A decade ago SOLACE (Society of Local Authority Chief Executives) produced a document that looked at possible future scenarios for local government (Rebirth or Stillbirth?). It warned of an obsession with targets, processes, and inspections, which would result in the actual services experienced by the public being degraded, or worse not meeting its needs.
About a month ago I went to a care conference sponsored by Vanguard Consulting and the contributions from local authority guest speakers (both front line staff and managers) highlighted a number of key issues that bedevil both children’s and adult care services at the moment. The typical issues are:
• It is easier to give any service rather than what a client wants or needs. Staff are customer focused, but many current systems are not, and this is made worse by targets. For example a Midlands council discovered that when it checked 28 cases, 4 were new, and 24 were revisits of old cases, and they also discovered there is an alternative universe where staff are doing private deals to get things done and give the client what they want or need
• A tendency to try and “close” cases as soon as possible as it “reassures” managers, and ultimately politicians and the media, that things are alright
• There is simply too much information to process on a daily basis
• Too much work is failure demand (i.e. re-dealing with old cases, rather than new cases). And the system has too many stages in the process and hence is slow and fails to meet customer needs in a timely fashion. For example, a council set out the issues with its Disabled Facilities Grant system: preventable demand was 71% of the work and there were 291 steps to the grant process, of which only 20 were required
• The way to cope with failure demand to date has been to raise thresholds to make it more difficult to access services, ultimately leading to higher costs – as inevitably only the most difficult and expensive cases are handled. In other words, work focuses on crisis and not prevention
• Too much energy is spent on monitoring cases, and not solving problems
• The current situation is pre-occupied with assessment, which then unlocks care and treatment. This often results in people getting simple help too late, and particularly for the elderly, this means their quality of life deteriorates, and they then require more expensive interventions
• There is genuine confusion about the role and understanding of the skills the staff have. The current system asks them to carry out roles (e.g. IT based work) for which they are not trained professionally
All of which sounds terribly depressing and could confirm that SOLACE’s warnings were right, yet I believe there is considerable hope for the future.
Now we know the problems we can do something about it. I think there is now widespread acceptance that the top-down process and target-driven approach to running public services (usually steered from Whitehall), that has characterised the last 15 years or more, has not worked. If anything it has driven up costs, failed to deliver what people want and caused public service professionals much pain. There is a realisation that the public really do want services from high quality, highly trained professionals who spend time with them, rather than filling out forms or being on the end of a phone line. Consequently I think there is an increasing focus on the “front line” and what it is doing, rather than looking over the shoulder at inspectors and “the centre”. And services should be designed around the customer and led by inspired and motivated leaders, rather than designed around a target or process and driven by “back room” staff. As the ultimate test of any service (public or private) is that if the customer is happy and gets what s/he wants or needs, then that is all that should be delivered, not all the current “extra” paraphernalia that just gets in the way.