the payment of honorariums at Bishop Road School. Where, it seems, a letter dated April 2009 outlining this payment scheme from Bristol City Council’s then service director Kate Campion to the school’s head got branded ‘confidential’ and was never tabled to governors or made public to parents. There was no reason for this confidentiality, which seems to have been agreed privately between the service director and headteacher.
Of course, had this letter been made public earlier the matter could have been cleared up in weeks rather than years. As it is, it’s still rumbling on 3 years later!
On a personal note, my partner contacted Bristol’s education department about this time last year requesting a meeting with someone to discuss the admissions process in relation to a local school place because she was confused by what they had happened. The request was refused out of hand. They don’t meet with parents.
Neither could she get answers to her questions over the phone. All their answers were generic – “it might have been this”; “it could have been that” etc.
Now the matter is being pursued through FoI and Data Protection legislation. And – judging from the tone, language and attitude contained in the responses – this is a personal affront to the service director who seems to have to personally deal with these requests.
This is a crazy way to deal with an inquiry that could be sorted out in 30 minutes in a face-to-face meeting. What kind of service expends so much time, anger, energy and resources in not being accountable for their decisions?
Paul you might be interested in check this out http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+reform/the+new+royal+adelaide+hospital/the+new+royal+adelaide+hospital a colleague of mine has just returned from working in a Australian hospital and how they work is completely different.
Public sector hospitals that are built around the citizen and have public/private co-operation without ending up a private sector hospital. Sort of puts the UK to sham doesn’t it!
The good news is that the cops do have families and are citizens of this country too, which means they are very vulnerable.