News and Comment

Local authority leaders need to make radical change to our children’s and adult systems

Friday 29 October 2010

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A major strategic challenge in public services is redefining and renegotiating the relationships between individuals, communities and public services by replacing ‘doing unto’ with ‘doing with’, replacing ‘one-size-fits-all’ with individual budgets and personalisation and replacing  outmoded universal services with the co-production and support that friends, family and community can provide.

Without a major shift in these relationships we cannot hope to tackle our social issues, including the twin problems of old age and dementia and ingrained poverty for particular families. A shift in relationship that offers potential could see the public as donors to charitable providers via co-payment as well as through individual payments to supplement state provision.

Local government and their partners are in pole position as lead commissioners of local services and can use their wider influence with local businesses to make better strategic decisions to meet these challenges. Directors of adult and children’s services share the lead in commissioning services that support people in need. When they are effective they can break cycles of deprivation.

For example, strategic commissioners can reshape services for the three per cent or so of families who are typically receiving the attention of as many as 30 different practitioners at vast cost and to very little good effect. While this is now well known, commissioners in local authorities need to change entire systems to establish effective ways of working with these households using evidence from successful approaches such as ‘Think family’, family interventions projects and family nurse practitioners to drive system change.

The approaches applied in, for example, Gateshead, Gloucestershire and Croydon, show that it may be possible to provide better services and save as much as 50 per cent of costs, with promising results emerging within 12 months of starting. Further benefits and cost savings are possible by moving resources into effective prevention and away from high-cost, last-resort services. The challenge for leaders is therefore to redesign systems and reallocate the resource currently tied up in traditional service teams across the system.

There is very little to be gained by change at the margins especially if it involves setting up yet another special project or programme without fundamental change to the system.