Why Public Services Find It So Hard To Deliver What Matters - - - PowerPoint PPT Presentation

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Why Public Services Find It So Hard To Deliver What Matters - - - PowerPoint PPT Presentation

Mar 28, 2024 35 likes •248 views

Why Public Services Find It So Hard To Deliver What Matters - Reshaping Services at Locality Level Simon Pickthall - Vanguard Cymru Vanguard Consulting Ltd Thinking Governs Performance Management Thinking Doing better things System

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Vanguard Consulting Ltd

Why Public Services Find It So Hard To Deliver What Matters - Reshaping Services at Locality Level

Simon Pickthall

  • Vanguard Cymru
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Vanguard Consulting Ltd

Thinking Governs Performance Performance System Management Thinking

Doing things better Doing better things

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Counter-intuitive ideas

All demand is ‘work’ Value demand & Failure demand

If you feel uncomfortable - go study!

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  • What Ruth said she wanted - what mattered to Ruth:
  • “I need help with housework and...”
  • “...gaining access to the upstairs of the property.”
  • “These two things would have such a profound effect on mine

and the children’s lives.”


  • What Ruth received:
  • The same anger management course twice for two boys
  • The same parenting programme twice
  • Help cleaning one bedroom
  • Toilet frame, perching stool and bath board for a bath she

could not access

  • Family intervention programme
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Vanguard Consulting Ltd

  • What Ruth said she wanted - what mattered to Ruth:
  • “I need help with housework and...”
  • “...gaining access to the upstairs of the property.”
  • “These two things would have such a profound effect on mine

and the children’s lives.”


  • What Ruth received:
  • The same anger management course twice for two boys
  • The same parenting programme twice
  • Help cleaning one bedroom
  • Toilet frame, perching stool and bath board for a bath she

could not access

  • Family intervention programme

Cost of Doing What Matters to Ruth

  • Total - £20,760

Cost of Services to Date

  • Total - £106,777
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  • And it took this many people to deliver it...
  • 8 social workers
  • 22 support workers allocated
  • 30 referrals
  • 16 assessments
  • 36 teams/services
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  • Between 1996 and 2012 Ruth had 129 different

interactions with public-sector agencies. From running a successful business with her first husband she deteriorated to having ill health, her children removed and being entirely dependent on the public purse.

  • Ruth was taken on by one of the new ‘Wellbeing’ teams

piloting locality working; she is now in suitable accommodation with her children and her situation has stabilised.

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Counter-intuitive ideas

All demand is ‘work’ Value demand & Failure demand

If you feel uncomfortable - go study!

Standardise and specialise Design against What Matters

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Check Plan Do

Change must be based on knowledge, not

  • pinion

Study Experiment

Make normal

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What matters to people in these systems?


  • “Just talk about what matters to me”
  • “Understand my specific concerns, don’t use a

menu of services to solve problems you think I have.”

  • “Feeling valued – feeling I contribute – social

involvement”

  • “Be transparent in your work”
  • “Wanting to be independent”
  • “A key person – one point of contact”
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Different Thinking - Different Solutions

  • We start from the demand in a locality, and

design public services to meet that demand.

  • This is not the same as changing local authority

boundaries.

  • This is not the same as ‘co-location’ - co-location is

necessary but not sufficient.

  • This is radical redesign of the entire public

service from first principles - restructure across existing organisations based on knowledge of local demand.

  • Common Purpose, Common Measures, Common

Principles

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Common Purpose

“Help Me Live a Good Life or Die a Good Death.”

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Cost%Analysis%Comparison

Police Social%Services Health%Service Local%Authority Education

£2k £6k £10k Historic% Approach Principles@ Based%Approach £%%83,649% £%%824 £%%3,379 £4k £8k £12k £14k £80k £%%646 £%%2,859 £%%214 £%%3,818 £%%33 £%%493

Principles.based2Approach £%2,210%

2%

£££ 99% £££ 81% £££ 93% £££ 99%

£%106,777% Historic2Approach

Multi@agency% Mtngs

2 4 6 8 10

I%am%listened%to% and%heard I%have%more% confidence% My%financial% problems%are% sorted My%children%can% sleep%in%their%

  • wn%room

My%children% have%space%to% play I%have%some% space%of%my%

  • wn

I%am%able%to% manage%my% home%better Our%sleeping% arrangements% do%not%affect% Start 29.06.12 24.09.12

I22need2serious2help (multiple2complex2needs) I2could2go2either2way2(multiple2problems)2 I2am2in2balance2but2need2a2little2help

5% 31% (64%)

