Public performance and delivery

What skills does a 21st Century fire service need?

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Dave Cross

Over the past twenty years the fire service, like many other public sector agencies has undergone radical change. Whilst the public’s expectation of the fire service as a response based fire and rescue service remains the same, the organisational expectations of fire fighters has increased markedly. To quote a senior Greater Manchester fire officer “The job of a fire fighter nowadays has changed from not just putting out fires… to almost being a semi social worker”.

This change was precipitated by the Bain report of 2002 and the resultant repealing of the 1947 Fire services Act to be replaced by the 2004 Fire and Rescue Services Act. No longer was it response, but prevention that became the fire service’s primary consideration. In line with this prevention orientated approach fire fighters nationally are now undertaking Home Safety Checks. It is the carrying out of these checks and the increased access into people’s homes that has brought about an increase in fire fighters generic skills. A fire fighter now has to be aware of a range of issues, some way beyond the fire safety sphere. These would include health and wellbeing of the occupant, child and adult protection issues, possible need for a vulnerable person’s referral or other agency involvement.

The rationale behind this is that the most at risk groups fall into the catchments of many public sector bodies. This is borne out in the MECC programme (Making Every Contact Count) and the Marmot review of public health. MECC is a means by which other, agency appropriate involvement can be sought through previously established referral pathways.

Through their prevention schemes, the fire services run a universal programme of home fire safety checks: they are in touch with members of the public from all sections of the community and not only attempt to prevent fires, but are also involved in running prevention programmes from home safety to road safety. They link up with schools, engage and inspire young people, visit people’s homes and develop relationships with the community – they are in the perfect position to deliver interventions and partner with other agencies to reduce health inequalities. The fire services do what every stakeholder involved in reducing health inequalities should do: engage directly with the community, work to provide them with the opportunities they need to live a healthy life and focus on prevention.”

Professor Sir Michael Marmot.

Of more recent concern for the fire service is an awareness of signs of radicalisation and counter terrorism for which the fire service forms part of the first and last line of domestic defence.

In addition to home safety checks fire fighters are actively engaged in local schools delivering targeted, curriculum supporting sessions on fire safety and road safety. Fire stations are considered a community resource. They can be used by external agencies if they are a better avenue into at risk groups.

The perverse incentive that was envisaged by decreasing calls is being realised (fires having fallen by 64% in 10 years). The continuing effects of the government’s austerity measures which has seen fire service budgets slashed by 25% over the last 4 years has seen staffing numbers and appliances decrease. This has come with increasing pressure from central government to adopt more use of retained (part time) fire cover as this is considered to be more cost effective. In response some metropolitan brigades are resisting these pressures believing them to be unworkable in major conurbations. This has brought about an increased and management supported use of social media. It would not be unusual now to find a fire fighter ‘tweeting’ from the fire-ground. Whilst this carries some risk to the organisation and people have on occasion had their fingers burnt. The benefit of informing the public of our activities is seen as outweighing the risk from the odd ill advised ‘tweet’ but is yet another example of the broadening role of the fire fighter.

Commensurate with that reduction in calls is a reduction in fire fighters experience. This has created a double edged sword, for while the public are becoming increasingly safer fire fighters are becoming exposed to more risk. Not just from a lack of practical experience but also because advances in building construction (double glazing, furniture) is making fires hotter and requiring far more refined technical skills to be able to adequately deal with and therefore realistic training needs to increase.

Fire services are now faced with the dichotomy of putting more time and resources into the ‘softer’ skills that, increase public health and safety, complement interagency work but ultimately reduce service demand and funding with the need for increased staff training and awareness not only in the equipment and procedures for personnel safety in an increasingly threatened world but also in the necessity for public awareness and marketing. The role of a fire fighter is not what it was.

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Dave Cross is Watch Commander at West Midlands Fire Service.

This post was originally featured on the 21st Century Public Servant blog.

