“… far too many public service systems ‘assess rather than understand; transact rather than build relationships; refer on rather than take responsibility; prescribe packages of activity rather than take the time to understand what improves a life’. The result is that the problems people face are not resolved, that public services generate ever more ‘failure demand’, that resources are diverted to unproductive ends, and that costs are driven ever upwards.”
This is the claim from Locality chief executive, Steve Wyler, in the forward’s to his organisation’s report ‘Saving money by doing the right thing: why ‘local by default’ must replace diseconomies of scale‘.
The report, published earlier this month, was written by and produced in partnership with Professor John Sneddon of Vanguard Consulting. He argues that the politically popular idea that the best way to cut costs in the public sector is to outsource services in massive blocks to large private sector contractors, who can provide cheaper, more efficient services through economies of scale, is fundamentally wrong. It’s wrong not only because the services provided to vulnerable people are worse but because they also fail to save money.
The most striking sections of the report are the case studies of four people, whose multiple interactions with public sector agencies are used to illustrate the problems generated through failure demand. In the case of public services, failure demand means someone approaches a public sector agency with a problem, the agency either doesn’t do anything or does something(s) that doesn’t help and, as a result, that person has to approach more public sector agencies to solve both the original problem and the additional problems created as a result of the original problem not being solved.
In one case study, Ruth, a victim of domestic violence struggling to look after her six children while also managing health problems, knew exactly what she wanted from public sector agencies. She wanted help with housework and adaptations to enable her to access the first floor of her home (which she wasn’t able to do due to health problems).
Ruth’s local social services department chose to provide her with: “Two anger management courses for [two of her children; Two parenting programmes; Help cleaning one bedroom; Toilet frame, perching stool and bath board for a bath she could not access; Family intervention programme”
These services were delivered by the combination of: “Eight social workers; 22 support workers allocated; 30 referrals in core flow; 16 assessments in core flow; 36 teams/services”
The help that Ruth actually wanted would’ve cost up to £20,760 over 4 years, the ‘help’ she has received has cost an estimated £106,777 over a similar time period.
In another, Melvyn, a 75-year-old ex-miner living alone in a council bungalow living with epilepsy and a lung condition wanted help to stay in his home and have control over his life. What actually happened was that: “Over the last 2 years Melvyn had spent 162 days in hospital of which, conservatively, 72 days (44 per cent) were avoidable. He had involvement from seven different agencies and 30 different teams and professionals. He went through 29 separate assessment processes. Given that the assessment process was repeated every time he re-presented or when one professional referred him to another, 66 per cent of these assessments were repeated.”
Melvyn’s health conditions have become progressively worse, his independence and quality of life have both been dramatically reduced and entering the residential care system now seems inevitable.
In these cases, public services clearly aren’t succeeding. Rather than meeting the needs and aspirations of vulnerable people, they’re offering one size (doesn’t) fit actions picked from a pre-determined menu of agree interventions.
Unfortunately, experiences of people subjected to multiple failed interventions from public sector agencies that send them hurtling into somebody’s righteously-exasperated case study, are used to justify a wide-range of different and often contradictory positions.
The report is weaker when explaining the arguments behind the ‘local-by-default’ model it proposes as an alternative. ‘Local-by-default’ means services providers having: “A thorough knowledge of the predictability of demand for services”.
This “enables service providers to ensure that people who present as needing help can be met immediately by people with the requisite knowledge and skills to assess need and organise service provision.”
The result is that: “Real economies of flow replace imagined ‘economies of scale’. Each locality is different; its needs can only be understood in a local context.”
The other principles the report advocates are: ‘Help people to help themselves‘, ‘Focus on purpose not outcomes‘ and ‘Manage value, not cost‘.
The question is what does that actually mean? In someone else’s ‘change the delivery model’ policy report, Melvyn’s story would show why it’s important that older people are given personal budgets to spend on commissioning the support they want and need, from whoever can provide it.
Free market commentators might argue that Ruth would have been better off if state agencies just weren’t there at all and she’d turned to a local church for help.
Sneddon and Locality argue for public service providers (whatever sector they’re employed in) who listening to people, find out what they need and help them get it. It’s ‘Person-centred’ and it’s ‘multi-disciplinary’. They don’t like payment-by-results or other forms of ‘outcome-based management’. Advocates of bigger, more impenetrable silos should look away now.
Some councils are trying the ‘Local-by-default’ model. Stoke City Council took: “the radical decision to launch a comprehensive multi-agency initiative – across local authority, police, fire and rescue, NHS and TSO-provided services – to understand how people interact with the totality of public services…”
Now: “Multi-agency teams work together in individual neighbourhoods, come to understand local issues and get to know local families. These pioneering projects are breaking down barriers, improving outcomes and rebalancing the lives of customers to boost the economic and social wellbeing of whole communities. The results are profound.”
There’s nothing particularly new about saying that we need good services rather than cheap ones. There’s also nothing new about multi-agency approaches. Whatever happened to Connexions? While I’m sure Vanguard Consulting does a good job with Councils and others it works with directly, on a wider policy level the report doesn’t have a clear, practical message for public sector decision-makers that extends far beyond ‘do good stuff, do less bad stuff’.
It’s equally unclear how talk of ‘managing value, not cost’ would miraculously make the battle for resources go away. While services that understand people’s needs are better placed to meet them, even the best run services will not be able to meet to all perceived need. ‘Saving money by doing the right thing’ (unsurprisingly) doesn’t have all the answers is a useful contribution to the debate about what public services are for and how they can be made to work better.