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Phil Swann: The spending climate changes but reform remains vital

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I am trying very hard to avoid becoming a grumpy old man. I resist reminding people about the lessons of history or about the virtues of initiatives I was involved in one, two or three decades ago. Honest, I do.

But the pressure to remind LGC readers of the value of the 2009 Total Place pilots is irresistible.

We all know that public services face demographic and other pressures that pre-date the financial crisis and subsequent “austerity”. Those pressures cannot be wished away by a change in government or a more relaxed spending round.

Unless there is a complete transformation in public attitudes to tax and spend, then it is imperative we rethink the scope of public services and how they are delivered, as well as how much (more) should be spent on them.

Total Place was an initiative promoted by Gordon Brown’s government which reported just before the 2010 election. I was a member of the team which delivered the Bournemouth, Dorset and Poole pilot, which focused on the provision of services and support for older people.

Throughout our work we kept on coming back to a core question: “How can we secure improved outcomes for older people at less cost through improved collaboration between agencies, deeper engagement with citizens and communities, and a genuine focus on place?”

Eight years of austerity later the reference to “at less cost” may well be questionable, but it was a legitimate challenge in 2009. The other three prongs of the question, however, remain entirely valid today and are too often overlooked.

The Total Place pilot report, still available on the website, shows how it was possible to provide improved outcomes for older people at less cost. We identified numerous barriers to achieving that goal, but they were not clinical barriers or service delivery ones. The barriers related to leadership and political courage, cultural and organisational change, pan-organisation financial governance, management capacity, and government diktats.

My plea is that any discussion about the case for additional investment in any public service is accompanied by a commitment to addressing barriers of the type that we identified in the Bournemouth, Dorset and Poole Total Place pilot. The public expenditure landscape may, just may, be changing. But the need for real public service reform is just as pressing as it ever was.

Phil Swann, executive chair, Shared Intelligence

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