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Total Place or total waste of time?

Fri, 12 Mar 2010 10:42:57 GMT

A public manager writes from the inside about how the Total Place initiative has failed to impress his chief executive

My chief executive thinks the Total Place initiative is a total waste of time and he is not alone.

We already acknowledge the total public sector budget in a locality is an impressively large figure and that it would be a good idea to better coordinate services, agree priorities and pool recourses. We don't need to spend time working out how large that figure is, nor exactly how it is spent.

I can see why central government is so keen on Total Place. Knowing exactly how big the total public sector budget pot is in any given locality allows them to boast of their generosity. Mapping services provides example of duplication and allows them to claim the best use is not being made of the money they provide.

If public sector agencies like the NHS and local government can't get their act together locally, runs the argument, then let's take out of the local budget the money that would be saved by better coordinated services and thus force local bodies to work together. This also has the benefit of reducing overall public sector spending.

Do the local authorities involved in the Total Place pilots really believe they can use the "evidence" to persuade Whitehall to devolve more power to them?

We know Whitehall operates in silo, with each Whitehall department holding different sections of the public sector accountable. It does this by designing performance indicators and setting targets and ringfencing funds. In so doing, individual departments pull and push in their own way, irrespective of what other departments are doing.

We also know that when budgets are tight the tendency is to retreat to core business and shunt costs across service, department and agency silos.

Perhaps it is not surprising that viewed from the front line, Total Place seems a total waste of time.

Information governance - does something have to give?

Fri, 12 Mar 2010 10:20:00 GMT

Collating data from all sources within the NHS has been the long-term goal, but balancing information governance with the demands of clinicians and frontline medical staff and patient privacy is not easy

Improving patient care versus Information Governance - does something have to Every time we acquire a service we leave forensic evidence. Every time we buy something with a credit card, go past a camera or visit a doctor, a little bit of information is left behind. There is a sea of data out there that is of critical value to us, and those who provide our healthcare.

Almost every aspect of a patient's journey through a clinical procedure is recorded though not, as you might expect, in a single system. Those who we trust with our health have an incomplete picture of us. This is because our data is held across a wide variety of IT systems distributed across many organisations and controlled by multiple information governance (or IG) rules, including primary care, acute care and social care and mental health.

IG exists to provide the laws under which this information may or may not be used and by whom. It is there to protect us from prying eyes – whether their motivation to do so will be to our benefit or not.

When a patient presents in A&E at 3am, drunk and with facial injuries, the A&E staff may not know that this person has a history of violence towards clinical staff. How they can react in the right way?

When an unconscious heart attack victim presents in A&E, how can clinical staff discover whether they are allergic to an enzyme routinely administered in such situations?

These examples show how vital information is held in systems which, through IG rules, clinical staff do not have the right or technical infrastructure to access.

Protecting patient data against unauthorised access is necessary for patient safety

Bringing patient data together from all the potential sources that exist has been a long-term goal for the NHS. The most common wisdom around this has been if you want systems to interoperate, then build a new system. However, the complexity of IG around this "new" system has traditionally stopped this from happening. Protecting patient data against unauthorised access is necessary for patient safety, but it can also make improvements to overall patient care more difficult to deliver.

To meet the needs of clinicians while respecting IG demands interrogation of the workflows around the use of patient data. Rather than building a new system, it's time to look at understanding the scenarios faced by clinicians in the real world so that IG can support the circumstances better.

From an integration point of view, this means getting information out of systems that are in place at the point of care rather than building a new system from scratch. Leaving the data where it is and linking it together based on the context of the situation means that IG considerations could be respected while the appropriate data for the circumstances is also delivered.

What does this mean for the future? Well, the information needed to support critical clinical decisions is already out there, in a system somewhere. Instead of building a new system, we have a National Spine for the transmission of data across the Health ecosystem. We also have state of the art techniques to give us utility based computing and interoperability, so why can't we strive toward a similar goal with the information about our collective wellbeing?

Taking this new approach means that IG will move up a layer, be responsive to circumstantial context and, I believe, will improve the lives of all of us.

Wayne Parslow is general manager, EMEA for Carefx

Report brings clarity to civil service pensions

Fri, 12 Mar 2010 10:19:03 GMT

Prospect union welcomes 'myth-busting' pension report from the National Audit Office, saying it shows true costs against an annual percentage of GDP

A new report from the National Audit Office into civil service pensions has been welcomed by the Prospect union, which it says has brought clarity to an often controversial subject.

