We are told austerity has ended. I have not met many people who seem to be experiencing an end to austerity on the ground. Budgets remain extremely challenging, and the structural impacts of austerity over such a long period of time are having increasingly extreme impacts on the most vulnerable in society.
Given wishing austerity away does not seem to be making a difference to the reality on the ground, we need to find a way to face the situation.
Learning to Think Differently
As always, adversity can be a springboard for radical and transformative thinking. However, the model below describes why we find it so hard to be transformative in our thinking. It illustrates two ways of learning: single loop and double loop (Chris Argyris, Reasons & Rationalisations (2004)).
(John Seddon, Freedom from Command and Control 2003)
When faced with issues, we naturally turn to what we know, and try to challenge the system as it currently exists, rather than question the thinking and assumptions that led to the design of the system in the first place. This can sometimes be borne from a feeling of powerlessness to challenge the wider system.
For example, we may look to improve the referral form between professionals as the information is not always complete. A focus group may spend time designing the perfect referral form, testing it, refining it and then training everyone in its use. This will help the system, but is based in Single Loop Learning – it has not challenged the underlying assumptions behind the system.
The reason we have a referral system in the first place is because we have different people, departments, functions and organisations involved. What would happen if we challenged the assumption that we need to split the work into functions? We would have no need for a referral form in the first place. This is Double Loop Learning. However, this feels extremely difficult compared with streamlining a referral form.
A Concrete Alternative
It has been done however. Organisations in Stoke realised that their systems were perfectly designed to create duplication, referrals, specialisms, and multiple assessments – because they were all separate systems. Housing officers would see somebody, as would a social worker, as would an occupational therapist, as would the police, as would the Citizens Advice Bureau. Within each organisation were even further specialist functions. By studying their systems from the perspective of citizens, they realised that what mattered to citizens was “one person to support me with what matters to me”. They also thought this would be a lot cheaper and more fulfilling for staff.
By challenging their underlying assumption about fragmenting and functionalising the work, they were able to create different operating principles, including:
- Do What Matters;
- Retain Ownership and Pull Support if Needed – Don’t Refer.
Crucially, they asked: “if we ignore the fact that organisations in the public and third sector are separate, and just use all our resources in a local community to support that community, what happens?”
Testing of this approach began, and was so successful, that the entire City was rolled into this new way of working in localities. The financial results for the sample of cases reviewed were as follows:
- Local authority spend reduced by 66%
- Health spend reduced by 97%
- Police spend reduced by 99%
- Criminal Justice spend reduced by 87%
Crucially, the learning from the work showed that while all organisations are experiencing increased demand, this demand is being amplified. This is happening in two ways. An individual or family that needs help, is required to interact with several departments and organisations. These different departments and organisations all have their own referral criteria, and assessments, duplicating the questions asked of the families and the demand many times.
Given this, our worries about increased demand can be thought of differently. We are all very busy, but we are duplicating work, and if we do not help people with what really matters to them, understanding this in their context, they are forced to re-present with the same underlying problem. They may not re-present to our part of the system, but they will re-present somewhere.
As such, by working in this different way, not just cost, but demand on the partner organisations reduced dramatically:
- Local authority demand reduced by 45%
- Health demand reduced by 99.7%
- Police demand reduced by 95.8%
- Criminal Justice demand reduced by 96%
In addition, the organisations involved learned how to identify families that would be likely to require support, and proactively approach them.
This way of working is now normal across the City, and the Auditor General has encouraged Wales to learn from this work.
Where To Start
Given this, instead of each part of the public sector continuing to work through how they can deal with increased work and less money, we could look at completely redesigning the public sector from first principles.
The starting point is for leaders of the different organisations to study the whole system together, from the perspective of citizens. If we studied demand from the perspective of a locality, we would learn the predictable issues, and which members of the community are experiencing those issues. Instead of tackling the housing difficulties, separately to the mental health difficulties, separately to the employment issue, separately to the finance issue – one team takes responsibility for all these.
In Stoke, a team member is not expert in everything, but they are the person who is responsible for understanding what really matters to the family. They then pull-in help from colleagues in the locality team who have particular expertise. This is very different from referring the family to another silo. Individuals in teams very quickly learn the skills needed to deal with predictable issues, and only pull-in when necessary. And there is no need for referral forms.
Additionally, a design based on a locality is far better placed to embrace the principles and practice of co-production and strength based working. Co-production entails working with people to develop services that matter to them, rather than bringing in services and hoping they work. Strength based working focuses on building on what people can do, rather than what they can’t do. Understanding a community and its assets, becomes normal in a locality based team. As all work is centred on what matters to citizens, control over the support provided remains in their hands. As such, reliance on the public and third sectors reduces, as communities take back control of their own destiny.
Let us be ambitious, let us stop trying to work out how to reorganise the silos in public services. Instead, let us take the practical steps to build towards one public service for each locality. It will be cheaper, provide more meaningful employment, and is what the public of Wales want.
We have the policy framework and ambition – all we need is leaders to be supported to take radical action and begin the next transformation of our public service.
All articles published on Click on Wales are subject to IWA’s disclaimer.
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