#NextStageRadicals @RSAinLondon @theQCommunity Mark Hall Deputy - - PowerPoint PPT Presentation

Next Stage Health, Care and Public Services 19/03/2019 #NextStageRadicals @RSAinLondon @theQCommunity

Mark Hall Deputy Head of Engagement The RSA @markhallrsa

Ian Burbidge Associate Director, Public Services and Communities The RSA @ianburbidge

Morning Agenda

09:45 – Welcome & Intro 09:55 – Radical Models of Organising 10:15 – Radical Model of Public Service 10:30 – Radical Models of Commissioning 10:50 – Radical Models of Regulation 11:10 – Tea/Coffee Break 11.35 – Radical Models of Leading & Learning 12.20 – Action Café Intro 12.45 – Lunch

What is the biggest challenge you face to implementing/supporting new ways

• f working?

What is the question, which if answered at this event, could help you most?

Local Cornerstone Presentation 2018

Local Cornerstone

@CornerstoneScot @Edelharris #LocalCornerstone

Our Vision – Local Cornerstone

Let us continue to put people at the centre of our activity and assist them to live the life they choose Let us continually strive to do more than we are contractually obliged to do Let us demonstrate that we genuinely value social care as a profession Let us use our charitable income to do some amazing things that help all the people we support to live a valued life

Local Cornerstone Presentation 2018

What is Local Cornerstone?

22/03/2019 11

Thank you

Helen Sanderson Founder Wellbeing Teams @HelenWBTeam

Janette Patsy Shirley Becky Jodie Scheduler Meeting facilitator Recorder Recruitment Storyteller

Confirmation practices Tactical meetings and Slack

Challenge? Commissioned by the hour

Success?

Radical New Models of Public Service

Mark Smith Director, Public Service Reform Gateshead Council March 2019

Case Study: ‘Juliet’

• Council Tax Debt, rent arrears
• Single mum, 11 year old child
• Depression, mental health problems
• ASB, fear of neighbour
• Overwhelmed by referrals
• ‘Hiding’ – “It’s too difficult”
• 30 min walk to new school
• Uniform
• Child behaviour starting to worsen
• “My life is ****”
• Debt as trigger, explored context

with visit

• Benefits were wrong – ate into debt
• Helped move closer to school
• Helped with uniform
• CAB helped with rest of debt
• Sister helped to support emotionally
• Took on more hours at work
• Training for qualifications
• Child settled down at secondary

school

• “Thank you for making my family

happy” COST: £90 + 6 visits and 9 phone calls

PSR Premise

Demand into core services Thriving in Gateshead

Decrease demand by improving situations 19% thriving 32% vulnerable

• Base method

Effective

• Community
• wnership/

adaptation

• Money
• Support

services

• Structures
• Governance

Sustainable Phase 1 1→2 2→3 3→IC Phase 2

How can we help people based upon a signal? What works? What makes that easy/difficult? What’s stopping us deploying this everywhere? How can we do this across an entire community and across the whole wellbeing system? Do we know what we want to be the ‘new normal’?

• Teams
• Roles
• Processes

Efficient

How can we make it easy to do this?

Phase 3 Direct action

Phase One Prototype – Using the Learning

• Base method

Effective

• Community
• wnership/

adaptation

• Money
• Support

services

• Structures
• Governance

Sustainable Phase 1 1→2 2→3 3→IC Phase 2

How can we help people based upon a signal? What works? What makes that easy/difficult? What’s stopping us deploying this everywhere? How can we do this across an entire community and across the whole wellbeing system? Do we know what we want to be the ‘new normal’?

• Teams
• Roles
• Processes

Efficient

How can we make it easy to do this?

Phase 3 Direct action

What we did…

We explored whether CTax debt is a good signal of wider need? We created a small and temporary team We tried a holistic approach We agreed on some basic rules and principles We built a network We focussed upon a single purpose: “Help me to thrive”

Case Study: ‘Mary’

• Call out of the blue from employee
• No light source, bar the TV
• Mould everywhere
• Huge utility debt
• Isolated, not eating much
• Potential £ abuse
• Freezing: layers of clothes
• Smell of urine, psoriasis on head
• Learning difficulties
• Would not look up
• “This is desperate” – GP
• “The worse I’ve seen” – Police Sgt
• Acted from visit one – food, power
• Many agencies got involved via a pull
• Got the place clean, got the GP out
• Sorting utilities and finances
• Police investigating
• Neighbours involved
• Daily visits
• She looks up
• She looks better
• She cleans
• She eats
• She has her money, a bank account

COST: £1600 + 30 visits

What happened?