The report presents figures as part of an annual percentage of Gross Domestic Product (GDP).

"When viewed in terms of percentage of GDP and thereby an indication of the country's ability to pay, projected costs look set to rise from 1.7% of GDP today to a peak of 1.9% in 18-19 years' time and then back down to 1.7% by 2059-60, " said Prospect Pensions Officer Neil Walsh.

Prospect said the report goes a long way to debunk the mistruths often perpetuated about the affordability of public sector pensions.

Walsh also claimed, "the NAO have brought clarity to a issue which other partisan groups often seek to bury in alarming multi-billion pound liability figures.

"The report makes it clear that public sector pensions are far from being the unsustainable burden on current or future generations of taxpayers they are often portrayed as. This doesn't even allow for all the effects of the public sector reforms agreed in 2007 which have had the desired effect of limiting future taxpayers' liabilities."

Walsh said that the figures reveal the average civil service pension to be under £6,000pa but that many of his members are paying more for the benefits: "the average civil servant contribution is 59% higher than 10 years ago," he said.

Social media: is it an election winner?

Tony Myers — Thu, 11 Mar 2010 16:25:50 GMT

The rise of social media or networking has presented problems for politicians on how to engage with a more informed public. Will the next election be won or lost in the blogosphere? No one seems to know, but what is certain is there are votes to be won out there

Can social media make or break an election? With a hung parliament predicted by many recent polls and political commentators, voting margins between the main parties may well be tight and there is a lot of talk of how social media could make a difference.

One aspect of this will be how political parties, particularly the party that forms the next government, engage with voters and potential voters through social media such as Twitter and Facebook.

At a timely social media summit in the heart of Whitehall, Conservative MP Jeremy Hunt, shadow secretary of state for culture, media and sport, pointed out the importance of communications. He said previous elections had been won and lost through email, producing good literature and direct mail. "The internet changes relationship with voters," he said. MPs are now much more accountable and online media enables voters ask a lot more questions, "especially about my expenses," he quipped.

But Hunt welcomed the change - particularly the change to access to information, "There are no more political masters, voters are just as informed if not more informed than politicians. We must learn from constituents not just give views."

Television will play a significant role

Tom Watson, former parliamentary secretary to the Cabinet Office, was more sceptical about social media making or breaking the next election. He believed that television will play a significant role, especially with the much anticipated live debates between the leaders of the three main parties.

"Issues are still at the heart of the election," Watson said. While social media and the internet, might draw people in with narrow interests and allow personal freedom, the election would, again, be about television, he told the audience - but "social media will give the election more texture".

After the election, however, social media will help drive change, according to Watson, who added that he was unable to understand why more MPs are not on Facebook of Twitter, given the usefulness of these media as tools.

Paul Waugh, deputy political editor on London's Evening Standard newspaper, revealed that to be a serious blogger you have to post at least four times throughout the day - and then stay up to speed on Twitter. Hunt responded that this could mean ministers would be in danger of spending all their time communicating, with no time for policy.

Watson said that the other problem was that when a story breaks on the internet, on twitter feeds, blogs etc - ministers have to stay calm and in touch with their community. He said the chancellor Alistair Darling is a master at keeping a cool head and staying perfectly calm during a crisis.

The power of new media was best exemplified by one MP with email addresses for a quarter of his constituents, which posed a conundrum - should he go to the local paper with a story about cuts at his local hospital, or should he email his constituents and post direct to his blog?

Power of new media

The power of new media to affect public services was also highlighted at the event, particularly in the handling of the snowy conditions during the recent worst winter for 30 years. There were stories about how the public, instead of phoning their council and complaining about untreated roads, actively became involved in the operation and helped councils by 'tweeting' when they came across empty grit bins or untreated and dangerous roads and footpaths.

This is just one example of the scale of people power. Social media sites are able to corral individual actions into one homogenous campaign making a large amount of small voices more powerful. Users of public services expect transparency and efficiency when connecting with an organisation, and now they have a very powerful platform to air their views, by connecting with like-minded people who have experienced similar problems. In the face of such a campaign, public organisations can no longer brush off such complaints

The consensus of the event was that social media may not offer an assurance of immediate victory, but parties are definitely assured of defeat if they don't manage and engage with these forms of communications properly.

It promises to be a fascinating campaign.

Tony Myers

The feeling's mutual: co-producers of services

Thu, 11 Mar 2010 15:04:07 GMT

All the talk is of mutuals being the way forward for public services. Tory leader David Cameron is a champion of the idea, and there is interest from local government services - but how would they work?

