Things are changing: Public Service Reform
According to Einstein, insanity is doing the same thing over and over again and expecting different results. So why are we surprised when aspects of government activity, that for decades have failed to change the trajectories of peoples’ lives, still don’t work?
If you were working out how to design quality public services from ground zero, you would never arrive at where we are now. In Essex alone, there are over 200 partners working to deliver services like health and social care, training and employment support, reducing re-offending and supporting troubled families, frequently to the same group of residents. Each of these organisations has its own culture, processes, and objectives determined by their parent departments in Whitehall, none of whom speak to one another.
The result is that we are wasting vast quantities of public money due to a fundamental lack of coordination between different arms of the state. And importantly, it’s the small volume high cost services that support the most vulnerable and deprived individuals that would benefit the most from a joined-up approach. But because different organisations have different budgets, we are missing out on a string of golden opportunities to invest in early intervention projects that could make a real difference to the lives of vulnerable people. Even when there is strong evidence that spending £500 per person on a particular cohort of individuals is likely to recoup many times that investment in years to come, it won’t happen if the £500 investment comes from my budget, but the £5000 benefit flows into your budget.
But the good news is that things are changing. Ministers have launched pilots in four areas of the country to trial new ways of joining up different parts of government to deliver more effective and more efficient services, and these pilots have developed some very interesting plans.
In West Cheshire for example, 9,000 women suffer domestic abuse every year. A slew of public and voluntary sector agencies are involved in initiatives to tackle this, but through jointly agreed investment in early and intensive support to deal with the underlying causes of abuse, women in West Cheshire will receive much better support while the public purse as a whole saves £20 million.
Ex-offenders are a group bounced around different government agencies more than perhaps any other, but in Essex that’s about to change. A social enterprise company will provide employment and training support to ex-offenders; mentors will work across increasingly irrelevant public sector boundaries; and the activities of three government departments, associated agencies and national contractors will morph into a single approach tailored for Essex. If these efforts reduce reoffending by just 5%, it would mean savings of £125 million with obvious benefits for the individuals involved.
Greater Manchester has a long history of working across local authority boundaries, but by providing intensive support for young adults at risk of short-term prison sentences by working with government it thinks it can save almost £200 million in the next five years.
Shunting elderly and vulnerable people between the NHS and local care services can be deeply unsettling for the individual and is incredibly expensive to boot. If an elderly resident living at home with early dementia develops an infection, becomes confused, stumbles and breaks his hip, and ends up in a nursing home after accessing doctors, nurses, hospital and council services, it’s a tragedy for all involved. Instead, identifying those at risk, and jointly putting in place preventative plans and measures (eg. grab rails to prevent falls) could keep people in their homes for longer.
It is this sort of thinking that is being rolled out in the Tri-borough of Kensington & Chelsea, Hammersmith & Fulham and Westminster, which are helping to trailblaze the sort of joined-up health and social care that should become the norm across the country within five years. Not only could this dramatically improve quality of life for many elderly people, but savings to the public purse are expected to be around £40m a year.
And this is just the tip of the iceberg. If these plans work out as hoped, then similar savings could be replicated across the country. And of course there are plenty of other areas where a more joined-up approach could deliver a win-win result of more effective services at lower cost. We’re talking many billions of pounds of savings for the exchequer here.
So it’s excellent news that the noises from Government are positive about the proposals submitted to them by the pilot areas. Now Ministers need to ensure that they do everything they can to see that these quietly revolutionary projects can get up and running as soon as possible. With some smart thinking, public services can be more effective for those that receive them and still save billions. And you would have to be mad not to want that.Tagged in: care services, essex, localis, ministers, nhs, public service reform, tri-borough
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