Front line, schmont line

First there was Demos’ Time to put trust back in the front line of public service.  Then came the Localis/KPMG report, The Bottom Line – a vision for local government, Reform’s The Front Line and last week we had the Government’s Putting the front line first.

The ‘front line’ is of course a term that comes from the battlefield and it has always struck me as curious that we should refer to staff who deal directly with the public as  front line.  Does it say something about how we view our customers?  Do we really see staff who have the most direct contact with the public as being at the forefront of the battleground doing combat with the enemy?

The trouble with these front line arguments is that in practice they don’t get you very far.  For sure the clinicians in a hospital do work that is vital but without their so called backroom colleagues, for example in procurement, ensuring that they have the equipment they need to do their jobs, they wouldn’t get very far.  The achievements and failures of large public service organisations are invariably the results of team effort.  Within a council there’s an inter-dependency between staff who deal directly with the public and those who facilitate them. Rather than being a hard split it’s a permeable relationship and rightly so. 

That inter-dependency makes the challenge of finding significant savings much more difficult.  It’s not necessarily simply a case of stripping away the middle managers and the paper-pushing bureaucrats or of service cuts.  There’s a need to really understand how different roles and functions fit together so that the best possible outcomes can be achieved with diminishing resources. 

Just as that won’t necessarily mean cutting discretionary services rather than reducing some statutory ones as CIPFA point out in After the downturn, neither should it be based upon a simplistic split between front line and support services.

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The Pushmi-pullyu approach to social reform

At least both heads are looking in the same direction

 The idea that there can be perfect congruence from the vision and aspirations of an organisation all the way through its various strategies and action plans to an individual employee’s objectives has always struck me as overly simplistic. In practice, the so called ‘golden thread’ tends to be as elusive as the golden medina.

In a similar way, I’ve never really been convinced of the delivery chain view of the world which sees a minister in Whitehall pressing a button and seamlessly through the mechanisms of national public service agreement targets, local area agreements and the rest, the desired outcome materialises on the ground.   Disappointingly, this idea of a simple causal relationship between interventions and outcomes has become hard wired into our regulatory frameworks.

I’m more attracted to models which recognise the complexity of the world in which public service organisations operate. In a fascinating article in Prospect, Left Brain, Right Brain, Matthew Taylor argues that the actions of the state need to combine ‘the push of reform with the pull of social meanings and connections.’

 This seems to me a more realistic way of seeing how the actions of organisations like councils must interplay with the values and social norms of communities.  We are all familiar with the initiatives which seemed eminently sensible on paper and when discussed amongst colleagues which proved to have no resonance when it came to implementation.

Matthew Taylor goes on to suggest that, ‘as the public sector enters a period of austerity, we need to remodel services around the goal of building individual and collective capacity. This means drawing on the best circumstances for the emergence of connectivity, self-control and altruism.’

Brave would be the council that said its three priorities were promoting connectivity, self-control and altruism. But it seems to me that we need to recognise that increasingly our role is about building capacity, embracing ‘the pull’ rather than focusing so much on pushing through our own provider-driven agendas.

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President Obama and the web

I’m grateful to my colleague, Ben Unsworth, who gave me a copy of a briefing paper by Chris Quigley of Delib Ltd on how President Obama has been using the web to facilitate a more participative approach to governance. 

Chris explains how Open for Questions encouraged citizens to submit questions on line, via text or video, as well as to rate questions submitted by others.  President Obama then responded to the top questions via an online town hall meeting held at the White House and streamed live on line. Recovery Dialogue enabled the public to contribute their ideas on how to ensure transparency about the way funds provided through the Recovery Act are spent.  As Chris points out the Recovery Dialogue demonstrated a new way of running policy roundtable ideas-sharing events- it enabled 20,000 people to be involved in the policy-making process.

It seems to me that there are a number of things that we can learn from the approach that the Obama administration is taking.

1. the aim is to generate ideas and collaboration.  It is about participation not technology.  So, to take a current example from UK local government, if we want to encourage e-petitioning it needs to be because it’s an effective form of participation rather than because technology now enables us to do on-line what we’ve done for centuries off-line.

2. the way to do this is by trialing specific projects and learning from them.  There are always a lot of unknowns when it comes to participation so piloting different approaches for specific purposes makes sense.

3. if you get this right the rewards in terms of the extent and quality of the participation are high – much higher perhaps than could be achieved through more traditional mechanisms for the money involved.

4. we need to move on from our pre-occupation with surveys – there are other more participative ways of engaging residents in ongoing conversations about the key issues affecting local communities.

