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 Doing things better Performance Vanguard Consulting Ltd
Counter-intuitive ideas If you feel uncomfortable - go study! All demand is Value demand ‘work’ & Failure demand 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 Vanguard Consulting Ltd
• What Ruth said she wanted - what mattered to Ruth: Cost of Doing What Matters to • “I need help with housework and...” Ruth • “...gaining access to the upstairs of the property.” � • “These two things would have such a profound effect on mine Total - £20,760 � and the children’s lives.” • What Ruth received: • The same anger management course twice for two boys Cost of Services to Date • The same parenting programme twice � Total - £106,777 � • Help cleaning one bedroom • Toilet frame, perching stool and bath board for a bath she could not access • Family intervention programme Vanguard Consulting Ltd
• And it took this many people to deliver it... • 8 social workers • 22 support workers allocated • 30 referrals • 16 assessments • 36 teams/services Vanguard Consulting Ltd
• 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. Vanguard Consulting Ltd
Counter-intuitive ideas If you feel uncomfortable - go study! All demand is Value demand ‘work’ & Failure demand Standardise and Design against specialise What Matters Vanguard Consulting Ltd
Change must be based on knowledge, not opinion Study Check Make normal Experiment Do Plan Vanguard Consulting Ltd
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” Vanguard Consulting Ltd
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 Vanguard Consulting Ltd
Common Purpose “Help Me Live a Good Life or Die a Good Death.” Vanguard Consulting Ltd
Common Measures Demand2Reduction2&2 Tier2232 � 2Strategic2 Cost2Removal2 Tier2222.2Geography2 CYP2 CYP2Re. CYP2asst.2 Rent2 Count2of2 Capacity2/Scalability2 Street2number Street2name Poctcode Referral referral to2service Arrears YAMH ASB VA Crime Flags A CARSON%ROAD ST%6%7BG Y N N Y N N N Y 3 5% B CROSSLEY%ROAD ST%6%7AJ Y N N Y N N N N 2 I22need2serious2help C BARNETT% GROVE ST%6%6NA Y N N N y N N N 2 (multiple2complex2needs) 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 31% 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 I2could2go2either2way2(multiple2problems)2 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 (64%) K IRENE%AVENUE ST%6%7HB Y Y N N N N N N 2 I2am2in2balance2but2need2a2little2help L NORRIS%ROAD ST%6%7AS Y N N N N N N Y 2 Cost%Analysis%Comparison I%am%listened%to% Outcomes/2Economics2 Historic2Approach Principles.based2Approach and%heard £%106,777% £%2,210% Tier2212 � 2Individual2 10 Multi@agency% Our%sleeping% Mtngs I%have%more% 8 arrangements% confidence% 6 do%not%affect% � £%%83,649% 4 Start £80k I%am%able%to% 2 My%financial% £14k manage%my% problems%are% 29.06.12 0 £12k home%better sorted 2% 24.09.12 £10k I%have%some% My%children%can% £8k £££ £££ £££ £££ space%of%my% sleep%in%their% £6k 99% 81% 93% 99% own own%room £%%3,818 £4k £%%3,379 £%%2,859 My%children% £2k £%%824 £%%646 £%%493 £%%214 £%%33 have%space%to% Vanguard Consulting Ltd Social%Services Local%Authority Health%Service Police Education play Historic% Principles@ Approach Based%Approach
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 Vanguard Consulting Ltd
Adult Social Care Vanguard Consulting Ltd
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%. Vanguard Consulting Ltd
All*Cases*Collective*Summary** Cummulative*Comparison*of*Pre*and*Post3Intervention*Activity:*All*Cases* 600 500 400 300 200 100 0 Yr1*Q1 Yr1*Q2 Yr1*Q3 Yr1*Q4 Yr2*Q1 Yr2*Q2 Yr2*Q3 Yr2*Q4 Pre.Interventioin*Transactions*(Cummulative) Count*.*Post.Intervention*87*47*10*0*0*0*0*0 Cummulative*Comparison*of*the*Number*of*Pre*and*Post3Intervention*Transactions:*All*Cases* *£180,000 *£160,000 *£140,000 *£120,000 *£100,000 *£80,000 *£60,000 *£40,000 *£20,000 *£. Yr1*Q1 Yr1*Q2 Yr1*Q3 Yr1*Q4 Yr2*Q1 Yr2*Q2 Yr2*Q3 Yr2*Q4 Pre.Interventioin*Cost*(Cummulative) Post.Interventioin*Cost*(Cummulative) Vanguard Consulting Ltd
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. Vanguard Consulting Ltd
Localities Report https://www.vanguard-method.com/news/? story=39&curpage=0 Vanguard Consulting Ltd
Why Public Services Find It So Hard To Deliver What Matters - Reshaping Services at Locality Level Simon Pickthall - Vanguard Cymru simon.pickthall@vanguardwales.co.uk 07951 481878 Vanguard Consulting Ltd
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 Vanguard Consulting Ltd
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