If David Cameron becomes prime minister, he plans to "unleash a new culture of public sector enterprise".

The Conservatives will give public sector workers such as teachers, nurses and social workers and service users the right to form co-operatives to run public services. The new managers would decide how they were run – within minimum national standards.

The twin objectives of reducing public sector debt and reconnecting with citizens increasingly disillusioned by current power structures could spawn some interesting new models for public service delivery.

Lambeth council has already announced plans to become a "co-operative" council. Residents who help run services would get council tax rebates. Lambeth hopes the scheme, based on the John Lewis partnership business model, will save about £30m.

How would it work?

Mutual models could take a variety of legal forms. They could be true co-operatives, established as companies limited by guarantee or industrial and provident societies, where members derive benefit from the venture's economic success.

Alternatively, they could be wholly non-profit distributing vehicles established in the public interest, such as community interest companies or even charitable companies. Civil servants are very attracted to models where citizens would become "co-producers" of services, to reduce costs and improve outcomes.

Growing interest

There is now growing interest from local government services, such as education support services, leisure, cultural services and libraries, as well as from health and social care.

Many managers are attracted by having more control over their own destinies and shaping the direction of their services. Often the services may be seen currently as "non-core" to the public sector host and, by gaining a degree of independence, access to new funding streams and selling their services into wider markets, they may be able to achieve a more sustainable future.

The 'right to request' in health

The Department of Health has encouraged the creation of social enterprises in primary health and social care since 2006. Lord Darzi provided new impetus when he promised frontline staff the "right to request" to set up a social enterprise in his 2008 review.

These organisations were supposed to be the 'disruptive innovators' who would reform the system from within. Progress to date in building scale from these models has been slow.

Our research shows there are essentially three reasons for this. First, there are often powerful vested interests in senior management who simply oppose large swaths of their service empire disappearing.

Yet, under the current process, senior management support must be secured to allow services to float off. Tactics as basic as stopping items from reaching a primary care trust board agenda can be used to halt progress. Some people have even been put through disciplinary hearings for daring to go behind the board's back. Without a powerful independent champion, it may be difficult to gain momentum.

Secondly, there is a shortage of early-stage working capital to support the fledgling enterprises in the initial start-up phase. However, once a contract has been secured, lenders will be keen to support enterprises with often very significant turnover.

Thirdly, the commissioning and tendering process to gain contracts is too cumbersome. Tender documents and contracts are often not fit for purpose and try to load too much risk onto fledgling providers. Outside providers find it difficult to compete on a level playing field. The current debacle over Andy Burnham's announcement that the NHS in-house team should be the 'preferred provider' has magnified the problem.

No one should underestimate the hard slog the 'disruptive innovators' face to launch new enterprises. It is a rollercoaster for some to navigate the bureaucracy to gain approval to spin out and persuade staff to make the jump, faced with union opposition on pension rights, which is often spun unfavourably. They need a unique blend of skills: a mission driven-zeal combined with a strong commercial nous and an appetite for risk. Exercising the 'right to request' requires nerves of steel and a strong determination to succeed. These pioneers will be a rare breed indeed.

Mark Johnson is managing director of specialist public services law firm TPP Law

Improvement in nation's health

Thu, 11 Mar 2010 13:44:24 GMT

Public health has improved but inequalities remain despite billions of pounds invested, a new Audit Commission report reveals

A new Audit Commission briefing, Healthy Balance, published today examines the progress on improving health and reducing health inequalities in England and where the money has been spent.

The Commission estimates that the NHS allocated £21bn to primary care trusts (PCTs) in In 2009-10 to reflect differences in health inequalities.

Overall health improvements include cuts in infant mortality and increases in life expectancy. But they have coincided with a widening gap between the poor and the better off.

Among its conclusions, the Commission suggests there may have been too much policy and guidance for PCTs and local authorities to keep up with.

Andy McKeon, the Audit Commission's Managing Director, Health, said: 'We know the health of the nation is improving. But variation in the health of people living in different parts of the country remains stark. Comparisons can be striking. While teenage pregnancy drops by 38% in one town, it rises by 14% in a neighbouring town.

"Billions are directed to deprived areas. But it is not always clear how much has actually been spent on reducing health inequalities, and what the impact of this or that programme has been. Progress is often disappointing."

He said the Audit Commission wanted to open discussions on some fundamental questions about improving the nation's health and tackling health inequalities because public spending will be more constrained in the years ahead.

The new Oneplace website shows public health outcomes across England.