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In praise of receptiveness

Like the teenagers we seek to influence, councils are only too susceptible to peer pressure. No sooner have we started to feel confident enough to say that we will no longer be hostage to targets than we all seem to be jumping collectively on the bandwagon of save, save, save.

And it seems to be a truth universally acknowledged within local government that a community of any description is in want of engagement. Despite research suggesting that levels of public participation have remained at about the same level since 1918, we are committed to suddenly coaxing large numbers of people out of their apparent indifference.

But rather than focusing on finding new ways in which the community can engage us, I believe the real issue is to make councils and other public institutions more receptive. Satisfaction from participation comes from feeling that you have effected change on an issue about which you care. So perhaps what we need more than e-petitions, citizen juries and the like, is a shift in mindset in public institutions – a readiness to admit mistakes and to act on feedback; receptivity rather than engagement. ‘Receptiveness,’ George Eliot wrote, is a rare and massive power like fortitude.’ It’s a power we could usefully tap into.

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Settlers, Prospectors and Pioneers

Last week, together with a number of other colleagues I met with the Campaign Company to learn more about some of the very interesting work they have been doing with outer London boroughs on community cohesion issues.

They take a ‘values modes’ (VM) based approach, making use of cultural dynamics. VM is mapping system that looks at the values that underlie behaviour.  The approach is based upon a belief that for an organisation to influence behaviour, one has to start with understanding the people you are trying to reach, not the problem.  Processes designed to elicit ‘behaviour change’ are doomed to fail.  The key is understanding what drives people in their lives.

VM segments people into three groups:

• Settlers – socially conservative, concerned with the local, belonging and wary of change
• Prospectors – want to acquire and display the symbols of success, want to make their lives better and be seen to succeed.  Early adopters but not innovators
• Pioneers – society’s scouts, always testing, innovating and questioning.  Attracted to what is ‘interesting’.  Some are strongly ethical, most at ease with change

I think it is interesting to set this segmentation against cultural theory’s four ways of understanding change, as set out by Matthew Taylor.  Cultural Theory argues that when we try to solve a problem, there are four ways of understanding the opportunities for change:

•  Hierarchial – based on rules and regulations
• Individualistic – assuming people do what people will do
• Egalitarian – drawing on shared values
• Fatalistic – change is something that happens to you

The Campaign Company in their work in Havering and Bexley has found that part of the reason why cohesion problems have moved almost seamlessly from more traditional working class areas to more middle class areas is because, although these people may have different jobs, possessions, and lifestyles, they are linked by values.

So perhaps a VM approach, backed-up by data mapping systems like Mosaic and informed by an understanding of cultural theory, may help us to tackle some of the most challenging issues we face, such as community cohesion.  But perhaps I should declare an interest.  I am, apparently, a ‘Transcendant Pioneer’ and that may be clouding my perspective.  You can find out what you are in the VM view of the world by trying their on-line questionnaire.

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No messages for anyone – Twitter, Herzog and Stephen Fry

Amongst the latest blogs to be posted at the bloggers’ circle, I was particularly interested in a piece by Blog for Prestolee on social intimacy and twitter. Prestolee outlines how the intimacy of regular contacts between ordinary people has been eroded in today’s increasingly dislocated society and as a consequence, the quality of our daily lives has been diminished. How far, Prestolee, asks can Twitter go in re-introducing intimacy?

My gut instinct is to say, not very far. The relationship between social media and real-life face-to-face interaction is an issue highlighted in the excellent Us Now film which explores a number of web 2.0 innovations. One example – Directionless Enquiries – seemed to me to encapsulate the problem. Directionless Enquiries connects lost people looking for help with knowledgeable locals who would like to help, using mobile phones. Nothing wrong in that. Except, would it not be better if you could just ask a passer-by? Do we want the kind of communities where we co-operate through web-based interactions or spontaneous face-to-face contact? Do things like Twitter and Directionless Enquiries make us feel more or less isolated in the long run?

I’m conscious that there is a danger in over-stating the contrast between the way we interact and the way we’ve interacted in the past. Is Twitter simply the modern equivalent of sending telegrams? We are social creatures, we have always wanted to communicate and our lives have always been a mixture of first and second-hand experiences.

The Victorian postal service was in its way a precursor of the web. In London, it’s said, you could mail an invite in the morning, receive a response in the afternoon and still have time to make preparations for dinner that same evening. The postal service enabled Charles Darwin from his home in Kent to maintain a dialogue with scientists and naturalists from all over Britain and further afield. That flow of information and ideas helped him develop his theory of natural selection. Would Darwin have developed his ideas without the first-hand stimulus of his journey on the Beagle? Probably not, but even still we shouldn’t under-estimate the part played by remote collaboration.