40 people

15 CTax signal 25 referrals

6 ‘Trapped’ 30 ‘Tangled’

2 not engaging 2 “won’t pays”

• 1,500+ actions
• @70 people contacted to help
• 70% (28) are happier with their

life and their prospects have improved

• 6 (15%) were no better, still

declining

• Over 50% of those helped saw

positive action that made a difference to them on the first encounter Team morale high No one wants to ‘go back’ Total cost @£70k

• £60 staff costs for 6 months
• £10k for casework costs

Relationships solve problems, rather than services and hierarchies Compassion and empathy systematically lead to innovation Simple, small scale actions and interventions are effective and good value We need to rethink what we mean by control Support is what we need to most and do the least Focussing upon efficiency via projects makes us less effective and less able to change Signals are a huge opportunity to reduce demand and inequality We don’t really know a problem until we know its context Eligibility criteria and screening Assessment “Boundaries” Front line roles, autonomy, authority, creativity Commissioning Role of leadership How the money works What we do, fundamentally How we ‘do ‘change Using intelligence to be proactive How we communicate, through word and deed Innovation is practically simple and culturally hazardous

Intervention Support Transaction

£££ ££ £

Building a proactive, preventative capability

• Responding to signals as well as

triggers/referrals

• Equipping front lines to understand

and solve problems holistically

• Rethinking autonomy and

management

System-wide resources

• Understanding the specific money

and capacity the falling demand can save

• Investing to accelerate this once we

are confident

Commissioning and contracts

• Making small scale and bespoke easy

where it needs to be

• Developing local wealth and

economies

• Commissioning for complexity

Regulation and inspection

• Identifying any tensions between

reform and regulation

• Establishing/augmenting existing

relationship with regulators that allow for innovation

The wider system across Gateshead

• Building in communities and partners

to create bespoke arrangements that work

• Understand where to lead, follow,

enable or leave alone and how this might vary

Taking direct action

• Council Tax/Debt recovery
• Personality disorders
• Universal Credit
• Growing the ‘groundswell’

Six specific challenges to chew over…

What are your key takeaways? Do you recognise any shared challenges/opportunities?

Radical New Models of Commissioning: Human, Learning, Systems

• Dr. Toby Lowe

Newcastle Business School

Summary

• What does working in complexity mean?
• Implications of complexity for

commissioners

• Embracing complexity:

Human Learning Systems

What does it mean to work in complex environments?

Complexity

People are complex Issues are complex Systems are complex = embrace complexity, because life is complex

Implications for commissioning OUTCOMES ARE NOT DELIVERED BY ORGANISATIONS!

The outcomes we desire are emergent properties

• f complex systems

The purpose of commissioning

• Commissioners DO NOT purchase services which

deliver outcomes

• Commissioners DO nurture the systems from which
• utcomes emerge - enabling collaboration and

coordination

They commission activity which:

• Responds to human variety
• Adapts to change

Commissioning practice

No more:

• Process specification
• Output targets
• Outcome targets

So what else can we do?

Key ideas

Funding, Commissioning and Managing in complexity involves: Being Human to one another: put on your VEST Learning and adaptation: improvement requires continuous learning Systems: Nurture healthy systems in order to create positive outcomes – be a System Steward

Human

To be Human, put on your VEST:

• Respond to Variety of human need and experience
• Use Empathy to understand the life of others
• View people from a Strengths-based perspective
• Trust people with decision-making

For Commissioners means:

• Long term funding
• Funding without Performance Measures/KPIs – they make it

more difficult to create good outcomes and they waste time & money

• Fund those organisations you trust to build effective human

relationships with people – e.g. Plymouth – £80m, 10 year Alliance contract

Learning

Young Foundation, Stages of Social Innovation

Current view: Learning is a phase in social innovation

• Learn & experiment.
• Find “what works”
• Do more of that

Learning

In a complex environment, learning is a continuous process There is no such thing as “what works” – because “what works” is always changing. “What works” is a continuous process of learning and adaption. = funders and commissioners are “purchasing” the capacity for organisations to learn and adapt.