A view from Barnet’s Chris Naylor: how the class of 2014 are responding to perma-austerity

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Chris Naylor

Two weeks ago I gave the lunchtime pep talk to a dozen young hopeful students each vying for a coveted place on Barnet’s graduate programme. Furiously clever, ambitious for Barnet and public services more generally – I didn’t envy those with the task of making a final selection. Like the alumni who have come through the Council’s programme before them, many of whom a decade on, as senior managers, continue to make a profound contribution to the success of the borough, the Class of ’14 will truly be the 21st Century Public Servants. Over the course of the next 40 years (probably 50….) they, with others, will come to define the scale, purpose and breadth of public services locally, nationally and perhaps beyond.

Along the way, the challenges that they will face are beginning to take shape. There are three striking features:

  •  deficit reduction and growing service demand, particularly in health and social care will mean public sector spending reduction and then restraint that has the potential to last deep into the second quarter of the century;
  •  meanwhile customer service expectations are rising exponentially and the public sector has so far proved too slow in response. From an inability to book appointments with the doctor, to the maddening requirement for the citizen to constantly re-provide to the state, information about themselves the state already knows and in some cases originated – serves to frustrate, erode trust and catalyse disengagement. And this coming at time when the scale of change facing the public sector requires greater proximity, not less; and
  • traditional interventionist measures to promote social mobility and other social outcomes will be challenged by a scarcity of public resources. Furthermore, rising health and social care demand, highlights the need to ensure that the public sector can properly demonstrate that services are provided fairly. Indeed there may well be a need to properly demonstrate that services are withdrawn fairly too. Fairness, of course being a concept that is ripe for debate and challenge!

Over the last 12 months Barnet Council has been working hard to develop ideas and options that address these trends, particularly as we expect them to manifest in the second half of this decade. The Council’s “Priorities and Spending Review” sets out a range of ideas to save money and achieve priority outcomes. They include many of themes identified by those interviewed by the 21st Century Public Servant Project: efficiency-particularly through the application of new technology; measures to promote economic growth; demand management; greater community enablement and facilitation and partnership working/integration. In Barnet, over the coming months these ideas and others will now be considered politically and with service users, residents and other stakeholders so that a conclusion can be reached. These decisions won’t be easy, by the end of the decade Barnet will be spending roughly half what it did in 2010 on the provision of public services.

In this context our workforce will quite understandably be concerned about job security. Not least because on the 1st April 2016 our workforce budget will be £68m per annum, while our savings target for the period 2016-2020 will be higher at £72m. All other things being equal – that will feel like a circle that can’t be squared. But the public sector will not disappear, realistically Barnet will still spend some hundreds of millions of pounds and employ many hundreds of staff, directly or indirectly, to provide services that require heavy personal involvement – Google has not replaced teachers, even if it has changed and enhanced the way they teach.

More importantly local government will continue to consist of good people doing good things for people – and it is this sense of moral purpose that attracts the Class of ’14, in much the same way it has attracted others before them. In this context, for public service leaders, at all levels and at all points in their career the truth is that the magnitude of change before them is not just a challenge to their skills and capability, but for some – many perhaps – it is a challenge to their philosophical outlook. To exemplify the point,consultation we undertook to inform the Priorities and Spending review revealed that many residents want Barnet to effectively market council services and the talents of staff – they are willing our organisation and workforce to be more entrepreneurial. It’s not, however, an attribute that universally characterises the culture of most local authorities. Indeed some folk will find the very notion alien to a public sector ethic. In Barnet the desire to be entrepreneurial has led us to establish ‘Re’, a joint venture with Capita to market our development and regulatory services. Several of the staff in the service/company have joint employment contracts, enabling them to provide a commercial service alongside their regulatory responsibilities. From its inception, it is a proposition that has had its supporters and opponents, notwithstanding the fact that the business model for Re sees a growth in employment and not a reduction. Winning the support and commitment of those staff transferring to the joint venture has been the leadership challenge both during the development of the proposal and for the post go live period. At the risk of sounding glib, the only way to win the hearts and minds of workforce in question has been to appeal to both their hearts and their minds. Reason, coupled with an on-going conversation and debate about their motivation and conviction to achieve good outcomes in Barnet.

