Digital solutions to problems have become commonplace, but there is a gap emerging between the digital expectations of citizens and the reality of Welsh public services.
When my son was receiving regular care from a consultant I asked if I could avoid the car journey and a morning’s lost school for him by Skyping into the clinic instead. The answer was no.
After accessing a GP service via an app on my smartphone within 8 minutes of checking availability, it’s a frustration to then spend 30 minutes repeatedly calling on the phone to get an appointment with my local NHS GP surgery.
These are just anecdotes based on a few of my own personal experiences, but they demonstrate that the digital expectations that have been set by our everyday experiences of Facebook, Amazon, Netflix and Google (the so-called FANG companies), clash with the reality of the way public services work.
Citizens expectations are being transformed online. If health, local government and other services fail to keep up with these changing demands, it could seriously undermine support for the values of public services in the future.
Of course there are complicated reasons why in each of these cases the system is the way it is, but the theme is that our services are often not designed with the needs of the end user in mind.
A series of reports over the last three years have set out a consistent picture of Welsh public services failing to capture the potential of digital approaches to improve outcomes. They set out a very similar picture of services falling well short of their potential to deliver easy ways for the public to use everyday services. The widespread use of faxes across the NHS, and the fact that even the smallest local authorities in Wales are using over 100 separate systems to deliver services, is a manifestation of a deeper problem.
After being a critic on the Public Accounts Committee of the performance of the digital arm of Welsh health service Wales – NHS Wales Informatics Service – I was asked by three Government Ministers (Julie James, Vaughan Gething and Alun Davies) to put together an expert panel to make recommendations for change across the public services.
The volunteer panel has an impeccable pedigree: Paul Mathews, the Chief Executive of Monmouthshire Council; Anne Marie Cunningham, GP and Associate Medical Director of NWIS; Mark Wardle, Consultant Neurologist and Chair of the NHS Wales Technical Standards Board; Victoria Ford, Director at Perago-Wales, a former Head of Communications for the DVLA and who was part of the team at the Government Digital Service (GDS); Dominic Campbell, interim Chief Digital Officer at Homes England and CEO of FutureGov, and Sally Meecham who has a range of experience carrying out digital change, most recently as Chief Operating Officer of the GDS.
In the spirit of the openness that characterises the culture of the digital approach I’ve been blogging throughout our deliberations.
The first thing to point out is that we recognise that there is good practice across the Welsh public sector. Whilst some Councils have introduced things like putting its parking services online, and text reminders of bin collections, many are way behind. In the same way some parts of the NHS are innovating, in Morriston hospital for example the kidney dialysis service allows patients to make decisions about their treatments by giving them digital access to their information through their smartphone or computer. Other parts of the NHS are still in the pre-digital age – hospital appointment letters are still routinely posted, and it’s not possible to access services online.
To scale up and sustain this good practice the panel has recommended a significant programme of change.
We call for the appointment of a Chief Digital Officer for Wales and a Minister for Digital with authority right across the public services; a Digital Strategy that ensures problems are addressed from the point of view of the member of the public who will be using the service; and a team of specialist digital ‘squads’ that can be called upon to help organisations develop workable solutions.
The panel makes six recommendations to the Government:
- Design public services around the needs of the user
- Establish clear digital leadership in Wales
- Develop and introduce digital service standards
- Identify skills and capability gaps and develop a plan to close them
- Create an approach to incentivisation and spend controls
- Agree a clear and ambitious timetable for change demonstrating pace and scale
There are two main themes to our findings: leadership and know-how.
At the moment there is a gap at the top – very few of the leaders of our health boards, local authorities and senior civil service can be said to be confident digital leaders. In fact, most don’t feel embarrassed to admit they don’t really understand it. They will often talk about Digital as an off-shoot of IT. It’s not the same thing, technology is one of the ways digital change is implemented, the key bit about digital is designing services that work for people.
Those who are successfully adapting services use what they call an agile way of working. Their starting point is to properly understand what the problem is from the point of view of the person who is using the service. They assemble small teams with a mix of skills to jointly tackle the problem through every step of its journey: from end to end. These are teams of digital experts, often drawn from the commercial tech industry and combined with in-house government talent. Peru, Argentina, United States, Mexico, Canada, Italy and Australia are just a few of the countries with such units, joining the ranks of long-evolving government technology programs in pioneers like Estonia, Israel and Singapore. They trial as they go – they iterate. This has the advantage of identifying issues early and correcting them, reducing the opportunity for costly mistakes.They build a small solution, test it, fix it and try it again – at each stage referring it back to what the need of the end user is. They are open about their challenges and their failures. And when they get something that looks like it works they scale it up – or ‘build out’. And they keep iterating and improving.
This is different to the way most organisations – in the private and public sector – have come to address digital problems. Most think digital is about technology, it’s not: But leaders often use the terms digital and IT interchangeably, and tend to approach a problem that can be addressed through procuring an IT solution alone – often via a private sector vendor.
And the second theme is know-how. One of the main constraints (and there are a few) for real digital change is capacity – there simply aren’t the bodies around with the mix of skills required to bring about change. The British Gas Data Science Centre in Cardiff have emulated the digital music service Spotify in assembling ‘Squads’ (or teams) of digital specialists who can be deployed across the organisation to work on solutions to problems that have been identified. These are multi-disciplinary and each has someone with similar skill sets – for example there’s a User Researcher in each.
Each of these Squads cross-pollinates – the specialists don’t just work in their own team but they also work across teams with their own expert peers working on other projects. This way silos can be broken down, and experienced shared – and the squads should have access to a wealth of public sector data.
The panel recommends that NHS Wales, local government and central government each host a number of multi-disciplinary Squads that would work on iterating solutions to user-identified problems.
The work in each sector would be overseen by a Chief Digital Officer (CDO) of their own – a CDO for NHS Wales, a CDO for Local Government, and a CDO for WG (and Sponsored Bodies). These would double up as Deputy CDOs for Wales and, together with a Chief Digital Officer for Wales, would provide collective leadership across the Welsh public sector. Together they would provide expert scrutiny and support to teams, inculcate learning by setting digital standards and spend controls, and help upskill the workforce through scaling up good practice. And they’d be accountable to a clear Ministerial lead at Cabinet level.
This approach would place each part of the Welsh public service on an equal footing. There would be no question of the Welsh Government telling councils what to do, but instead working with them as partners to understand user need and provide capacity to solve problems.
Each of the multi-disciplinary Squads would share experiences horizontally across their peers working in different parts of the public services, so a user researcher working on a problem in Conwy Council would share experiences with user researchers working on separate problems in National Resources Wales or in Cardiff & Vale University Health Board for example.
This could help break down the silos within and across public bodies, and make best use of scarce resources. Open and transparent sharing would lead to the realisation of the ‘Once for Wales’ principles.
We need to use digital to enable us to ask for the public services what we actually want, rather than how to put up with what systems we are given. This is a big change agenda. It will require real leadership resources and a willingness to change. If we continue to fail to act on the expert recommendations that have been made we will waste more money and our public services will fall further behind.
We must not let that happen. We have a responsibility to act.
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