Many people have waited a long time to hear something like the commitment made in Wednesday’s autumn atatement – to ‘developing and extending the principles underpinning the Troubled Families programme approach to other groups of people with multiple needs’.
This is significant for at least two reasons. First, it may prove to be the most ambitious chapter yet in our ongoing struggle to reach and improve the lives of some of our most disadvantaged citizens. Second, the savings projected from this approach have clearly already been banked by the government. In other words, a lot rests on getting this right.
The commitment was a rapid response to last week’s report Bolder, Braver and Better by the service transformation challenge panel. I found the panel’s analysis sound but couldn’t square the ambition of its title with its reform principles: ‘people are the focus of delivery’, ‘outcomes for people take priority’, ‘frequent users of public services are encouraged to make better choices’ and ‘multi-agency provision of services are the norm’. While working as a civil servant, I was involved in several reports with remarkably similar language and sentiments, and this has left me wondering where the ‘transformation’ is going to come from this time.
To be fair, the panel’s central argument is less about the nature of change needed than about the challenge of spreading transformation beyond isolated oases. They were clearly perplexed that the burning platform of reduced supply and increased demand has not yet triggered the bolder or braver approaches we have long known are needed. In essence it repeats the message implicit in countless best practice boxes of years gone by: ‘they managed it so why can’t the rest of you?’.
The panel has invoked a familiar machinery of pooled budgets, improved evidence and national mandates as enablers of wider change. It is rightly wary of rolling out nationally prescribed models and instead it has helpfully identified ‘common threads’ in successful Troubled Families schemes which might be extended.
A bold and brave approach would be to ask local leaders
to help build collaborative, trusting ecosystems of support
The problem is that the Troubled Families approach required large amounts of political and financial capital to drive change for just one nationally-defined group. The scale of transformation needed to meet the wider challenges of the austerity is of another order of magnitude altogether.
At Lankelly Chase, we are funding work across many pioneering organisations such as Coventry Law Centre, Grapevine, Edinburgh Cyrenians, Participle and MAC-UK that points to changes needed at much deeper level than pooled budgets. We are reaching the conclusion that if services are going to make a real difference to people with multiple needs, they are going to have to rethink and where necessary junk some of the core principles that currently define them. I will give two examples here – eligibility thresholds and targeting of priority groups – both of which are quite recent inventions and yet have come to feel like inevitable system architecture.
A core assumption of how we manage demand for public services is that we need to establish and enforce eligibility thresholds. The greater the demand, the higher the threshold has to rise. Without thresholds, we are terrified that the floodgates of public need will consume stretched services.
Hidden from view are the costs that these thresholds generate: the costs of assessment, reassessment, discharging people from caseloads, readmitting people on to caseloads; the costs of waiting for people’s needs to escalate until they cross the threshold; the costs of people hiding from the traumatising experience of repeated assessments until they reach crisis point; and yes, the cost of multiple needs when none crosses a threshold and the person has to resort to emergency services.
With threshold-defined services we are never able to gauge the true level of demand, or know whether our fears of open floodgates are justified. If some of our core services were instead demand-led, it is possible to imagine a new self-regulating equilibrium emerging in which people’s problems were resolved much earlier because they felt able to ask for help when they needed it. Such an equilibrium would rely much less on high cost crisis services to act as a pressure valve.
Alongside eligibility thresholds, we also hold that groups who generate the highest cost and greatest social harm should be identified, prioritised and targeted. But again, there are perverse consequences.
Targeting is not an infallible science. It is created out of imperfect data, and misses people equally in need of help. It concentrates the collective system on one cohort to the detriment of others who were not quite captured by the quantitative profile. Hence we celebrate our effect on those we have prioritised while ignoring the consequences for those we inevitably deprioritised.
Targeting distracts from the tougher work of system change and instead creates its own siloes and exclusions. Yet it is so endemic in our service culture that we respond to its limits by yet more targeting. We target those in the cracks, ‘the excluded’, which only increases the inefficiency of fragmentation. As with threshold-defined services, people fear the stigma of targeted services and hence we resort to costly outreach in order to ‘grip’ ‘hard to reach’ people better.
We do have the option of concentrating high-quality universal or low-threshold services in neighbourhoods of high need. Many of the members of Locality strive to do precisely that. They allow people to access trusted support in ways that help them build bridges to their community and so increase their social capital.
What these examples reflect is how constrained we have become by a limited repertoire of ideas that came into being for good reasons but have become hugely over-extended. They have brought us close to a monoculture in which we respond to problems with the same logic that created them in the first place.
Beyond ever greater coordination, rationalisation and prioritisation, we need a richer plurality of services that allow people to access human-scale support in ways that work for them. Our monoculture is enshrined by procurement processes that view all services – from small scale community projects to large monoliths – through a single lens. This has led to voluntary organisations being commissioned in the very image of the public services they were set up to correct or balance. Government policy seeking urgent transformation has to allow this paradigm to be challenged.
A bold and brave approach would be to ask local leaders to help build collaborative, trusting ecosystems of support, which they didn’t control but to which they contributed. These ecosystems would privilege diversity and would flatten the hierarchies of funding and profession which currently dictate that some services are more ‘core’ than others.
A truly bold and brave approach would require local leaders to see themselves as genuinely accountable to those needing support. This is a politically tricky thing for national reports to recommend when they are proposing a better deal for socially unpopular groups. But I am struggling to think of examples where service outcomes have improved without a real power shift from vested provider to customer or client.
It is an irony of national reports that they all now eschew central prescriptions when this is precisely what they offer. If we actually trusted people to know what they needed, when they needed it, in the form that they needed it, my strong belief is that we would see costs tumbling. This is what bold and brave looks like, because it wouldn’t be popular and might not work.
While safer options may seem plausible, they risk more of the same. It is only by addressing where the power, control and accountability lies that we will get the transformation we seek.