One final observation: The 21st Century Public Servant research, rightly alerts to the tension between technology-led commoditisation of public services and the desire/requirement for a more ‘relational state’. But I would challenge a view that asserts too strongly that both responses are mutually exclusive. Insight derived from joined up data gives us the potential to engage more directly with individual residents based specifically on the services they use or the place where they live. For example we can already send details of a planning application in a resident’s street directly to the phone in their pocket. Ideally they could use that phone to work out their chances of getting their child into a particular school.  And if we know they’ve been looking at catchment areas, much as Amazon directs to similar products, we too should point “here are some children’s events in our libraries”. We hold that information, we just need to get it packaged and sent in a way that is useful to a resident.

The Class of ’14 were born between 1992 and 1994. They’ve been using social media and the internet before they became teenagers. The application of new technology to re-design services and better engage service users isn’t a novel idea – to them it’s both obvious and assumed. Over the coming years we should expect them to adopt the best levels of personal engagement from the most customer orientated parts of the private sector and develop new forms of civic engagement – using big data to make small but regular differences that change our residents lives for the better.

Chris Naylor is Chief Operating Officer at Barnet Council.

How can the 21st century public servant survive an era of perma-austerity?

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Catherine Mangan

We are launching the first theme from our 21st Century Public Servant project – the need to survive a seemingly unending period of austerity – to coincide with the Local Government Association conference, where austerity is a central theme.

Our research with local government and other public service delivery organisations found that ‘perma-austerity’ is both inhibiting and catalysing change, as organisations struggle to balance short-term cost-cutting and redundancies with a strategic vision for change.

In our interviews with people working in public service delivery and in national stakeholder organisations (more details on research design are here) some talked about the current ‘narrative of doom’ is preventing progress – some talked about a sense of loss and grief for the past; with organisations paralysed by the impact of the cuts, and unable to provide a new vision to work towards. As one put it, ‘No message of hope – leadership is putting council into survival mode by the language they’re using. Nobody is planning for post austerity.’ One interviewee spoke about the effect of losing large numbers of staff: ‘You hear the language of loss everywhere. I get affected by it.’

Although interviewees accepted that the financial context offered opportunities for doing things differently, some commented on the challenge of moving forward whilst dealing with the reality of the impact of large scale redundancies: ‘The cuts are forcing us to confront change. In public service, change doesn’t necessarily happen unless there is a crisis or a disaster, or it happens very slowly. But think tanks and consultancies can find it exciting, for them it’s a massive playground. We have to remind them that people are losing their jobs, services are being cut. There has to be a balance.’ Others commented that the enormity of the challenge needs to be recognized and responded to: ‘It’s not salami slicing because you wouldn’t have salami that big, it’s hacking things off. It’s about rethinking the role of the state in light of the changing economy, technology, the changing ways that people live their lives. The cuts are so big that we have to confront the questions we have been putting off: what is a library service, what is a leisure service?’

The biggest shift being driven by austerity is developing a different relationship with citizens: ‘We won’t have the money so we will have to focus on the enabling and facilitating, enabling the rest of community to do it.’ As one interviewee put it: ‘You can only get so far by being a supply side mechanic, cutting and slicing. You need a better sense of what your people are like, who they are, what their networks are, how they can do more not for themselves but how they can be more a part of the value that you create about what you do as a council.’

However another interviewee described the difficulties she encountered in reconciling the austerity agenda with more relational ways of working: ‘There is a complicated tension between the desire on the one hand for efficiency and rational processes versus the expectations and needs of customers which is more relational and focused on the personal and local. We are expected to do both, to move to the more relational in the government’s commitment to localisation and neighbourhoods. But elsewhere we are moving to customer relationship management and call centres. You phone or visit a call centre, pick up a ticket, it’s not a holistic relationship with the person on the other end of the phone.’