Systems

Commissioners are System Stewards

What does a healthy system look like? Lankelly Chase System Behaviours:

Perspective

• People view themselves as part of an interconnected whole
• People are viewed as resourceful and bringing strengths
• People share a vision

Power

• Power is shared, and equality of voice actively promoted
• Decision-making is devolved
• Accountability is mutual

Participation

• Open, trusting relationships enable effective dialogue
• Leadership is collaborative and promoted at every level
• Feedback and collective learning drive adaptation

Thanks for listening

toby.lowe@northumbria.ac.uk @tobyjlowe Exploring the New World:

RADICAL MODELS OF COMMISSIONING: Commissioning Challenges for New Models Kathryn Caley Operations Director, SK Nurses

19th March 2019

52

53

• Short term contracting / commissioning cycles

Insufficient time to initiate change, embed change & realise benefits

• f change. Need min 2 years but longer timescales would be even

better to make realistic judgements / carry out meaningful (and quantifiable) evaluation

• Which system partner makes the “investment to

save”? or

• What share of the investment does each partner

contribute?

Impact of successful new models are likely to be system wide Not clear up front what the savings benefits will be and what proportion each part of the system will benefit

54

• Can cash savings actually be realised?

Does success mean cash is released or does success simply create more capacity to absorb existing demand. Creating capacity to help manage increasing demand is a reasonable ambition but cash strapped systems cannot always identify this “extra” investment

• Poor understanding of existing clinical outcomes

and costs of community based services

Difficult to evaluate the clinical & cost effectiveness of new models in comparison with existing models. Many existing “hidden” costs that can be overlooked in economic evaluation of new models e.g. costs associated with service duplication, repeat activity that does not deliver clinical benefit, bureaucratic overheads

55

• Perceived risk associated with new organisational

models

Self managed models - Concerns around governance & regulation Social enterprise models – political issues around perceived privatisation; concern about sustainability Old Power vs New Power (New Power: how it’s changing the 21st century and why you need to know; Henry Timms & Jeremy Heimans; 2018)

Thank you for listening

Kathryn.caley@sknurses.co.uk @sknurses

Jeremy Cox FRSA Helen Sanderson FRSA

Radical Models of Regulation

resting heart rate – a Registered Manager

what happened ?

the provider experience

Registration & Inspection Inconsistency “Encourage improvement?”

the challenge for regulators

“Structure produces behaviour, & changing underlying structures can produce different patterns of behaviour”

Peter Senge

what do you see?

“We ensure health & social care provides safe, effective, compassionate, high-quality care, & we encourage care services to improve”

pa pathol thologi gical cal …… pur purpos poseful ul

a framework for collaboration

pa path thologi gical cal

Unequal power Defensive reasoning Formal interactions Design for compliance, gaming to hit numbers Reactive response to regulation Contain the inspector

re regul gulator tory mechani hanisms

1.

• 1. antici

cipatory 2.

• 2. direct

ctive

• 3. organisational
• 4. relational
• 5. informational
• 6. stakeholder
• 7. lateral
• 8. systemic

Pur urpo poseful ul

Power shared - mutual trust & respect Generative - productive reasoning & appreciative enquiry Space for informal interaction Design for value Mutually agreed ways of working & capability- building Transparency &

• penness

8 regulatory impacts source: King’s Fund / University of Manchester 2018

Integration

 Today: Inspect & rate individual

providers

 Integration means greater

complexity

 Complexity requires



a systems view



a balance of the 8 mechanisms

to summarise…

regulator

provider Tak ake r respons

• nsibility

work on both sides to correct the power imbalance Be P Pragm agmatic the regulator will be stronger & slower than the provider Stay pr princi ncipl pled use ‘pathological to purposeful’ & the 8 mechanisms Inno nnova vate f for

• r i

int ntegration

• n

‘inspect & rate providers’ won’t cut it

• Does this resonate with your

experience ?

• Can you influence provider,

regulator or both?

• Where can you start?

please discuss through the day…

Radical Models of Leading and Learning #NextStageRadicals @RSAinLondon @theQCommunity

Action Café Intro #NextStageRadicals @RSAinLondon @theQCommunity

Aft fternoon Agenda

13:45 – Action Café Part 1 15:00 – Tea/Coffee Break 15:20 – Action Cafe Part 2 1630 – Wrap up & Close

Action Café Part 1 #NextStageRadicals @RSAinLondon @theQCommunity

Round 1

What is the quest behind the question? Try to go deeper than the story provided by the table host.

Round 2

What is missing? Once the quest has been redefined, what makes the picture more complete? Broaden the picture. What areas haven’t been covered?

Action Café Part 2 #NextStageRadicals @RSAinLondon @theQCommunity

Round 3

What next steps will I take? What help do I need? What did I learn?

Wrap Up #NextStageRadicals @RSAinLondon @theQCommunity

What will you commit to taking forward / doing differently following this event?