John Seddon reflects on how a systems thinking method has improved public services but is now under threat from cuts, commissioning and ‘big society’ as the government fails to move beyond central control and large-scale initiatives.
David Cameron described the ‘big society’ as a ‘culture change’, where people are free and powerful enough to help themselves and their communities. He said government must foster and support a new culture of philanthropy and social action.
The good news: we have a growing body of evidence of where services have been improved, setting economic benchmarks, at the same time as improving community life. The first example of the vanguard method – a systems thinking approach – in action in health care is delivering better stroke care at half the cost. Patients and families are much happier and have confidence in the health service. In many examples of benefits processing in local authorities, benefits are sorted in days and the whole of peoples’ circumstances are taken into account; claimants are delighted and take a more constructive attitude to their own circumstances and their local authority. In policing, dropping the centrally-promulgated labels for ‘crime’ and ‘incidents’ in favour of understanding how communities define their problems leads to resolution of problems, improving both community cohesion and the community’s relationship with their police. In social care, joint studying and re-design between local authority and health services is delivering improved social care at massively less cost; helping people who need support to live with dignity within their communities. And in housing we have seen the private and public sectors working together to deliver repairs on the day and at the time tenants want. In fact this was our first lesson in the impact of good service design on community cohesion: people take greater responsibility for their own ‘space’ when services work.
All of the above examples employ the vanguard method for service design. They understand the nominal value of the service user, they absorb the variety of this demand, they have better means of control, using measures that relate to the purpose of the services from the users’ point of view, they are designs that have emerged from studying rather than being ‘planned’ or ‘specified’ in any sense and they demonstrate that better service can be provided at much lower costs – they drive out costs by managing value. They exploit, in a positive way, the systemic relationship between purpose, measures and method.
Beyond the application of the vanguard method to service design, we see other important innovations occurring in communities: ‘Local area coordinators’ provide continuity in relationships with people who need support, accessing that support from statutory, voluntary and community resources. Token economies: where people gain credits for their efforts in helping others and exchange the tokens they earn for help that they need. And we see investment of peoples’ time being matched by cash from local government to pursue local initiatives to solve real problems.
All of the above could be construed as within the rubric of the ‘big society’. Yet they are not; paradoxically many of these innovations are at risk from the ‘big society’.
The Local Government Chronicle recently ran a feature on the ‘big society’, to mark its first anniversary. What did we learn? Of the four ‘vanguard’ local authorities, one had withdrawn from their ‘vanguard’ status for political reasons and the other three had simply re-labelled initiatives they had already started a year ago as ‘big society’ initiatives. When we ask people we are working with in local authorities about their take on the ‘big society’, most give us blank looks.
What is government doing? Two things: the first is pulling a lever marked ‘scale’. The government is driving ‘commissioning’, the delivery of services against specifications with a preference for large-scale organisations as suppliers. For example in drug treatment, social, and health care we see contracts being awarded to providers who are obliged to deliver services as specified. The result is a failure to meet the nominal value of service users. For example, people who need help with bathing get their thirty minutes, no less, no more; and it may mean a different person on each visit. What ought to be a thermostat in the care system is removed; there is no incentive to re-enable people. Similarly with drug treatment, we see treatment professionals being obliged to follow the ‘treatment’ as specified in their contracts, spending as much as 50% of their time in bureaucratic reporting of compliance while the ‘treatments’ fail to meet the variety of drug users’ needs. With meals-on-wheels contracts we have seen specific instructions not to report on a change in the condition of the meal recipient (‘just do what the contract says’).
Ministers believe that scale will reduce costs. By contracting for ‘transactions’ they may well see a reduction in the transaction costs but as these standardised services fail to meet the users’ needs, costs can only rise. Some of these costs will be knowable, the greater unknowable.
Ministers also believe that ‘choice’ will drive up quality and drive down costs. I should point out that there is no evidence in the economics literature to support this view; it is no more than an ideological belief. Regardless, commissioning is reducing choice; it is driving many local voluntary services out of business as they do not have the clout to bid for contracts. At the same time, cuts to local authority budgets have been passed through as funding cuts to thousands of local voluntary providers. We have seen local area coordinators sacked, shocking when you know that these people are the means for dealing with the variety problem in the context of community services: local area coordinators worked because they ‘pulled’ services to needs; but they are replaced by commissioning, which ‘pushes’ specifications without regard to needs.
Local authority people are being schooled by central government on how to do commissioning; how to specify the services required and establish measures to control the providers on the bases of unit cost and activity. Meeting specifications is about as far as you can get from meeting purpose and, ironically, meeting purpose would drive costs down, as the examples I began with illustrate.
The second thing the government is doing is employing an organisation (Locality) to send hundreds of ‘activists’ in to communities, whose job it is to encourage the ‘big society’ to happen. Sending out activists to create the ‘big society’ may create some activity, especially where people have problems they want to solve, but it is not an effective method for creating change, not least because it implicitly discounts those who are currently doing great work. Recognising these people is the better place to start.
Fritz Schumacher, claimed by some to Cameron’s inspiration for the Big Society, said you have to start at the human level if you want to change society. The first task, he argued, is to recognise people who are already doing something about it, to support them and ask: what do we need to do as government to ensure that more of this good work happens elsewhere? He, like other economists, warned that the de-humanisation of work will lead to the failure of society; in the context of the Big Society, making work instrumental (adhere to contract) is to go against the grain; instead work should be purposive and vocational – just as it already is for many who now feel disenfranchised by the Big Society.
To give him credit, Cameron also said that top-down, top-heavy, controlling micro-management from the centre doesn’t work and only serves to sap energy and diminish contribution. But illustrating the centre’s belief in ‘levers’, he and his ministers pull the lever marked ‘big’, replacing micro-management with macro structure.
Cameron said you can call it liberalism, you can call it empowerment, you can call it freedom, you can call it responsibility, but, he said, ‘I call it the Big Society’. If we had to choose a better operational definition for the ‘big society’ maybe it should be called Big Business or, perhaps, the Big Folly. Suggestions welcome.
But I do not despair. The costs of the scale initiatives will emerge, in time, and embarrass the politicians, the problems we have in our communities will not go away and in the meantime, those who are delivering services that work which are also having profoundly beneficial effects on their communities will continue, even if under the radar. Some, of course, will lose their jobs but they will never lose what they now know.
To give a final example: people responsible for housing allocations learn, when they study the service, that most of the people on the housing waiting list will never qualify for a house, so they let these people know where they stand and take them off the list. They also learn that there are many people on the list who have a problem which would not be solved by providing housing and they work to help these people take responsibility and solve their problems in their communities. And, when they get down to the few who actually need a home, this shorter list can be accommodated. These new, citizen-focused, problem-solving designs, delivered by people that Cameron would describe as ‘empowered’ (noxious term), which build strength into communities, also operate at much less cost.
As Schumacher observed, small really is beautiful.
This article originally appeared in Vanguard News, August 2011
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