Tier22122Individual2

Outcomes/2Economics2

Tier2222.2Geography2

Capacity2/Scalability2

Tier22322Strategic2

Demand2Reduction2&2 Cost2Removal2

Street2number Street2name Poctcode CYP2 Referral CYP2Re. referral CYP2asst.2 to2service Rent2 Arrears YAMH ASB VA Crime Count2of2 Flags A CARSON%ROAD ST%6%7BG Y N N Y N N N Y 3 B CROSSLEY%ROAD ST%6%7AJ Y N N Y N N N N 2 C BARNETT% GROVE ST%6%6NA Y N N N y N N N 2 D CROSSLEY%ROAD ST%6%7AJ Y Y Y N N N N Y 4 E CROSSLEY%ROAD ST%6%7AJ Y N N N N N N Y 2 F CROUCH%AVENUE ST%6%7HT Y N N N N N N N 1 G GALLIMORE%CLOSE ST%6%4DZ Y N N N N N N N 1 H GREENBANK% ROAD ST%6%7EY Y N N N N N N Y 2 I HUNTILEE% ROAD ST%6%6EP Y N N N N N N N 1 J IRENE%AVENUE ST%6%7HB Y N N N N N N N 1 K IRENE%AVENUE ST%6%7HB Y Y N N N N N N 2 L NORRIS%ROAD ST%6%7AS Y N N N N N N Y 2

Common Measures

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Common Principles

  • We will listen to understand and communicate

clearly

  • We will work with you and bring together only those

people who can help you live your good life

  • The focus of our intervention will be to facilitate

solutions

  • We will actively engage with our local communities,

support networks and other sectors to develop alternative opportunities for people

  • We will only capture information once which is

appropriate and relevant to our purpose

  • We will solve problems that stop the front line

helping people live their good lives

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Adult Social Care

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Social Care

Sample Size 93: 12 prevented hospital admissions 25 reduced lengths of stay 6 prevented admissions to long term care homes 10 prevented carer breakdowns 29 prevented packages of care 18 reduced packages of care 7 prevented equipment provision

  • Sample Size 250+:

24.1% of referrals previously led to statutory funded packages of care - now down to 10.9%. 28% reduction in residential and nursing care placements. Average domicillary care packages reduced from 12 hours to 9.7 hours per week. 46% reduction in contacts into Social Services. Underspent community care budget (cost avoidance of £1.5 million in 2013-2014). 30% reduction in assessments. Re-referrals reduced from 46% to 10%.

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100 200 300 400 500 600 Yr1*Q1 Yr1*Q2 Yr1*Q3 Yr1*Q4 Yr2*Q1 Yr2*Q2 Yr2*Q3 Yr2*Q4

Cummulative*Comparison*of*Pre*and*Post3Intervention*Activity:*All*Cases*

Pre.Interventioin*Transactions*(Cummulative) Count*.*Post.Intervention*87*47*10*0*0*0*0*0

All*Cases*Collective*Summary**

*£. *£20,000 *£40,000 *£60,000 *£80,000 *£100,000 *£120,000 *£140,000 *£160,000 *£180,000 Yr1*Q1 Yr1*Q2 Yr1*Q3 Yr1*Q4 Yr2*Q1 Yr2*Q2 Yr2*Q3 Yr2*Q4

Cummulative*Comparison*of*the*Number*of*Pre*and*Post3Intervention*Transactions:*All*Cases*

Pre.Interventioin*Cost*(Cummulative) Post.Interventioin*Cost*(Cummulative)

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System and Practice

We cannot expect individuals working at the frontline to practice differently, if the system is not designed to encourage and support this.

We must change the system first.

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Localities Report

https://www.vanguard-method.com/news/? story=39&curpage=0

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Simon Pickthall

  • Vanguard Cymru

simon.pickthall@vanguardwales.co.uk 07951 481878

Why Public Services Find It So Hard To Deliver What Matters - Reshaping Services at Locality Level

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Some further reading

The Toyota Production System

  • Taiichi Ohno

The New Economics

  • W. Edwards Deming

I Want You to Cheat Freedom from Command & Control; a Better Way to Make the Work Work Systems Thinking in the Public Sector

  • John Seddon (Vanguard)

Punished by Rewards

  • Alfie Kohn

The Machine That Changed the World

  • Womack, Roos & Jones

Understanding Variation

  • Donald Wheeler

Tracking Medicine

  • Jack Wennberg

www.vanguard-method.com wellbeing.vanguard-method.com

  • Vanguard Websites – lots of content

www.livesthroughfriends.org