Reverse engineering public services

A frustrating point has been reached in public service reform. We’ve finally grasped the importance of early intervention and prevention precisely at the point when we seem least able to afford it.

Of course, this poor timing isn’t coincidental. Financial constriction has brought into stark relief how eye-wateringly expensive crisis services are to run. Yet the growing and eager consensus that we should manage demand for the hard end of the system feels as belated as the regretful hangover. We seem only capable of wisdom after the event.

Now we have entered the ‘if only’ stage of our collective hangover. If only we had invested in early intervention when we had the money. If only we could now find a method of reinvesting money from crisis services into prevention work. If only we could raise sufficient social finance to pay for early interventions alongside running crisis services. If only we had developed convincing ways of predicting cashable savings from prevention activity.

These sentiments are not only unproductive, they feed a narrative of ‘it’s all too late’. But is it?

The choice between prevention and crisis services is often presented as absolute. What this dichotomy rests on, in my view, is the clunky paradigm in which one intervention is viewed as directly negating the need for another further down the line. What it fails to contend with is complexity. Prevention and crisis services do not exist in isolated relation to each other. There are all manner of other real life variables that disturb this neat formulation and which are potentially just as relevant and important.

It may surprise some to know that life is lived outside of interventions, that people are butting up against different parts of the system all the time. Our desire for silver bullet interventions always risks distracting us from attending to system behaviours elsewhere. If we are to stand a realistic chance of delivering early and preventative strategies, we need to dispense with the zero sum game of programmes and interventions and start thinking systemically.

The fire service is undoubtedly among the most successful public services in the UK at prevention. Our year-on-year fall in house fires has not been achieved by building better fire engines. It has happened because each fire has been investigated, its cause established, and the evidence used to influence small but significant changes in things like housing design and product manufacture.

This is a classic example of what John Seddon, the systems thinker, would call stemming failure demand. The demand for a service, in this case house fires, is understood and tackled at source. The clues to prevention are seen to lie in rigorous attention to the nature and circumstances of the fire.

A major limitation of the way we deal with social fires is that things which are systemically interdependent rapidly become compartmentalised, with separate business models, separate evidence bases, separate professions and constituencies of interest. Many things are lost in the process, and a key loss is the iterative feedback loops that would allow one part of the system to shape another.

As we are fond of saying in social policy, you couldn’t run a business like this. Imagine a department store where the complaints department was operated as a separate fiefdom, which measured itself purely on customer satisfaction with the resolution of complaints. If no information about these complaints was fed back into the store then customers would see no improvement and would vote with their feet. In other words, the efficiency of the complaints department is not the reason we shop at a store. Yet we run our public services as if this were the case.

Then imagine that the complaints department was actually a separate business whose sustainability depended on a reliable stream of complaints. What incentive would it have to work with the store to stem demand?

In Transforming Rehabilitation we are on the verge of agreeing long term contracts with predominantly private providers to soak up failure demand. There appears to be no possible incentive for them to work with players further upstream to reduce their own market share. And yet in our prisons we have an incredibly rich source of evidence, in the journeys that brought many prisoners to this point, that relate to the glitches, blindspots and shortcomings in wider public systems that we could exploit to drive wider system reform.

As with house fires, the prison population (and it could just as easily be the homeless population) represents a continually morphing picture of failure demand that could provide system leaders with a litmus test of the success or otherwise of their own strategies. You can imagine a prison leader challenging colleagues in housing and health on why his or her prison has recently filled up with drug-addicted, homeless people. And yet most of our compartmentalised systems are geared to asking what should happen next, not why it happened in the first place.

In social policy, we are like small children playing our first football match. Everyone wants to run after the ball. There is no excitement or pay off in holding back. And to over-extend the metaphor, prevention and crisis services become two balls on the same pitch with two sets of players pursuing them separately.

All of which suggests that we need strategies capable of treating our various social services as part of one interdependent system. By doing so, we open up the possibility of reverse engineering the system from the point of failure. Of course, evidence of failure isn’t and shouldn’t be the only way of improving services. But it is surely one of the indispensable starting points.

What stands in the way?  Politics, vested interest, public opinion, turkeys voting against Christmas, a defeatist conviction that social failure is inevitable. Arguably what allows the fire service to act preventatively is a public that will not allow fire engines to be decommissioned. Fire officers can therefore be reasonably confident that successfully stemming failure demand will not be at the expense of their own jobs.

In the case of less publicly cherished services, the mindset that money is irretrievably locked into the hard end of the system has been dealt quite a blow by the austerity. Previously unimaginable sums have been stripped out of ‘untouchable’ budgets. These shocks to the system have loosened the cement around barriers to people doing the right thing. It ought now to be possible for commissioners to act more systemically and incentivise those behaviours that will help stem failure demand. For example, contractual rewards for collaboration between prevention and crisis services would encourage providers to build feedback loops between previously unrelated parts of the system.

Ultimately we should be rewarding the steady and iterative redistribution of business from the crisis to the prevention end of the system. This would be a painstaking process, requiring scrupulous attention to the journeys of people through services. It would require us to design data systems very differently and relate to outcomes and success in counter-intuitive ways. And not all of this change would be achievable by re-gearing reward structures. It would also require a different type of leadership, one that was able to understand the difference between pursuit of mission and pursuit of growth.