Council managers: can do, must do, will do

Wed, 10 Mar 2010 15:38:47 GMT

A survey of senior council managers has revealed that despite financial and social challenges, local authorities remain bullish about the future and are being creative with IT solutions as they strive to deliver 'more for less'

Despite expectations for overall budget and staff cuts, there is nevertheless a clear 'can do' mindset in Britain's local authorities towards reshaping their activities in order to achieve improved services built around the individual - and to deliver 'more with less'.

This upbeat assessment comes from a survey of 100 senior council managers attending Civica's recent annual conference in Manchester. Despite the current financial and social challenges to local authority services and flexibility, it is clear that there is still plenty of scope for savings for service delivery improvements through greater exploitations of technology.

Nearly 60% of those surveyed indicated IT remains a "key investment area" for 2010 in order to deliver critical service improvements.

Square the circle

Different pressures on local organisations to 'square the circle' are highlighted in the key priorities identified by our delegates. These include sustaining service levels and delivering improvements in service performance and efficiency, as well as protecting local communities through to economic recovery - further evidence that local government managers are doing their utmost to balance targets with meeting their community needs.

While nearly half of managers interviewed (47%) expect spending cuts, councils are adopting a range of operational strategies in response to such pressures. One third of delegates said they were re-engineering workflow processes, which suggests strongly that there is still considerable opportunity to remove duplication and stream line business processes, supported by modern IT systems, The mobilisation of local authorities' workforce continues - nearly a third (31%) said that greater use of mobile and flexible working is a key strategy.

Perhaps most encouraging, authorities appear to be planning to work more closely with their neighbours and other partners. One quarter of those interviewed said use of shared services was a key lever within the current climate.

Senior local authority managers are closely watching the performance of innovations that might support their citizen-centric services in the future. Nearly two thirds of respondents think that the data.gov website will influence community services in some way. One third (33%) believe that it will help councils identify demand for specific services. Almost as many (29%) say it will drive local authorities to improve their service levels.

Organisational change

Perhaps the greatest long-term significance for councils' performance came with the delegates' recognition that organisational change is the most critical factor in local government transformation and cost reduction process. This was recognised by more than 40% of delegates - up from 33% at our 2009 conference. It was significant, too, that only 25% of interviewees believe that the so-called 'easyCouncil' approach to running a local authority would be appropriate. Personnel buy-in is preferred to risky radical change.

The quiet confidence of local government over its ability to deliver continued efficiencies and change is both striking and encouraging. Our council managers still believe that effective change and greater productivity will come from within, by modernising and streamlining the delivery of their local services.

David Roots is managing director, local government & regulated markets, Civica

Property: government adopts a professional approach

Wed, 10 Mar 2010 12:40:17 GMT

This week the government's launched its property asset management with a vice admiral at the helm to steer it through the choppy waters currently lapping at Whitehall's shore

Among its objectives of saving money the government hopes to drastically reduce the cost of running its estate. But as well as talking the talk it has to walk the walk and a new campaign has been launched to ensure that Whitehall departments have all the relevant skills in place.

The launch, under the auspices of the Office of Government Commerce, an independent office of the Treasury, also helps to clarify the role of the "head of the asset management profession", a newly created position to which Vice Admiral Tim Laurence was appointed last summer.

Laurence launched the initiative this week explaining that its aim is to identify and build the skills needed to support the delivery of the government's high performing property strategy.

That in its turn aims to reduce the annual running costs of the government's £30bn estate by up to £1.3bn before 2013.

The OGC says that the approach mirrors methods it adopted to build the government's procurement programme and project management professions.

As well as publishing best practice guidance and developing a competency framework the campaign will establish a professional community within government.

Laurence commented that a key objective of the new profession is to build a sense of community. He added that the "pan-government" campaign will "help develop our identity and our role in managing government's property assets to meet business objectives."

A census is being conducted across the civil service to establish definitions for the profession and support the recruitment of professional membership in order to encourage membership of this community.

The launch also included an open invitation to "public sector individuals" registering an interest in joining the government's property asset management profession to contact the OGC service desk.

As part of the campaign the OGC simultaneously published guidance on the operation of the Property Asset Management Capability Assessment Model (PAMCAM). This is described as a self-assessment tool that will highlight shortfalls in skills and capabilities.

The Royal Institution of Chartered Surveyors (RICS) is working with OGC to develop best practice standards, guidance, training and qualifications.

