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Attempts to localise services have started in the wrong place

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Now that they have a majority, the Conservatives must seize the opportunity to honour their manifesto commitment to localise public services.

The prize is significant, in both monetary terms as costs will fall dramatically and also in human terms; local, citizen-centred services get more lives back on the rails and demand for services falls. Shouldn’t that be the purpose of public services? But realising the prize depends on how it is done.

The recent attempts to localise services during the coalition government were dependent on winning bids for money and adherence to Whitehall’s requirement to create new structures first. It is the wrong place to start.

The consequence in so many examples has been moving organisations, for example health and care services, into one building. This does nothing to alter the inherent obstacles of working to the usual targets and budgetary constraints.

Further, winning a bid to localise has meant months, if not years, of work complying with Whitehall’s desire to see not only structures but governance arrangements, risk analyses and other plans in place. A veritable feast of management factory endeavour with only opinions as to the nature of what needs to be done and how to do it.

Effective change is emergent; there is no need for any plan. Moreover, emergent change is fast and there is nothing more urgent than solving the problem of services for people whose lives have fallen off the rails.

The first and vital step is to understand demand in citizen terms, not provider terms. It comes as a surprise to discover that demand for health and care services is both stable and predictable, thus immediately a current myth, that demand is rising, is exposed.

With good knowledge of the predictability of demand by type a service design can be quickly established to have the expertise required to understand people’s needs and context, and from there deliver services working to the following principles:

  • The service user must define what a good life (or good death in some circumstances) means in their terms. The service user is helped to take responsibility for achieving that and any resources required are pulled from the community, voluntary sector and statutory services to assist in achieving their aim
  • It is only when an effective service is established that attention should be given to matters of structure and governance, ensuring that the purpose of the service is supported not obfuscated.

The Conservative manifesto anticipated 25% efficiency savings through ‘place’ budgeting. It is, in truth, a modest ambition. The evidence shows the prize is greater; but what matters is how we go about achieving it.

John Seddon is author of The Whitehall Effect

 

 

 

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