Month: July 2013

Beyond Nudge is behaviour change and demand management

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Catherine Mangan and Daniel Goodwin

A three-fold change to the design and delivery of public services has been taking place over the past decade. Expectations of user choice or personalisation, the drive for localism and most particularly the implications of cuts in public spending, all increase tensions within the public service framework. One key factor underpins all of them: they require fundamental change in the expectations of individuals, communities and service providers if best use is to be made of ever diminishing resources whilst securing public well-being.

Many experts have said that the critical public service challenge of the decade is to encourage behaviour that benefits both the individual and the state, whilst preventing long term expense. They want to discourage behaviour which creates user dependency and attracts further costs. Behaviour change is vitally important, they say, because we can no longer provide the services we have always done, in the way we have always provided them. Various approaches to altering the behaviour of citizens have been outlined in a growing body of evidence.

Councils are navigating within a ‘perfect storm’ of reducing funding and increasing demands from demographic change, public expectations and the rising cost of delivering services.  We know that we cannot continue to meet the level of demand for services in social care and children’s services. Councils’ financial modelling shows that at the current levels of demand, by 2022 the council’s entire budget will not be enough to cover the costs of children’s and adults social care services.

Somehow, the level of citizen demand on services needs to be contained, and reduced. Merely changing the way in which existing services are delivered will not save enough money. For example if the current trend of people needing care continues and the use of personal budgets in their current form is extended, there is a clear risk of double pressures on the public purse, as current services such as day care continue to be provided rather than de-commissioned.

We believe that following simultaneous outcomes will be required in the future, some of which will be the responsibility of public services:

  • Reduced dependence/reliance on state to pick up the pieces.
  • Improved individual well being and resilience.
  • New and improved community/social networks.
  • Sustainability – both in terms of the environment and also the future of public services.
  • A better understanding in the community of the cost of public service and its relation to taxation.
  • A shift in the underlying expectations of individual citizens and communities of the ‘deal’ that they have with the state as to the provision of public services.

There is a need to change the contract between the individual and the state. There has been a range of reports and statements from think tanks and central government departments extolling this approach. The RSA 2020 Public Services final report provides a good summary of many of the more detailed points. It calls for a new ‘social citizenship’ approach where as citizens we should have a duty to contribute as well as a right to receive support. This takes us beyond the simplistic ‘Nudge’ theory towards a better understanding of how to navigate the challenges of the present to achieve a better future.

This blog summarises some of the key messages in:

Beyond Nudge – How can behaviour change help us to do less with less? By Daniel Goodwin and Catherine Mangan in  Staite, C. (ed.)(2013). Making sense of the future: can we develop a new model for public services? (Birmingham: University of Birmingham/INLOGOV).

Portrait of OPM staff member

Catherine Mangan is a Senior Fellow at INLOGOV.  Her interests include public sector re-design, outcomes based commissioning and behaviour change.  Prior to joining INLOGOV she managed the organisational development and change work for a not-for-profit consultancy, specialising in supporting local government; and has also worked for the Local Government Association, and as Deputy Director of the County Councils Network.  She specialises in adult social care, children’s services and partnerships.

 

Why do we need a new model of public services?

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Catherine Staite

Public services, including those commissioned and delivered by local government, have changed substantially in the past ten years. There have been changes in service delivery mechanisms, in relationships between users and services, in organisational structures and in partnership arrangements. It appears likely that the next ten years will bring at least as much change, if not more. One thing is clear: the old model of public services – people expect and services provide – is no longer tenable.  The growing gap between demand and resources has been described in terms of ‘the jaws of doom’.  That is one way of looking at the future.  Another way is to see the opportunities which we have to renegotiate ‘the deal’ between people and public services.

INLOGOV is working with a wide range of local authorities and other bodies to test a new model of public services. The model draws together many of the themes in current debates about the ways in which the public sector is likely  to have to change, in particular, how public services can manage demand, build capacity and achieve better mutual understanding, through the development of stronger relationships with communities as well as through co-production and behaviour change.  The purpose of this model is to support public service leaders – both political and managerial – to make better sense of a complex world.