The 21st century public servant will have to ‘find a way through that knot’.

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.

21st century public servant: the discussion phase

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Catherine Needham

After nine months of researching the 21st Century Public Servant, we are today formally starting the discussion phase of the project. We have undertaken a literature review, we have spoken to over 40 people working in public services in public, private and voluntary sector bodies, and to national stakeholder organisations. From that we have identified key themes of what it means to be a 21st Century public servant which we will be blogging about over the next few months.

We begin this week with a focus on ‘perma-austerity’ which is the key contextual factor for public services, and a major theme at this week’s Local Government Association conference. As well as sharing the findings of our research we will have guest blogs from people working in and close to public services about ways to address the challenges of austerity.

A clear finding from the interviews we’ve done is that there is no unified vision of the future of public services and the people who work to deliver them. The future will be messy and tentative, with paradoxes being managed and lived with rather than solved. In the same spirit we don’t feel we have come up with the answers in this project, but rather with a series of themes that we want to test out with you. If you feel inspired to blog or comment that’s great.

We will be discussing the themes at the IPPR today, beginning a series of project events. You can also come along to the Inlogov stall at the LGA conference to find out more.

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Catherine Needham is Reader in Public Policy and Public Management at the Health Services Management Centre, University of Birmingham, and is developing research around public service reform and policy innovation. Her recent work has focused on co-production and personalization, examining how those approaches are interpreted and applied in frontline practice. Her most recent book, published by the Policy Press in 2011, is entitled, Personalising Public Services: Understanding the Personalisation Narrative. Follow Catherine on Twitter: @DrCNeedham.

The Great NHS Robbery – and the great fraud headline con

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Chris Game

Some social phenomena are exceptionally tricky to measure: the black economy, white-collar crime, illegal immigration.  So when someone claims to have done so, no matter how flaky their findings, they attract huge, and largely uncritical, media attention. Like last week’s excitement about the scale of NHS fraud.

The catalyst was a Panorama programme – The Great NHS Robbery – that needed some pre-transmission headlines. The programme consisted mainly of specific cases of GPs, dentists, pharmacists, private contractors and suppliers who’d been found guilty of defrauding the NHS. It alleged that the Government’s official NHS fraud figure of £229 million p.a. is a huge under-count or under-estimate, and suggested that, having cut the staffing and budgets of NHS Protect and other fraud investigators, the Government was turning a proverbial blind eye to the scale of the problem, especially by comparison with the increased resources it allocated to the detection of the much smaller quantum of benefit fraud.

Old cases and political sniping, however, don’t make major headlines. What Panorama needed were some seriously big and scary figures, and fortunately there were some to hand – just down the M3 at the University of Portsmouth’s Centre for Counter Fraud Studies (CCFS). By happy coincidence, the CCFS was about to co-publish, on the very same day as the first showing of The Great NHS Robbery, a report analysing, as the programme put it, “the most rigorous data on health care fraud in the world”, and containing some “staggering” findings for the NHS.

The BBC had its headlines – “NHS fraud and error costing the UK £7 billion a year” – and Panorama had its audience. Other contemporaneous media headlines were all apparently taken either from the BBC’s plug story or the programme itself. Some were fractionally more cautious, like The Guardian’s “NHS fraud could be as high as £5 billion a year, says former health service official”; others less, like the Nursing Times’ “Fraud costs NHS £7 billion – enough to pay for 250,000 nurses”.

None of the authors, it seemed, went to the CCFS report to check how the loss figures were arrived at and what they represented – possibly imagining that a global report on such a complex and technical topic, representing the product of several years’ research, would be vast, probably undownloadable, and incomprehensible to the average reader.

