How to change our failing systems
As the human and financial costs of the failures of our public services add up, it’s time to create human-centred systems that are truly transformative, says Clare Goff
The flagship Tory borough of Wandsworth in south London is not where you would expect to find a thriving voluntary sector that is challenging and changing the health system to greater support the needs of its BME community.
The Wandsworth Community Empowerment Network – the only surviving CEN from former prime minister Tony Blair’s 2001 policy – has created six community networks, which train local leaders in family therapy. Through the Black Pastors Network and the Dementia Network, those with mental health issues are gaining help and support from an early stage.
Malik Gul, who formed the CEN in 2001, was scandalised by the over-representation of black and ethnic minority people at the acute end of mental health provision. According to data from the Department of Health’s DRE report, black communities are 44% more likely to be sectioned under the mental health act and 14% more likely than white people to be turned away when they ask for help from mental health services.
‘The local mental health trust called these people “hard to reach”’, says Gul. ‘I said, “I see these people every day, they’re not “hard to reach”.’
The health system was failing a large proportion of its population; Gul’s answer was not to attempt to improve the local health institutions with better targets and processes but instead to tap into the latent ‘social capital’ in the local community.
At a time of complex social, economic and environmental
problems our social systems are unable to provide the necessary solutions
Through holding local conversations and building trust and capacity over many years Wandsworth CEN has changed the system for the better. And by focusing on a problem in its early stages the networks are expected to save millions for the local mental health trust.
Starting from ‘year zero’
Rarely a week goes by without new evidence that our public services are ‘broken’, that people have been failed by the ‘system’. The stories in the press focus on targets not being met, reforms not working and adequate care not being provided. Often the response is for even greater reform to further improve targets and efficiency. The evidence however is pointing in a different direction, away from ‘system’ improvements towards a more human-centred approach.
Gul changed his local health system through local collaborations, conversations and relationship building over many years. He understood the need for a response that is embedded within the community rather than created by building a new layer of administration.
Interestingly – and perhaps controversially – he attributes his success at least in part to the fact that there wasn’t a strong community sector in place when he began his work. ‘It was ‘year zero’, he says. ‘Wandsworth had not been corrupted by the voluntary sector culture which, towards the end of the Blair regime, was being co-opted into a delivery arm of the state.’
Clare Hyde had the same ‘blank page’ feeling when she became the first manager of a small women’s health organisation, WomenCentre, in Calderdale. She joined from a large local authority and was given free rein as manager. ‘It was an absolute joy to work in such an unfettered way,’ she recalls.
She set about asking questions and creating her own, intuitive, solutions to helping women suffering multiple problems, from domestic violence to substance abuse, mental health issues and insecure housing. She questioned the statutory silo approach that bounced women from service to service without actually solving their problems, and instead created a one stop shop based around the woman and beginning with empathy and care.
‘We were there to be a good mother to women dealing with multiple problems, to hold their hand for as long as it takes without creating dependency.’
Over a period of 20 years, Hyde turned the WomenCentre from a tiny local organisation focused on women’s health to an exemplar institution serving the needs of women suffering multiple disadvantage from across the country. Her starting point was compassion and her organisation flowed from the women who walked through the door seeking help, rather than attempting to fit those women into existing organisational processes.
While Clare Hyde and Malik Gul have created human-centred, collaborative organisations building social change they did it largely by going against the current grain. At a time of complex social, economic and environmental problems our social systems and structures are unable to provide the necessary solutions. Despite huge sums of money spent on reform, public services are struggling and it is becoming clear that further reform is not the answer.
Systems fuelled by ‘failure demand’
To John Seddon, author of The Whitehall Effect, it is the systems themselves that are exacerbating the problems they were set up to deal with. The industrialisation of public services has, he says, created services focused on transactions rather than humans in need of help.
Since Margaret Thatcher came to power, spend on public services has risen from £150bn in 1985 to £674bn in 2013. During this period successive prime ministers have attempted to drive down costs through the introduction of efficiencies such as shared services, back offices, outsourcing, regulations, targets and ever more elaborate IT systems. But the effect has been to drive costs up while, in many cases, making the services themselves worse.
For if the objective of commissioning processes is to achieve the lowest cost for the service, whether it’s an outsourced call centre dealing with housing queries or a contract for social care provision, the result will be standardised services that are unable to meet the variety of people’s needs. This leads to clients who keep coming back for the same service, or, when their needs get worse, require more acute interventions.
‘Failure demand’ – demand caused by a failure to fix something in the first place – now accounts for as much as 80% of transactions in public services, according to Seddon.
A lack of trust between sectors holds back the kind of
collaboration needed to bring about transformative change
His book is filled with examples of what happens when services focus so heavily on efficiencies, on targets and regulations that they lose sight of the person they are trying to help.