INLOGOV’s model brings together the disparate cultural, structural, political and financial challenges facing local government and wider public services into an integrated framework, which takes account not only of individual drivers of change but also of the inter-relationship between changes in public services and the wider political and social context in which those changes are taking place. If we have a coherent model which reflects current and future realities it will be easier for us to explore possible solutions together.

We have concentrated on the challenges and opportunities for local government, in partnership with other local and national institutions.  That is not because we think local government is the most important player on the public service stage, it is because we think it plays a unique role as a convenor and mediator between conflicting interests within complex networks of players.  It is in this role that it can provide the creativity and connectivity to help shape solutions to the seemingly intractable problems of rising demand and falling resources.

The key drivers for a new model are: building stronger relationships with and between individuals and communities, increasing co-production of better outcomes by focusing on capacity, as well as need, and changing expectations and behaviours.  Before we can deliver these benefits we will need to change the way we think, plan and act.  There are many good, small scale examples of innovation which are delivering real change but now we need to scale up change to have a real impact – reducing dependency, building confidence and improving outcomes.  These are not quick fixes, so the sooner we start and the more energy we invest the sooner we’ll be able to achieve a sustainable relationship between public services and the communities they serve.

 

This blog post summarises some of the key messages in:

Why do we need a new model for public services? By Catherine Staite

Ch. 1 in Staite, C. (ed.)(2013). Making sense of the future: can we develop a new model for public services? (Birmingham: University of Birmingham/INLOGOV).

Catherine Staite

Catherine Staite is the Director of INLOGOV. She provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.

The role of the third sector in delivering public services: what we know and what we’d like to know

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James Rees

Inlogov and TSRC recently held a stimulating and well attended seminar involving guests from University of Illinois at Chicago. It was a great opportunity to share knowledge on the role of third sector organisations in public services, and to compare the ways in which there are similarities facing TSOs in both the US and UK.

But as so often it begged many questions as well and I want to reflect a bit on both the state of what we know and what we ought to know about the third sector’s role in delivering public services (in the UK!).

When I talk to people about the research that I do, the usual response is “what on earth is the third sector?” followed by “do they really deliver public services?” I’ll come back to the first question but the second is certainly very interesting.

There is a very long history to the involvement of what we now call the third sector in meeting welfare needs and providing services. Many are aware of early charitable and philanthropic action in the 19th century (Barnardo’s, RNIB and RSPCA for example); there was an explosion of mutual, co-operative and associations in the early industrial period; and before the dawn of the welfare state many health services were provided in voluntary hospitals that worked in partnership with local government.

Pete Alcock pointed out how these forms of the third sector had waxed and waned in response to political and economic change, leading right up to the 1980s Conservative interest in the third sector as alternative providers, the influence of New Public Management, and New Labour’s commitment to ‘partnership’ with the sector, written into a Compact.

In my discussion I suggested that it was useful to look at different levels or ‘strata’ of the third sector in relation to service delivery.

There are the big national charities (for example Barnardo’s, NSPCC, RNIB and the Salvation Army). It’s probably fair to say that the public perceive that these organisations rely on donations and fundraising, but they also hold very significant contracts to deliver services. For example Barnardo’s and Family Action run ‘Sure Start’ Childrens Centres. Action for Blind People, part of the RNIB Group, deliver a number of publically funded services to people with sight loss including schools, supported housing, and tailored health services within the NHS. This of course is only a tiny snapshot of what is by far the most visible part of the sector.

All of the mentioned organisations, and many more of varying sizes, large, medium and tiny, are involved in the Government’s controversial Work Programme, which aims to help benefit recipients into sustained employment. Our recent research drew attention to the difficulties charities were facing in terms of the strictures of the payments system, the lack of resources, and the prevalence of perverse ‘creaming and parking’ behaviour.