Right to Control: Trailblazer councils test disabled access

Jane Dudman — Wed, 10 Mar 2010 09:08:00 GMT

More choice and more control over services will give disabled people a more personalised support by integrating areas such as housing, employment and community care

The way disabled people access government services has taken a step towards integration, with the announcement of eight 'Trailblazer' local authorities that will test the new Right to Control policy.

Right to Control aims to give disabled people more choice and control over the services they receive and is seen as a major step towards the government target of achieving disability equality by 2025.

The policy has involved intense negotiation between different central departments to enable local authorities to provide personalised support for disabled people, by integrating different services, including housing, employment and community care - but not health.

Personalised budgets for healthcare

Jonathan Shaw, minister for disabled people, said that the health bill going through parliament will be an opportunity to look at personalised budgets for healthcare, but added that identifying funding streams within devolved health budgets is more challenging than identifying the budgets for social care and access to work. "We will do the health pilots and see if it is possible to align them to the Right to Control areas," he commented. "But this is the direction of travel and the 'Trailblazer' areas will give us good and important lessons as to how to shape future policy."

He added that it will be important to develop sustainable funding for user-led organisation that are going to provide advocacy and support for disabled people.

The eight Trailblazer areas that will test the new arrangements include Greater Manchester, Leicester, the London borough of Barnet and Essex county council. James Wilson, programme manager for Right to Control at Essex county council, says the programme will, for the first time, enable disabled people to combine money from different state funding streams, as a cash payment, to be spent on whatever they think most appropriate for their needs.

"This really gives us the opportunity to take our personalisation agenda to the next stage," comments Wilson. "We have a vision in Essex to move to an approach that includes all public sector organisations, not just the council, and this will be the catalyse to do some of that change."

More tailored services

The services will include most of the main funding for disabled people's services, says Wilson, although it will not include disability living allowance, attendance allowance, employment support allowance or health funding. Despite this, it will enable people to arrange more tailored services, or to buy equipment they need and has been warmly welcomed by disabled people's organisations.

Richard Watts, director of policy and development at the Essex Coalition of Disabled People, said the new policy is "incredibly important" as a natural extension of moves towards more personalised services, particularly in its inclusion not just of social care services, but also employment and education. He said the long term aim would be to include health funding as well. "But we know this is a really innovatory way for statutory authorities to work," he said. "It is a really good first step to integrating services around individuals' lives."

One example could be that if someone is assessed as qualifying for a disabled facilities grant, a local authority may authorise funding for a stairlift and an upstairs shower. "Under Right to Control, the user will have the cash equivalent, to which they could contribute a bit of their own money and could, for instance, build an extension downstairs, using builders they know and trust, rather than those used by the local authority," explained Watts.

Essex is hoping to develop a single, integrated way of assessing disabled people's needs, rather than individuals having to fill out different forms for each type of funding.

Last month, the Office for Disability Issues launched a consultation, which will run until mid-May, on the regulations that govern the Right to Control Trailblazers.

Jane Dudman

View from the front line: beware the silent assassin

Tue, 09 Mar 2010 14:58:28 GMT

A public manager writes from the inside about change at the top and how a new, ferociously determined leadership is making an impact

People expect change if there is new leadership at the top of the organisation but they don't always anticipate it correctly. They expect a new set of priorities and expect "talk" of a change in the culture.

They expect a management restructuring, changes in job titles and job descriptions. However, these are often cosmetic changes; the real change is in management style and people often don't like it.

Most managers recognise there is room for improvement, that things could be done differently and better, that within their organisation there are islands of good practice but that there is not enough shared learning.

A silo mentality

They know a silo mentality exists in some departments, that there is a tendency to over complicate things and all too often the professionals want to go for a top-notch solution rather than something that is affordable and good enough. They know the financial situation will require painful and unpopular changes - possibly changes they themselves have previously championed but for which the leadership had no appetite.

The language of management has changed. The talk is now of "savage" budget cuts, the pressure to "do more with less" and managers are described as standing on a "burning platform".

Leaders start using phrases such as "less consultation and more action". The move to a more corporate way of doing things becomes a centralising straitjacket, driven by cost cutting. The desire to achieve a consensus on shared priorities and a common vision is replaced by a requirement to accept and own the leadership view, a view which is never explicitly stated but implied, requiring individual managers to agree first and work out later what is needed, because questions are discouraged and debate replaced by self censorship.

Professionals who have become used to year-on-year budget growth, who have been protected from the harsh realties of the real world and who just can't accept that the good times have come to an end will wave their shrouds, while senior mangers will be adamant that their management structures are not bloated and that their job is not possible without their current level of support services. Turkeys don't vote for Christmas so debate is pointless.