Interestingly, though, it’s none of these things. The Financial Cost of Healthcare Fraud 2014: What data from around the world shows runs to just 16 pages, including the two covers. The rest comprises: Contents, Foreword, three prefaces, three pages about the authors and publishers, a full-page picture, a blank page … and a 4½-page ‘report’. There are no “data from around the world”, so, even with the glossy pictures, you could, if you wished, download it in about a second.

However, to save you having to plough through all 4½ pages yourselves, let me take you through the methodology step by step.

1.  Do a literature review of the 92 studies of healthcare fraud and error losses that you’re  able to find that have been undertaken since 1997 – not ‘globally’, but in languages you can understand: the UK, US, France, Belgium, the Netherlands and New Zealand;

2.  Don’t worry about the studies being in numerous completely different areas of health care, but average out the quoted financial loss figures in all 92 studies and cite that average with real authoritative precision – i.e. not 7%, but 6.99% – because, remember, these have to look like “the most rigorous data on health care fraud in the world”;

3.  Globalise your ‘research’ by finding a figure for global healthcare expenditure for some recent year (no, not ‘global’ as in your six countries, but really global) – say, $6.97 trillion for 2011 (or £4.48 trillion) – and again don’t worry about whether they’re US or International $$ or what the figure actually represents, for this is one of those footnote- and reference-free reports;

4.  Divide (3) by (2), and again state the sum with great precision: that this shows that £313 billion is being lost by the world’s healthcare services each year – or 25% more than when you last did the sum in 2008;

5.  Guess – because you’ve apparently no evidence one way or the other – that the financial integrity of the NHS is probably about average for the six countries you’ve studied, and assert that it is therefore losing 7% of expenditure each year – or £7 billion out of its roughly £100 billion total – in ‘fraud and error’, making sure, of course, that you emphasise the fraud bit.

6.  Add a little diagram, as shown below with the addition of my clarification of where the UK figure comes from.

game graph

I must confess at this point to having misled you a little. I mentioned that the report contains no “data from around the world”, and indeed there are no figures for the UK or any other individual country.  The £7 billion came in the Panorama programme, from one of the report’s two principal authors, Jim Gee. Gee is the former health service official referred to The Guardian’s headline: former CEO of the NHS Counter Fraud Service and now Director of Counter Fraud Services at BDO LLP – not, sadly, the British Darts Organisation, but Binder, Dijker, Otte and Co., an accountancy firm specialising in anti-fraud services – and Chair of the CCFS at the University of Portsmouth. Gee left it to the programme’s presenter to add that “he puts more than £5 billion of that £7 billion down to fraud, rather than financial error” – which explains the other part of The Guardian’s headline.

Though certainly not on the same scale as its undercover filming of LSE students in North Korea, Panorama’s decision to rest the central argument of this programme on such flaky statistics, produced at least in part to further the interests of a self-promoting business services company, seems to me another clear editorial misjudgement. Certainly it irritated me when I pieced together the above account and realised that in effect I’d been conned.

Much more importantly, though, it must in anything other than the short term undermine, rather than substantiate, the key points the programme was seeking to make: that the way the Department of Health currently measures and estimates NHS fraud is grossly inadequate and damagingly misleading; that governments, and this Government in particular, see it in their interests to under-record the scale of fraud (and financial error, for that matter); and that more, rather than less, funding should be being invested in fraud detection and inspection services.

The sad truth is that Panorama seized on CCFS/BDO’s £5 to £7 billion because there was nothing better or more accurate available. Jim Gee’s ‘methodology’ suggests to me that he’s probably underestimating global healthcare financial losses and overestimating those of the NHS, but neither I nor the Government have any way of officially demonstrating it. Nor is there any likelihood of the Government, since it is substantially in denial, embarking on a programme to reduce the losses by up to the 40% within 12 months that Gee, wearing his BDO hat, considers feasible. I doubt if many others agree, but, to adapt the proverb: in the land of the dataless, the one-figure man is king.

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Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.