There’s another aspect to all this that interests me. Does our seemingly insatiable need to be connected say something about us? In public spaces people are more and more enclosed in their private worlds of mobiles and ipods (but, again, is that different from having your head in a book?) In Herzog, Saul Bellow’s eponymous protagonist is a neurotic who is constantly composing unsent letters to the great and good of past and present times. When Stephen Fry tweets to his 55,000 followers about England’s win at Lords (Joy. Bliss. Divinity. Excellence. Radiant effulgence. Rapture. Content. Yards and yards of fine, fresh, fragrant happiness. All is good) I wonder if we’ve somehow entered the fun but mad world of Herzog’s compulsive letter writing with the one difference being that that we all now have send and receive buttons.

By the end of the novel when Herzog finds a measure of equilibrium, we are told that ‘at this time he had no messages for anyone.’  Today, most of us always seem to have a text or a tweet or a blog up our sleeves.

The last word on all this, at least for the moment, should go I think to Rohan Gunatillake of NESTA who has coined the phrase, ‘ungeeking’ to describe what happens when behaviours developed online make their way into areas of our lives independent of the technology through which we learnt them. He suggests that the great prize is the ungeeking of social networking – in other words to translate the radical connectivity between individuals and the communities of shared interest being developed on-line into increased social glue in our towns and cities. That seems to me a worthy aspiration.  In the meantime you can follow Rohan on Twitter.

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Bloggers’ Circle – a round-up

A while back I mentioned about a bloggers’ circle being set up by Matthew Cain.  I’m pleased to say that the initiative with RSA backing is now up and running.  If you would like to find out more about the bloggers’ circle, the details are on a recent posting by Matthew Taylor.

The idea of the bloggers’ circle is to make the most of the collaborative and creative potential of blogging by sharing posts more widely, and as a member I have just received the first of what will be a regular crop of blogs.  This is a round up of some of the postings.

In Good and faithful servants, Julian Dobson, a commentator on regeneration, relays the key messages from a fascinating discussion he chaired at the Centre for Local Economic Strategies’ summer conference.  Julian’s blog quotes the community leader, Dick Atkinson, as saying public services fail because they don’t spend money in ways that meet local residents’ needs and that the answer is to shift control to a neighbourhood level.  Julian emphasises the importance of trust at the neighbourhood level and freeing up councillors to use local resources to reconfigure services to meet local needs and stimulate growth.  Interestingly, scrutiny isn’t something that appears to have got a mention at the CLES conference although according to DCLG’s consultation paper launched this week, ‘Stronger Local Democracy’, better scrutiny holds the key to stronger local leadership. 

Jane Mason, a writer who is working on a project to develop a contemporary understanding of virtue, blogs about the need to open up opportunities for people to become non executive directors.  She takes issue with a comment in the Financial Times that there is an insufficient supply of mature professionals to act as NEDs, especially if the number of days they are required to work increases.  For me, Jane’s blog raised some very interesting parallels with councillors.  There are similar issues, for example, about widening the pool from which councillors are drawn and the qualities that Jane identifies for NEDs – the ability to formulate questions, drive for answers and the courage to admit when you don’t understand something and make sure you get the answers you need before you take decisions – are equally applicable to councillors.

Emma Mulqueeny in her blog draws attention to two recent publications – a Cabinet Office report on learning from the world’s best public services and a Lords Information Committee report on creating better connections between people and parliament.  The first report in particular is very relevant to local government practitioners as we seek to find innovative solutions to tackle the effects of the impending spending squeeze.

Rob Greenland’s blog – Nudge Nudge, bag, bag – highlights the clever way in which Tesco has encouraged customers to use less plastic bags.  The question he was asked by the cashier was, ‘have you got your bags with you?’ As Rob points out, this is a perfect example of nudge.   The choice architecture has been changed.  Instead of the default being a wad of free plastic bags, the expectation is that we will now have brought our bags with us.  To me this is a helpful reminder that behaviour change can come about quickly through simple means.  I particularly liked Rob’s blog, as he goes on to describe how a plastic bag wrapped itself around the rear sprocket on his bike on his way back from the supermarket – ‘a desperate act of revenge from a dying breed’.  So this time round, I would say Rob’s post is my pick of the week.