The quiet individual, the ordinary Joe

This is the new, humble but ferociously determined leadership. It is not about an inspirational or charismatic individual who by sheer force of personality brings about change. It is not about consensus leadership based on shared values and good people management skills. This leadership style is the quiet individual, the ordinary Joe, who appears to have little interest in making a name for themselves or having a high profile but who is determined to do what ever needs to be done. A style that others may perceive as unnerving, even intimidating.

It is a leadership style that often delivers in the short term but what about the longer term? Having shaken things up, these leaders tend to move on before they are moved on. If your organisation is characterised by a bout of this type of leadership you would be unwise to challenge it; just hope these leaders move on soon.

Nudge, nudge, say no more

Tue, 09 Mar 2010 12:53:00 GMT

Shadow chancellor George Osborne wants to embed 'behavioural economics' throughout government. This says that policy-makers should 'nudge' people to make particular choices

So, if government wants people to save to avoid a looming pension crisis, then it should automatically enrol them into a pension scheme. This is a feature of the forthcoming personal pension accounts, and nudging is being explored in places such as Barnet for council services.

Nudging is undeniably attractive for policy-makers searching for how to make smarter use of public spending. But nudging is not a quick fix and should only be seen as part of a broader approach to tackle policy challenges.

The US academics Richard Thaler and Cass Sunstein popularised behavioural economics in their book Nudge, and Thaler is now an adviser to the Conservative party.

Behavioural economics

Behavioural economics suggests that people are not simply the rational choosers of standard economics. Instead, people are thought to be shaped more by habit, inertia, and social norms. This view questions some existing approaches to policy. If people are inert and driven by habit then we might expect that formal education and information to have a limited effect on behaviour.

More emphasis should be placed on the way that institutions and policy guide the choices that we make: the so-called 'choice architecture'.

But how valid is nudge theory? I have been reviewing this as part of an Economic and Social Research Council project looking at 'asset-based welfare', that is the Child Trust Fund and Saving Gateway.

Behavioural economics assumes that government knows best. But often this may not be the case. For good reason, government might find it difficult to unpick the different parts of a policy problem, leaving aside any moral qualms we might have about pushing citizens in specific directions. Furthermore, government might lack proper evidence to guide its decisions. Government might only know the right nudges in a limited number of areas where there is plenty of evidence.

Going beyond nudging

Even if policy-makers can decide on the right nudges, citizens still have to make choices. Thus nudging still means it is important to consider the help and support people may need to make choices. This means going beyond nudging. If people are defaulted into a particular savings scheme, then there is still a need to consider what types of support should be made available for those who decide they want to contract out.

However, nudging is not a catch-all solution. It is one of a series of approaches that may be useful for policy-makers. The challenge then is to see how nudges can combine with more conventional policy approaches.

Take efforts to boost saving to provide security in retirement. A behavioural approach might highlight the role of institutions such as automatic enrolment as a way of encouraging people to save. But, this should exist alongside the continuing importance of public spending on the state pension as well as financial education.

Relying on nudges alone is not enough. As with most shiny new toys, the gloss comes off once you take it out of the packet and start playing with it.

Dr Rajiv Prabhakar, a Lecturer at the Open University and fellow at the LSE

Efficiency savings: are they simply cuts in disguise?

Tue, 09 Mar 2010 11:19:17 GMT

Very few of the government's much-vaunted 'efficiency savings' can be justified by hard evidence, experts say. As a result, they may actually harm services

The pressure on local bodies to run services better and save money is constant, and growing. But when councils and other agencies start changing services to achieve so-called 'efficiency savings', how can they be sure they are doing the right thing?

Experts are increasingly worried that many programmes have little evidence to suggest they will work, and are not being assessed in the right way. As a result, they warn, changes may simply result in worse services and fewer people being helped.

Eilis Lawlor, a researcher at the New Economics Foundation (Nef), wrote a report in 2008 looking at the pressure on childcare providers to work more efficiently. "What seemed to be happening," she says, "is that this really translates into cuts.

"The idea is that they will reduce back-office functions and let go of administrative staff, but in reality, what people [at councils] were experiencing was greater pressure on unit costs – the cost of services they were commissioning – and passing on the cuts to providers."

Little systematic checking

The heart of the problem, she says, is that there's little systematic checking, after the fact, of which changes have really made services more efficient and which have simply cut them back.