Public service ‘reforms’ are being driven by central and local government but are impacting on the voluntary and community sectors, which, rather than equal partners helping solve complex problems, have become co-opted into playing the same game.
Seddon cites the example of Camphill Village Trust, a charity that creates communities to serve the needs of people with mental health disabilities. Residents and volunteer co-workers live and work together and each contribute to the community according to their abilities. It’s an example of a non-hierarchical community based approach focused on assets and compassion. When the Camphilll Village Trust came under the regulation of the Care Quality Commission however it didn’t see the thriving lives of both residents and co-workers but only a lack of ‘best practice’ and record keeping. Professional managers were brought in and the volunteer co-workers were replaced by paid care workers; residents were given choice over what they wanted to do and many of the rhythms of community life that had sustained them fell away; the use of drugs increased and residents left.
‘Rigidity traps’ keep broken systems in place
Anyone working in regeneration or public services will recognise the frustration at the inability of services to truly serve, of systems that continue to be subsidised despite the fact that they’re clearly not working, and of innovations that are not given time to develop.
Gary Bishop and his wife Hannah set up JustLife after they befriended a group of people living in unsupported temporary accommodation in their Manchester neighbourhood. One of them – Jason – was a long-term heroin user who had been placed there after leaving prison. He later died from an overdose, and his body was not found for two weeks. The Bishops began to investigate the temporary accommodation system and found it riddled with problems; they set about trying to change it and now run Just Life to help support those living in such accommodation in Brighton and Manchester.
Gary Bishop admits that his organisation is far from creating the transformative change he envisaged. He doesn’t want to become another voluntary sector body delivering services, competing for funding and putting a ‘sticking plaster’ on problems.
But he says that the current structures make it difficult for charities to do more than paper over the cracks and that a lack of trust between sectors holds back the kind of collaboration needed to bring about transformative change.
‘The third sector knows what’s happening on the ground but no one trusts it to do the job properly,’ he says. ‘The private sector has massive resources and skills but is seen as being in it for the money, while the public sector can see the whole picture but is considered too bureaucratic to make change.’
Many of our social and economic systems are in what system theorists call a ‘rigidity trap‘; they have become reliant on doing things a certain way and are unable to break out of fixed patterns of behaviour even when they are no longer working. While commercial organisations have the profit motive to keep them innovative, local public sector organisations find it less easy to change. Silos and specialisms become entrenched and often stand in the way of collaboration and innovation.
To some the industrialisation of services is part of an ideological approach that fits in with the current neo-liberal agenda; to others power structures of whatever political affiliation will always strive to maintain the status quo.
But cracks in entrenched structures are beginning to show, driven partly by frustration, partly by the complexity of our social, economic and environmental problems but primarily by an austerity agenda desperate for new – and cheaper – ways of working.
Evidence is amassing that the damage caused by current systems is becoming too costly, and those with their hands on the purse strings are beginning to take notice. A new narrative for local economies is emerging after decades of failed regeneration. The early action task force, led by Community Links is making the financial case for a preventative approach, while Locality’s Diseconomies of scale work is collecting stories of the human and financial cost of short-term efficiency drives.
New approaches are starting to break through. Participle and FutureGov are recreating public services that work with the assets already available in communities; the integration agenda is gathering pace with the Making Every Adult Matter approach breaking down silos in adult services; regeneration is being re-thought in Preston by making the money circulating in the local area work harder.
Collaborative and holistic, networked approaches, are slowly replacing silos and targets. In systems change and resilience theory there is an understanding that no single agency is able to solve the complexity of problems; the more diverse the voices and inputs into solving a problem the better.
The Centre for Local Economic Strategies’ resilience model measures local resilience through the strength of the relationships between the social, private and public sectors within a place, understanding that entrenched problems such as unemployment cannot be considered in isolation.
‘If the outcome is more jobs you need to think about who needs to be involved in creating them, from the business sector to education, the wider economy, local transport networks, public and private capital, the social economy. Who are the players that need to be engaged?’, says Neil McInroy, chief executive of Cles.
The status quo bias
But the reality of a truly collaborative approach is not easy, particularly for those infused in the current, linear way of seeing the world.
Lambeth Council is undergoing a profound period of culture change aimed at involving its local community in the creation and running of services. Having launched as the Co-operative Council in 2010, it soon realised that encouraging greater citizen involvement was not enough and set about plans to shift its own focus from that of service provider to ‘collaborator’. It has since overhauled its commissioning model, restructured many of its processes and attempted to embed co-production into the organisation. But while the processes may have changed, some of its people are taking longer to catch up.