But in the interests of balance, I also want to highlight an article by a journalist, Jenni Russell which was in last week’s Guardian.  Entitled, New Labour’s great mistake is to think we are all automatons’   the article emphasises the need for public services to respond to us as people and give us the sense that we matter.  We are not dispassionate observers of our society, making cool calculations about its success or failure on the basis of government-generated numbers, she argues. This may seem very much an argument of today but it isn’t really.  Over 150 years ago, Charles Dickens covered similar ground in his novel, Hard Times and I was reminded of his line, ‘the subtle essences of humanity elude the utmost cunning of algebra’.

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The answer to the question is scrutiny

I went this morning to the Institute of Mechanical Engineers to hear John Denhan, the Secretary of State for Communities, launching a new Department of Communities and Local Government (DCLG) consultation document, Strengthening local democracy. I gathered that it was a hastily arranged and low key launch and while Chris Leslie of the New Local Government Network which was hosting the event, described the proposals as wide-ranging, John Denham’s speech seemed rather short on new ideas.

The Secretary of State described the measures set out in the consultation document as ‘the biggest shift in power in a generation’. However, when we came to what was actually being proposed, I don’t think I was the only person present to feel somewhat under-whelmed. The consultation document is framed around these five areas:

• giving councils greater scope to scrutinise the spending and decisiosn of local service providers;
• exploring barriers to the use of existing powers and whether there are other powers councils should have;
• ensuring councils have the powers they need to tackle climate change
• ensure accountable leadership in sub-regional structures;
•  better articulating the relationship between central and local government

Scrutiny

John Denham said that scrutiny was the lion that has failed to roar.  His depiction of scrutiny as a lion is something that many local government practitioners might want to challenge (more of a mouse than a lion, perhaps?)  But one thing which is clear from the consultation document is that the Government is placing a lot of emphasis on the scrutiny function. The paper states that, ‘the best way to support councils to take on a stronger role is to increase their powers of scrutiny.’

Strengthening scrutiny may be one way to enhance the role of councils but is it really the best way? Is scrutiny the key to putting local government at the centre of decision-making in the locality? And is a desire to scrutinise really what motivates people to become councillors? Many of us would argue that the jury is still out on the effectiveness of scrutiny within local government. It is a model which has largely been transplanted from Whitehall without the level of resourcing that is a critical factor in the success of some parliamentary select committees.

But put that to one side, the Government wants to hear our views on broadening councils’ scope to scrutinise LAA partners, especially around expenditure. It wants to look at bringing more public services under the local authority scrutiny regime (and will be issuing statutory guidance on health scrutiny this Autumn), make council leaders ensure scrutiny is a core function and that it is adequately resourced.

Barriers and powers

The consultation document sets out how the Government’s approach to public service reform is now switching from a system based on targets and central direction to one where individuals have enforceable entitlements over the service they receive. What does this mean for local government? – a key role in ensuring these entitlements are delivered, the paper suggests. Tangibly government is proposing to introduce a specific power to enable councils to enage in mutual insurance arrangements; encourage local initiatives that foster closer working between primary care trusts and councils; explore reductions in the volume of central prescription and inspection explore how partnership workign could be streamlined

Climate change

 The Government wants to explore the role councils can play in meeting the UK carbon budgets. Ideas put forward include considering the local authority role in co-ordinating funding streams to support low carbon activity, supporting councils offering innovative financing for energy efficiency and perhaps even green mortgages. Sub-regional working Here the emphasis appears to be on sharpening accountability – for example by making sub-regional partnerships subject to scrutiny and exploring options around direct democratic accountability at the sub-regional level.

Central – local government relationships

 The consultation document sets out some proposed principles to articulate the most effective role of local government and asserts that central government complies with these principles already! The key issue around any such statement of principles is how can their impact be secured. The document proposes a joint parliamentary select committee to scrutinise broad adherence to the principles.

Summing up

So, scrutiny at both local and national level, is very much at the heart of this new consultation document. During the discussion after John Denham’s speech, Andy Sawford asked what the next steps would be. Is it a strange time to be launching a consultation, ten months before a general election? John Denham argued that whether parliamentary time could be found to enact any proposals requiring legislation in what will be a truncated parliamentary session would depend to a large extent on the response to the consultation. We’ll see.

Asked by Chris Leslie how the ideas set out in the consultation differentiated the Government’s localist credentials from those of the Conservative Party, John Denham argued that the Government was making a stronger commitment to ensuring national rights of entitlement – that you would get good quality services wherever you are in the country, whereas the Conservative approach would result in greater local variations.

A cynical view would see ‘national rights of entitlement’ which are consistent everywhere as not all that different from national targets and minimum standards of performance but clearly the Government feels there is an important distinction to be made.