Cheryl Hopkins, Birmingham city council's commissioner of children's services, agrees. "A lot of the government initiatives that are rolled out, number one aren't evidence-based, and number two, have no cost-benefit analysis assigned to them" she says.

For a different point of view, Hopkins and her colleagues are looking overseas – in particular, to a man called Steve Aos, who works for the Washington state government in the US. He helps run the state's institute for public policy, an agency dedicated to testing the effectiveness of supposedly 'evidence-based' programmes.

Aos takes a tough line on the claims made for many schemes. Taking crime reduction as an example, he says he has no time for studies that simply look at how much crime individuals commit before and after they go through a particular programme.

"Too many other things can cause changes in someone's offending behaviour. We throw out that kind of study," he says. Unless the evaluation compares one programme against another, replicating the scientific standard of a randomised, controlled test, "we don't even consider that real research ... we don't go there."

Aos is only slightly more enthusiastic about research carried out in the "rarefied" setting of academia. Such programmes tend to be run by highly motivated individuals with a level of ability that can't be replicated "in the normal labour market" – and so he discounts their predicted benefits by 50%. (That does make some researchers "angry". But he has a thick skin, he says.)

Programmes have to be monitored once underway, too. Aos cites a Washington State programme that aimed to reduce juvenile violence through therapy. The therapists following the programme's instructions "by the book" got the expected results, he says.

"But the ones doing something else were not getting the expected effect. When you looked at the whole thing, the effects cancelled out and it looked like it was achieving nothing."

Lawlor says the UK has no equivalent of Aos's work. "Some [agencies] do, but it's more sporadic and it is not done in a systematic way." She cautions, however, that his work is "quite a narrow" cost-benefit analysis focussed on whether programmes save money.

Measuring outputs

"The problem with measuring outputs is [often] you are measuring something that's irrelevant or perverse," Lawlor says. For instance, if GP workloads fall, it is often seen as a sign that people are becoming healthier.

"Actually, it could mean they have completely disengaged from the system and have become homeless and that's why they are not accessing the GP services. It [measuring outputs] is telling you things have changed. It doesn't tell you things have improved."

In response, Nef has developed a measure called the social return on investment, which rates programmes on harder to define outcomes, such as the health benefit of keeping people in work. Charities use it, but as yet few councils do.

Hopkins says Birmingham is now carrying out its own randomised tests on, for instance, community-based justice programmes. The council wants to set up a dedicated unit, modelled on Aos's, to carry out such scrutiny.

There's even a chance it could host a national centre for evaluating public programmes, which the Conservative social justice spokesman, Iain Duncan Smith, has indicated he would like to set up if the Tories win power at the next election.

Unless these moves towards better measurement become more widespread, efficiency programmes remain "a blunt instrument", Lawlor says.

"There's a lot of public services that don't work, but at the moment we don't have a clear enough sense of which ones do and which ones don't. Any cuts will just be removing the good with the bad."

Good leadership in challenging times: what's the secret?

Tue, 09 Mar 2010 09:00:00 GMT

Development charity Common Purpose has tried to find answers by interviewing 12 successful leaders from different sectors to see if there are common themes which can be adopted by others

Transparency about expenses and resilience are key qualities identified for public and voluntary sector leaders by leadership development charity Common Purpose.

The charity has released a series of interviews with 12 leaders from the private, public and voluntary sector about the qualities needed for good leadership in challenging times.

In the interviews, Peter Housden, permanent secretary at the department of communities and local government, says the ability to work in partnership has become increasingly important across the public sector.

"The type of leaders who will serve us well are going to be pretty open individuals who get their self confidence from that openness and sense of sharing and are always looking beyond their own circumstance – as leaders, as an organisation – to wider responsibilities and wider resource," he comments.

Dame Suzi Leather, chair of the Charity Commission says 2009 brought a big change in perceptions of public accountability for leaders. "One of the things that characterised 2009 was that it became the year of the personal," she said. "How much of what I used to think of as private information actually really is public information. People have a right to know what I spend on hotels, what I spend on taxis – actually I do think that is public interest information."

But Leather added that personal attacks on leaders are a real challenge to resilience.

Resilience was also mentioned by Sir David Normington, permanent secretary at the Home Office, who said personal resilience in a crisis is a real issue, but added that there are ways to deal with this.

"The model of leadership is not heroic leadership – it's about teams of people and building the capabilities of teams so that you can share the load and you can share the response," he says. "If you have built complementary teams, you will be in a better place in 2010."

