Next Stage Health, Care and Public Services 19/03/2019 #NextStageRadicals @RSAinLondon @theQCommunity
Mark Hall Deputy Head of Engagement The RSA @markhallrsa
Ian Burbidge Associate Director, Public Services and Communities The RSA @ianburbidge
Morning Agenda 09:45 – Welcome & Intro 09:55 – Radical Models of Organising 10:15 – Radical Model of Public Service 10:30 – Radical Models of Commissioning 10:50 – Radical Models of Regulation 11:10 – Tea/Coffee Break 11.35 – Radical Models of Leading & Learning 12.20 – Action Café Intro 12.45 – Lunch
What is the biggest challenge you face to implementing/supporting new ways of working? What is the question, which if answered at this event, could help you most?
Local Cornerstone @CornerstoneScot @Edelharris #LocalCornerstone Local Cornerstone Presentation 2018
Our Vision – Local Cornerstone Let us continue to put people at the centre of our activity and assist them to live the life they choose Let us continually strive to do more than we are contractually obliged to do Let us demonstrate that we genuinely value social care as a profession Let us use our charitable income to do some amazing things that help all the people we support to live a valued life
What is Local Cornerstone? Local Cornerstone Presentation 2018
22/03/2019 11
Thank you
Helen Sanderson Founder Wellbeing Teams @HelenWBTeam
Janette Patsy Shirley Becky Jodie Scheduler Meeting Recorder Recruitment Storyteller facilitator
Tactical Confirmation meetings and practices Slack
Challenge? Commissioned by the hour
Success?
Radical New Models of Public Service Mark Smith Director, Public Service Reform Gateshead Council March 2019
Case Study: ‘Juliet’ • Council Tax Debt, rent arrears • Debt as trigger, explored context with visit • Benefits were wrong – ate into debt • Single mum, 11 year old child • Helped move closer to school • Depression, mental health problems • Helped with uniform • ASB, fear of neighbour • CAB helped with rest of debt • Overwhelmed by referrals • Sister helped to support emotionally • ‘Hiding’ – “It’s too difficult” • Took on more hours at work • 30 min walk to new school • Training for qualifications • Uniform • Child settled down at secondary • Child behaviour starting to worsen school • “My life is ****” • “Thank you for making my family happy” COST: £90 + 6 visits and 9 phone calls
PSR Premise 19% thriving 32% vulnerable Decrease demand by improving situations Thriving in Gateshead Demand into core services
Direct action How can we do this across an entire community and - Base method - Teams - Community across the whole - Roles ownership/ wellbeing system? - Processes adaptation - Money - Support services How can we make it easy - Structures to do this? How can we - Governance help people based upon a signal? Effective Efficient Sustainable Phase 1 1→2 Phase 2 2→3 Phase 3 3→IC Do we know what we want to be the ‘new normal’? What’s stopping What works? What us deploying this makes that everywhere? easy/difficult?
Phase One Prototype – Using the Learning Direct action How can we do this across an - Base method - Teams - Community entire community - Roles ownership/ and across the - Processes adaptation whole wellbeing - Money system? - Support services How can we make it easy - Structures to do this? How can we - Governance help people based upon a signal? Effective Efficient Sustainable Phase 1 1→2 Phase 2 2→3 Phase 3 3→IC Do we know what we want to be What’s the ‘new stopping us What works? normal’? deploying What makes this that everywhere? easy/difficult?
What we did… We created a small and temporary team We explored whether CTax debt is a good signal of We tried a wider need? holistic approach We agreed on some basic rules and principles We built a network We focussed upon a single purpose: “Help me to thrive”
Case Study: ‘Mary’ • Call out of the blue from employee • Acted from visit one – food, power • No light source, bar the TV • Many agencies got involved via a pull • Mould everywhere • Got the place clean, got the GP out • Huge utility debt • Sorting utilities and finances • Isolated, not eating much • Police investigating COST: £1600 + • Potential £ abuse • Neighbours involved 30 visits • Freezing: layers of clothes • Daily visits • Smell of urine, psoriasis on head • Learning difficulties • She looks up • Would not look up • She looks better • “This is desperate” – GP • She cleans • “The worse I’ve seen” – Police Sgt • She eats • She has her money, a bank account
What happened? - 1,500+ actions - @70 people contacted to help 15 CTax signal - 70% (28) are happier with their 30 ‘Tangled’ life and their prospects have 25 referrals improved - 6 (15%) were no better, still declining 40 people - Over 50% of those helped saw 6 ‘Trapped’ positive action that made a difference to them on the first 2 not engaging encounter 2 “won’t pays” Team morale high No one wants to ‘go back’ Total cost @£70k - £60 staff costs for 6 months - £10k for casework costs
Front line roles, Commissioning autonomy, authority, How the money Eligibility criteria creativity Using intelligence to “Boundaries” works and screening be proactive Assessment Simple, small scale actions and Signals are a interventions are Compassion and Relationships huge opportunity We don’t really effective and empathy solve problems, to reduce know a problem good value systematically rather than demand and until we know its lead to services and inequality context innovation hierarchies We need to Support is what rethink what we Innovation is we need to most Focussing upon mean by control practically simple and do the least efficiency via and culturally Role of leadership projects makes us hazardous less effective and Intervention £££ less able to change Support ££ What we do, fundamentally How we Transaction £ communicate, How we ‘do through word and ‘change deed
Six specific challenges to chew over… Building a proactive, System-wide resources Commissioning and preventative capability contracts • Understanding the specific money and capacity the falling demand can • • Responding to signals as well as Making small scale and bespoke easy save triggers/referrals where it needs to be • Investing to accelerate this once we • • Equipping front lines to understand Developing local wealth and are confident and solve problems holistically economies • • Rethinking autonomy and Commissioning for complexity management Regulation and The wider system across Taking direct action inspection Gateshead • Council Tax/Debt recovery • Personality disorders • • Identifying any tensions between Building in communities and partners • Universal Credit reform and regulation to create bespoke arrangements that • Establishing/augmenting existing work • Growing the ‘groundswell’ • relationship with regulators that Understand where to lead, follow, allow for innovation enable or leave alone and how this might vary
What are your key takeaways? Do you recognise any shared challenges/opportunities?
Radical New Models of Commissioning: Human, Learning, Systems Dr. Toby Lowe Newcastle Business School
Summary • What does working in complexity mean? • Implications of complexity for commissioners • Embracing complexity: Human Learning Systems
What does it mean to work in complex environments?
Complexity People are complex Issues are complex Systems are complex = embrace complexity, because life is complex
Implications for commissioning OUTCOMES ARE NOT DELIVERED BY ORGANISATIONS! The outcomes we desire are emergent properties of complex systems
The purpose of commissioning • Commissioners DO NOT purchase services which deliver outcomes • Commissioners DO nurture the systems from which outcomes emerge - enabling collaboration and coordination They commission activity which: • Responds to human variety • Adapts to change
Commissioning practice No more: • Process specification • Output targets • Outcome targets
So what else can we do?
Key ideas Funding, Commissioning and Managing in complexity involves: Being Human to one another: put on your VEST Learning and adaptation: improvement requires continuous learning Systems : Nurture healthy systems in order to create positive outcomes – be a System Steward
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