Appropriately enough, given that we were at the Institute of Mechanical Engineers, a portrait of George Stephenson looked down on us all. As everybody knows, it was Stephenson who built the first public railway line.  The railways revolutionised almost every aspect of nineteenth century, they were a truly transformational change.  I guess if you feel that the scrutiny function is the best way of strengthening local democracy then you might feel that these proposals may also bring about signficant changes.  But I suspect that scrutiny may be more like canals were to the railways.

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Losing the personal touch

This year’s Dorchester Lecture was given by Robert Winston, the medical scientist and broadcaster. One of the issues that Lord Winston raised in his speech is the use of technology by today’s doctors. Lord Winston suggsted that doctors are losing the ability to assess patients in person. Rather than contact with the patient being the essence of medicine, he suggested in his speech that today doctors do an MRI scan or an x-ray and don’t alke to the patient.

Perhaps Lord Winston is guilty of being old-fashioned. After all it’s getting the diagnosis right that matters most. But I think his point is well made and has resonance for all of us in public services. We are all keen to exploit the cost-effective use of new technology to reduce expensive face-to-face transactions. Whether it is an automated check out at the library or the ubiquitious call centres and web forms, we perhaps, too, for all our talk about engagement are actually becoming increasingly impersonal and remote in our dealings with residents.

Of course we wouldn’t want to be without MRI scans, xrays or the option of paying for services on-line. But there is a challenge here – how do we realise the undoubted benefits of new technologies without missing the wood for the trees? In the anticipated drive for savings we should be mindful that councils are part of the fabric of the local community and much of their strength as organisations comes through real life interactions.

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Reconfiguring mental health services

I had a very interesting afternoon today at the Kings Fund where I was participating in the third in a series of discussions groups organised by West Kent Primary Care Trust as part of a consultation about services for people with complex personality disorders.  The consultation covers services for people throughout London, the East of England, South Central and South East regions – an area encompassing 62 PCTs.  The consultation was triggered by a decision to close the Henderson Hospital which is located in Sutton – one of two residential services in London providing what are called Tier 4 services.

The NHS categorises its mental health services into six tiers. Tier 1-3 services are offered in local communities.  Tier 5 and 6 services are provided in hospitals and other secure facilities for people who are at risk of harming others.  Tier 4 services are for people with complex personality disorders who may need extra care.

The NHS is consulting upon four different structural options, the main difference between the options concerns the balance between outreach community-based teams and the number of live-in facilities (none to four).  The discussion group included service users, clinicians, third sector practitioners and two local government officers.  Three fundamental issues were identified from the outset:

1) the difficulty of looking at Tier 4 services in isolation.  Whatever happens in Tier 4 is related to what happens in Tiers 1-3 and there was a general concern at a lack of integration, compounded by the variability in Tier 1-3 services across the 62 PCTs.  That said, it was also recognised that to try and tackle all the tiers in one consultation was probably not manageable.

2) the starting point should be an evidence-based understanding of people’s needs, the mix of service approaches which are likely to be the most effective and only then is it possible to determine the best structural arrangements.  Trying to identify the optimum number of live-in centres first felt like putting form before function.

3) There was a general view that individual PCTs are not willing to fund Tier 4 services and this was cited as the reason for the closure of the Henderson hospital.  Funding for Tier 4 services should be allocated centrally, it was suggested, otherwise whatever model of service provision was adopted it would not work.

The participation of service users in the discussion group was very positive and brought a dimension to the debate which I felt would otherwise have been missing.  For example, in emergencies some people with personality disorders may need residential treatment and one of the service users was able to talk powerfully about the impact of being locked up with psychotic patients (i.e. Tiers 5&6) in hospital in the absence of any alternative facilities.

While there seemed to be a general feeling that some kind of live-in treatment facilities were likely to be required, some participants emphasised the outcomes that could be achieved through providing intensive community-based services to out-patients.  In some ways it is a debate which is similar to the ‘care in the community’ discussion – to what extent are people’s best interests served by enabling them to continue living independently?  One clinician suggested that it was important to emphasise that the role of the NHS was to provide treatment not accommodation.  He suggested that perhaps partnership arrangements with housing providers should be explored in a new model of provision rather than NHS residential centres.

One of the ideas which emerged from the discussion was that rather than putting all the available resources into a combination of community teams and residential facilities, a significant proportion of the available funding could be put into building capacity – improving the training available to staff, developing an evidence base to improve understanding of which interventions are most effective and ensuring that best practice and knowledge is shared more effectively.

I took away a number of things from the session including a much better appreciation of the complexity of the issues around mental health service provision; how faced with this kind of complexity we often take refuge in structural arrangements and above all, the value in bringing together a disparate mixture of people to problem-solve in this way.

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