We Need to Change the System First

Photo of Simon Pickthall
Simon Pickthall

Guest blog from Simon Pickthall, Vanguard, in the lead up to our Re-Shaping Services with the Public event #ReshapeServices

Most frontline people who work in the public services think of co-production as a positive step.  However, time and time again, I meet people who are working in this way under the radar, or undertaking exciting and innovative work despite the system within which they work. Naturally, this constrains how effective they can be.

My key learning has been that unless you change the system within which people work first, co-production will always face an uphill battle.

For example, I have had the privilege to work with many inspiring people in social care. As always they were committed to working with individuals who needed support. However, they were constrained and, in some cases prevented, from providing this support in a co-productive way by the system within which they worked.

By spending time following work through the system from the perspective of the people receiving help, in the space of just six days they had uncovered the underlying problems in the system.  They discovered multiple assessments that lost the person’s story, performance indicators driving dysfunctional behaviour, and multiple referrals between professionals leading to enormous quantities of bureaucracy, including some professionals who needed to refer to themselves!

However, the fundamental underlying issue that they learned, is the system is underpinned by the assumption that we need to provide ‘services’ to citizens. As the frontline have a menu of services they could offer, these dedicated individuals found themselves assessing the citizen to fit into this menu. The system also treats each request for help as a single transaction, without being in a position to understand what really matters to the individual and helping them achieve this. This, in turn, leads to enormous numbers of re-referrals, as individuals return as what matters to them has not been achieved. The assumption behind the design of the system is that standardisation and menus are necessary to control the budget – in fact, by constricting the ability of the system to absorb variety, and help people achieve what matters to them, costs continue to rise. This is further exacerbated by delivering services to people, rather than working with them.

Once they realised this, they were in a position to challenge the assumptions that had led to the design of the current system. They were, therefore, very keen to try something different. This different approach started with having a good conversation with the citizen. Rather than turn up with an assessment recording tool, they just asked variations of “What would a good life look like to you?”. This question produced completely different answers. Citizens simply said things like: “I would like to go shopping”, and “I would like to continue to dress smartly”. Without the constraint of a menu of services, the social workers and health professionals were able to think creatively about how to solve these problems with the individual, not just attempt to solve the problem for them.

Creating a system that helps citizens articulate what a good life looks like to them, and co-producing methods to help them achieve their good life, removes the power imbalance between citizen and state. In addition, it saves money.

Below are some of the results achieved by working in this way in social care:

  • 28% reduction in residential and nursing care placements, together with a reduction in domicillary care hours – average care packages reduced from 12 hours to 9.7 hours per week.
  • 46% reduction in contacts into Social Services.
  • Underspent community care budget (cost avoidance of £1.5 million in 2013-2014).
  • 30% reduction in assessments.

Rationing through menu driven standardisation drives in costs, and prevents committed individuals embracing co-production. The message is that we need to help the frontline workers in the public sector build relationships, not give them menus.  A recent report published by Locality and Vanguard, demonstrates that over £16 billion of savings can be made across the public sector if we moved to these different principles. The report can be accessed here: ‘Saving money by doing the right thing: why ‘local by default’ must replace ‘diseconomies of scale’

This can only be done, by intervening in the public sector systems directly. Once the current principles behind the design and management of work are understood, they can be challenged and changed. From this a new system can be created enabling co-production to thrive and reduce costs.

As such, the starting point is to spend time understanding how and why the current system makes co-production so difficult, rather than simply bolting on coproduction and hoping for the best.

Change Thinking – Change Lives.

Simon Pickthall worked in the public sector in Wales for many years before forming Vanguard Consulting Wales.  He has been fortunate to have worked with many leaders in Wales to help them understand their organisations using the Vanguard Method –  and improve them as a consequence.  Simon was privileged enough to work on the Munro Review of Child Protection, and is committed to helping the public, private and third sectors deliver social justicesimon.pickthall@vanguardwales.co.uk

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