The work programme experience shows how public service delivery can be controversial and risky for charities, both financially and reputationally. But the costs are balanced by the opportunities contracts provide for charities to lobby government (where involvement can equal ‘insider status’ and credibility); and many charities argue it is consistent with their mission to bring their expertise to bear to improve services for their own client groups.

In my view there is a ‘missing middle’ as far the third sector and its role in public services is concerned. Missing only in the sense that we know less about it and there is a huge variety of experience so it is difficult to make generalisations about what is happening at this level.

Many organisations are much smaller than the ones mentioned above and tend to operate at the level of a region like the north-west, across a small number of local authorities, or even within a neighbourhood. They might have contracts with a local authority or a PCT (soon to be a CCG), and this part of the sector delivers a bewildering range of services.

We have been studying just these sorts of organisations as part of current research into public sector commissioning of the third sector. I have been struck firstly by the immense variety exhibited by organisations at this level, in terms of the types of services that they provide, their size and scope of operation, and seeming difference in their ethos, culture and degree of professionalism.

Secondly I have been struck by how vulnerable some seem to apparent threats in the current environment, most obviously loss of existing contracts and grants as a result of (mainly local authority) cuts, but also the possibility of competition from other TSOs and private sector organisations, and a wider sense of uncertainty, verging on fear.

Perhaps in some sense this is par for the course for the sector, and no organisation has a special right to exist. But I do wonder if we fully understand and value what might be lost if we start to lose these organisations in any great number, as they undoubtedly play an important role for many communities and individuals.

Finally, TSRC has done a great deal of research on organisations ‘below the radar’. Arguably again little is really known about how grassroots groups might interact with public services, enhance them, or what impact austerity might have on this vast ‘ecosystem’ of organisations. Much the same can be said about the important role of volunteers in public services. At the same time there is growing interest in how small community groups can be part of the co-production of public services.

Back to that first question: what on earth is the third sector? As soon as we start talking about different levels of the third sector, the huge diversity it contains, and the porous boundaries between in this case the grassroots and community sector, it begs the question of why we use the label ‘the third sector’. Are we dealing with a sector at all?

In an esoteric but influential paper in 1997, Perri 6 and Diana Leat argued forcefully that the sector had been ‘invented by committee’, in other words it was a social construction that suited the interests of some key political interests and society might have been better off without this invented sector and an obsession with the ‘politics of organizational form’. Pete Alcock takes a softer line, suggesting that the sector is held together in a ‘strategic unity’ in which tensions and disparities are sometimes played down in order strengthen the sector’s hand in negotiations with the state. These might seem like questions designed to keep academics in jobs, but it is interesting that people in the sector seem to keep asking similar ones as well: what makes our sector distinctive? What are our unique values and ways of working?

The seminar was interesting because even in the short amount of time we had available participants began to pose some really hard questions for academic research. I hope we can return to many of these:

  • What is the ‘right’ role for the state in providing public services?
  • Is the third sector just a foil for ongoing privatisation of the public sector and wider public realm?
  • Is the third sector doomed to be under-resourced, vulnerable and ‘under-professionalised’? Or can innovations like social finance and social impact bonds make a revolutionary difference?

rees-james

James Rees is a Research Fellow at the Third Sector Research Centre at the University of Birmingham. His recent research concentrates on transformations in UK public services including the role of the third sector, but his longer term interests have been in the governance of urban and regional governance, with a particular focus on the politics of city-regionalism; critical perspectives on urban housing market restructuring and housing policy; and more broadly on issues in urban regeneration, neighbourhoods and community. Follow him on Twitter: @jamesrees_tsrc.

A relational revolution in local public services

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Chris Lawrence-Pietroni

On June 13 2013 BBC News broadcast CCTV footage of 83 year old Muriel Price suffering in her own home. Like so many elderly people receiving local authority care, Muriel relied on a private provider to send care staff to look after her basic needs. Taken over the course of one month, the footage revealed a pattern of neglect: carers turning up late or not at all; Muriel suffering the indignity of having her incontinence pads changed in full view of her neighbours; her food being prodded by a carer to test its temperature.