Julia Middleton, the chief executive of Common Purpose, said she wanted to ask whether the country was facing a "crisis of leadership". She said the recurring themes of a good leader are trust, transparency, leading a crisis and the need for bravery.

Reach Higher for more equality on local councils

Mon, 08 Mar 2010 13:29:10 GMT

Reach Higher is a new initiative aimed at representing more black and ethnic minority staff at senior management level in local government. Simon Ighofose, the first black voluntary director in Leicester city council, explains its mandate

Workforce diversity needs a higher profile if it is to be considered as a priority by local authorities and translated into serious action that will drive out inequality in the workplace.

I was the first black voluntary director in Leicester city council. Working with colleagues in the council's black workers groups, equality forums and senior management teams, we developed the Reach Higher programme, which is helping address under-representation at a senior management level within the council.

A rolling annual programme selects eight black and ethnic minority (BME) staff to attend the council's most senior decision-making boards as voluntary directors. Each candidate is expected to contribute to and inform strategic discussions from their perspective, using their understanding of the situation.

In addition, Reach Higher provides a wrap-around support programme, utilising mentoring and training to develop management competencies in areas identified by a 360-degree survey conducted at the outset.

The survey also serves as a baseline against which individual performance can be assessed. The annual cost of implementing the programme equates to approximately £2,500 for training and 20 days participation per candidate.

A second phase of Reach Higher will see the current pilots, targeting middle-managers, rolled out across the organisation.

Once implemented, this will create up to 21 further opportunities for candidates to attend divisional management meetings as voluntary heads of service, again supported by mentoring and training.

Compete successfully on merit for middle and senior management posts

Reach Higher will continue to develop, empower and grow a pool of BME staff that can inform as well as challenge the quality of service planning and implementation across all parts of the council. We hope that this in turn will increase the likelihood that candidates from this home-grown BME management talent pool will compete successfully on merit for middle and senior management posts as they become available through recruitment.

The programme has been championed from the outset by Sheila Lock, the council's chief executive. It has received unanimous cross-party support from all the council's elected members.

Unlock, tap into and focus talent

The process of developing Reach Higher has helped unlock, tap into and focus talent, passion and capacity latent among BME staff, many of whom now advise and help council divisions implement positive action aimed at delivering a workforce that at every level of the organisation reflects the local population.

On its own however, the Reach Higher programme is not enough. Targets around workforce diversity are also required because competing priorities place great pressure on local authorities to allocate sufficient resources to deliver a workforce that, at every level, reflects the local population.

In developing the next phase of Reach Higher, we are looking into the possibility of creating Reach Higher apprenticeships in middle and senior management. This would seek to further develop managerial competencies among BME staff by supporting them to take on greater budget and management responsibilities.

Reach Higher is designed as a positive action initiative and as such, future phases of the programme will seek to tackle under-representation of other equality groups.

Simon Ighofose is chair of the Regeneration & Culture Black Workers Group at Leicester city council

• More information about the Reach Higher programme is available from his website

Civil service strike: walkout begins

Mon, 08 Mar 2010 11:33:38 GMT

Up to 270,000 civil servants, including House of Commons security staff, are expected to join a two-day strike called by the PCS union as a protest against changes to redundancy payments

Civil Servants in Leicestershire and Somerset have joined the two-day strike called today by the Public and Commercial Services union in response to plans by the government to cut redundancy payments.

As more and more regions joined the protest a spokesman claimed that the "vast majority" of its members will support the walkout.

Up to 270,000 civil servants are expected to join the protest nationwide that threatens to cause disruption in government regional offices, jobcentres, courts, call centres and Whitehall departments. The strike is also expected to affect parliament, where House of Commons security staff are due to stop work for the first time in 25 years.

Mark Serwotka, the union's general secretary, said there was "incredible anger" about the proposed changes. Membership had grown since the strikes were announced last month, he said.

"Civil servants face losing up to a third of their entitlements and tens of thousands of pounds if they are forced out of their job. The government is tearing up the contracts of low-paid civil and public servants whilst it claims it can do nothing about bankers' bonuses because of contractual obligations," he said.

The government has spent 18 months negotiating the changes, which will cap redundancy payments for those earning more than £30,000 a year at twice their annual salary. Five other civil service unions have accepted the deal, which will save £500m over three years.

Tessa Jowell, the Cabinet Office minister, said the government had already agreed that civil servants earning less than £30,000 – 80% of the total – will still qualify for redundancy worth up to three years' salary. "This package brings the civil service more into line with the rest of the public sector and still offers more generous terms than much of the private sector," she said.