‘All the architecture and structure has now changed and most people understand the thinking, but many are struggling to make that shift in their behaviour. The gravitational pull of the old system is really strong,’ says Anna Randle, head of strategy at the council.
Perhaps for the first time in history, there’s an opportunity
for us – as human systems – to help shape change
The so called ‘status quo bias’ that pulls people back to their old ways of working takes a long time to shake off.
Sarah Billiald, managing director of Collaborate, agrees. She worked at creating change in the probation system both within central government and as chief executive of Kent Probation, and saw the difficulties involved in shaking off the systems within which people had become used to operating. ‘It’s hard to retrain your brain, especially if you are in the public sector.’
In many cases the new frameworks that are being introduced, far from being transformative, are replacing one bureaucracy with another, leaving old patterns pretty much intact.
‘There is a danger that systems thinking can get caught up in more bureaucracy, in co-commissioning and boring round tables and partnership working that is divorced from the end user,‘ Billiald says.
Creating human-centred approaches
The costs of systems failure is now so high however that perhaps for the first time in history, there’s an opportunity for us – as human systems – to help shape change.
Change may seem overwhelming but it always starts with baby steps. It could be taking time out each week to reassess your service’s mission and purpose; leaving your desk and talking to citizens as Lambeth Council workers have done through the Open Works project; taking a ‘year zero’ approach to an entrenched problem.
It may have taken a deep recession and a cruel austerity agenda to see that our failing systems need change, but the way forward is now being mapped out by innovators and systems changers and people fed up with the status quo.
People like Love Barrow Families, a team of adult and child health and social workers learning to listen deeply to families in need, and build relationships based on trust and care. Like Monmouthshire Council, which has created an intrapreneurship school to help it to embed openness to new ideas and create more holistic ways of working. Like council leader Jim McMahon who challenged the old guard in Oldham.
For the systems that we have were created by people, and can just as easily be re-created by people.
‘We talk about systems as though they are inanimate objects but it’s people who create processes and assessment tools,’ says Clare Hyde. ‘People blame the system but it’s us that make it that way. We are the system and if it’s broken we can fix it.’
10 ways to change a system:
- Put a shelf life on your organisation. Most organisations aimed at social change grow over time and often get further away from the problem they were set up to solve. MAC-UK – an organisation ensuring that deprived young people have access to mental health services – has given itself a ten-year shelf life to ensure that its focus is on embedding its ideas into practice rather than on running and building another organisation.
- Seed a movement not an organisation. The Transition Town movement works like a virus, infecting people to come together to create greater resilience in their local communities. It has a template for change that new groups can take on and adapt as they see fit. Likewise, the Civic Systems Lab creates ‘platforms’ through which civic change can happen.
- Be ‘of’ the community. Paternalism is still alive and kicking in many organisations that are unable to shake off the hierarchies and power structures that arise when one group of people tries to help another. But organisations like Barca in Leeds and the WomenCentre take people and community as the starting point from which their work flows. Time banks and appreciative enquiry help to level hierarchies.
- Focus on root causes not symptoms. Most social problems are symptoms of deeper issues, be they structural inequalities in society or deep-seated problems within a person. While it is important to deal with the symptoms that manifest themselves – be they substance abuse or homelessness – this needs to be combined with a focus on tackling the roots of the issue and the systems keeping those problems in place.
- Collaborate around a problem, leaving organisational egos behind. Many blame middle managers for putting up barriers to change. As people move up hierarchies within organisations and become more specialised they often find it difficult to think outside of their rigid professional boundaries. But space can be created to allow staff to think without their organisational hats on. Monmouthshire Council is creating space and time to build innovation into its structures.
- Focus on people’s capabilities and assets not their deficits. As our leaders and media scapegoat and stigmatise vulnerable people, we need organisations that see the person not the label. Leeds Gate is improving the quality of life for gypsy and Irish traveller communities.
- Scale values not organisations. The organisational structure is often not the best vehicle through which to create change. It is sometimes more powerful to practice and nurture strong values that change behaviour. Julie Fawcett turned around the run-down Stockwell Park estate and transformed the lives of countless young people by spreading the values of ‘love, tolerance and forgiveness’.
- Leave behind the safety blanket of professional methods and learn something new. In Lambeth Council staff members who spent part of their working week talking to citizens at the Open Works shop set up on a local high street, said that the experience had fundamentally changed the way they did their jobs. A team of child and adult health and social workers called Love Barrow Families has overturned the way it works to put itself truly at the service of families in need.
- Listen. At Barca in Leeds they practice ‘active listening’ to truly understand what is going on in the lives of their clients and ensure that their responses are based on fact rather than assumption. A commitment to listening also means that they are continually learning from those with whom they interact.
- Practice humility.