Yet despite her treatment Muriel still found a reason to be grateful: ‘It’s terrible the way they treat old people. I’m lucky I’ve got a family to look after me. Those that haven’t got a family – God help them, poor Devils’.

Public concern over the treatment of vulnerable people supposedly being cared for by public services has increased as a number of scandals have hit the headlines with Winterbourne View and the Mids-Staff Inquiries being only the most high-profile. Shocking as these cases are, anyone working in health and social care knows that it’s casual neglect like Muriel’s that is far more common. And with the ageing population and financial constraint that is the backdrop to any contemporary discussion of local public services, the likelihood of others facing similar experiences is growing.

When confronted with these tragedies the question that lingers is: how could anyone treat another human being in this way? How is it possible to knowingly leave an elderly person alone for 13 hours? How could you expose an adult to the shame of having their incontinence pads changed in public when all that is required is that you draw the curtains? Why stick your fingers into someone else’s food? Would you treat a member of your own family like that?

The answer to this last question is (one hopes) “no” – and that of course is the point. As Muriel so rightly points out, she is lucky to have family that care for her and look out for her welfare. It is these relationships that not only give her life meaning (the regular visits of her grandson and trips out in her wheelchair) they also keep her safe (it was her grandson who installed the CCTV). These relationships, built up over years of mutual exchanges of love and practical support, mean that Muriel and her grandson see each other not as ‘clients’ or ‘tasks’ but as human beings to be valued.

The challenge of enabling genuinely relational services is not new, but it is growing and becoming more urgent. It is a simple fact of demography that personal social care is going to become an even greater part of public service and (for the foreseeable future at least) a political reality that the financial resources available to support it are going to be even fewer. Working out how to meet the needs of vulnerable older people with humanity is one of the most pressing issues facing local public services. The relational challenge, however, goes much further.

Firstly, enabling relationships to flourish between public service providers and those they serve – individually and collectively – is an absolute necessity if our aspirations for co-production and behaviour change are to be realised. It is increasingly understood that achieving significant change in so many of the challenges facing society – obesity, living well into old age, educational attainment, training and employment in an uncertain job market (to which you can add the pressing issue of your choice) – requires the active engagement of all of us as citizens. It is therefore at this point of interaction between citizens and the public services they use that we should focus our attention. As the new model of public services presented in Chapter 1 suggests, effective relationships, building trust and behaviour change are intimately connected.

Secondly, we know that the quality of the relationship between citizen and service provider can be a key determinant in the quality of the outcome of the service: evidence from fields as diverse as education, employment services and healthcare all suggest this.

Finally, we are slowly coming to understand that the complexity of organisations like those delivering local public services and the rapidity of change that they face mean that only those that are flexible and adaptive will excel. The process of constant learning needed to enable success itself requires a fundamental shift of attitude towards the nature of work – a shift of attitude that takes seriously the need to create meaning for staff within our organisations such that they carry with them the motivation, courage and adaptability needed to face the challenges of their daily tasks.

In this context enabling genuine relationships – relationships that carry with them more than a transactional or instrumental benefit – are not a soft option ‘nice to have’ but a hardnosed prerequisite for effectiveness. What we need is a relational revolution in our local public services.

This blog draws on ideas in Chapter 2 of a new book ‘Making Sense of the Future’

lawrence-pietroni

Chris Lawrence Pietroni joined INLOGOV as an Associate in September 2012. His work focuses on achieving sustainable systems change cross public services in the UK and the US. Building on over 15 years’ experience in local government working with senior leaders on the design of innovative service improvement and community engagement strategies, his work now focuses on the intersection between service design, leadership development and community empowerment. Much of Chris’ current work provides accessible ways for leaders to draw on systems thinking to enhance their collective effectiveness. Together with Mari Davis, Chris is pioneering the application of insights drawn from social movements and community organizing to achieve sustainable systemic change.