Sarah Gillinson
It has been widely publicised that David Cameron and Nick Clegg want the opinions of frontline workers in public services about where to cut public spending 'fairly'.
The response has been varied – from union outrage that staff should be co-opted into eliminating their own jobs, to confessions from within the NHS, police and others that there is plenty of waste that could go.
This desire to make well-informed, strategic cuts that impact minimally on the services that UK citizens rely on is understandable and laudable. But the tactic of asking frontline workers for their opinion on where cuts should be made is misguided.
Innovation Unit's research into 'radical efficiency: different, better and lower cost public services' suggest that innovators who succeed in improving outcomes for users – and make savings of between 20% and 60% at the same time – start by asking a simple question: what will it take to improve the quality of life of people in our community?
This is a very different starting point from that of the prime minister. Instead of starting with cuts, it starts with aspirations. Instead of asking staff about individual public services, it asks users about cross-cutting social issues.
Fundamentally, this opens up a whole new possibility – that following a series of cuts, we could end up with a different and better system. Not a streamlined and demoralised version of the old one.
A radically efficient approach to cost-cutting also demands and incentivises greater community involvement – the Big Society in practice. In focussing services on what will really improve the quality of people's lives – and involving users in developing ways of getting there – there is a real incentive for those people to participate much more in delivering them.
Our radical efficiency case study from Sweden was of Patient Hotels – spaces adjacent to hospitals where maternity and cancer patients amongst others can recuperate. In designing those spaces, the patient hotel explicitly made provision for family and friends to stay with guests.
They help guests to move around the hotel and keep their spirits up, reducing the burden on nurses. Family and friends are only too happy to oblige as they can see much quicker improvements in their loved one's condition than in the hospital, where they are passive bystanders. They are not coerced or cajoled into contributing their time, they see it as being in their own best interest. And local commissioners save 60% per patient.
So starting with aspirations can mobilise new resources from communities for different and better services, focussed on people's most important needs. Starting with cuts David Cameron and Nick Clegg could do much more to mobilise this constructive cost-cutting process and greater input from communities.
Instead of asking frontline staff about where to cut, they should be devolving authority and funds to them, whilst empowering and inspiring them to work with communities to understand how they could improve the quality of their lives.
They should do this in four ways:
1. Give local authorities real freedom to innovate: allow them to pool their funding across services to focus spending on the cross-cutting priorities that will truly impact the lives of people in their community; at the same time, replace central 'targets' and performance indicators with a duty of 'radical transparency' – develop local indicators that tell the real story of the local outcomes you are trying to achieve, and how you are doing.
2. Enable new governance structures: encourage cooperative trusts that are owned and run by local people (like the Goodwin Trust in Hull or the Sunlight Trust in Margate) to in local areas.
3. Support local authorities to think differently: radically efficient innovation relies on new ways of conceiving the challenges we face – local authority professionals cannot be expected to do this without the tools and processes to support them.
4. Create a new sense of direction: central government should stop talking about cuts and start talking about the aspirations and priorities of UK citizens. They should be inspiring new ways of thinking and focussing on local need – not depressing a whole generation of public servants.
The Big Society is a compelling idea and cuts should be made fairly. But David Cameron and Nick Clegg are going about it the wrong way. The way to do this is not through consulting frontline staff about which cuts would be least bad. The radically efficient way to do it is to liberate, support and inspire frontline staff to understand and focus their spending on the areas that will improve quality of life in their communities.
Sarah Gillinson is a partner at the Innovation Unit and is co-author of the Radical Efficiency report
From Flip Chart Fairy Tales
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