- December 19, 2019
For the last two years I have been a Fellow of Practice at the Government Outcomes Lab (GO Lab) which is part of the Blavatnik School of Government at Oxford University. It has been an immense pleasure and privilege to have had this role, from which I step down at the end of the year.
The GO Lab is doing a great job in bringing together a wide range of thinking on how we better deliver pubic services and address complex societal issues, around a central focus on how we deliver better social outcomes. This has also been pretty much the raison d’être of ATQ for the last seven years, which is in part why I ended up as a Fellow in the first place.
The Deputy Director of GO Lab, Nigel Ball, last week published this blog with some challenging reflections on whether and how a new government, with a substantial majority and clear mandate to govern for five years, will address the knotty problem of public service reform. I am extremely loath to summarise Nigel’s complex and nuanced arguments, and would urge you to read his blog in full before you read this one, but his central thesis is that public services have, for several decades, drawn heavily on both private sector management practice and, through outsourcing and privatisation, direct provision. This has led to a focus on top-down targets and contract-driven accountability for service performance and delivery. Nigel argues that:
“Many people – and much recent research – would agree that these ideas, though once useful, are running out of steam. A new approach seems to be slowly emerging, with a very different core underlying idea: greater participation with communities. No longer should we view social problems medically, talking of a “treatment” at the right “dosage” which can be measured for its “effect”. Rather, citizens themselves, grouped by a shared geography, interest or need, can participate in designing and delivering public services. No longer should we use top-down contracting mechanisms, making both public and private delivery bodies answerable to government agencies for the services they run. Instead, government and its agents should give away some of their decision-making power, and work together hand-in-hand with communities and civil society organisations. This might mean they hand over more cash no-strings-attached, and trust people to be intrinsically motivated to do a good job. For some of the most evangelistic proponents of the new approach, even the idea that it is possible to “deliver” outcomes is misguided – if we focus instead on working out what a better system would look like, the outcomes we want will appear.”
My initial reaction to these ideas is that they have much merit. In particular, I agree with the view that services should be designed with and for those they affect and are designed to help, rather than being imposed by those who think they know better; and that rigid contracting and commissioning models, backed by targets that distort delivery, can do as much harm as good. Beyond that, I would like to offer three ‘micro level’ observations and one ‘macro level’ thought.
At the micro level, I think this sort of empowerment of communities can co-exist alongside some of the good things that have emerged from the prevailing models of the recent past, and that there are a few babies that I would not want to see thrown out with the bathwater. These reflect both our own project experience and the evidence we have gathered through evaluations of others work. They include:
- The value of better evidence for what works (preferably supported by a thoroughly worked-through theory of change). Such evidence is far from perfect, and there are many limitations to how robust it ever can be in a policy/social context, but it is I think better always to start from an evidence base where it exists.
- The outcomes culture. Our consistent experience as both advisors and evaluators is that a focus on outcomes has benefits. One of the major disappointments of national debate is that it focuses almost entirely on inputs, rather than on outcomes, or even outputs. Witness endless bid and counter-bid throughout the election about who will build the most hospitals, recruit the most police officers, train the most teachers etc. I have become a strong believer in the value of identifying, measuring and managing through outcomes, with and without monetisation, and would need some convincing that such outcomes-based approaches are a retrograde step
- Strong performance management. By this I don’t mean the process of managing performance, which I agree can be over-driven by arbitrary targets. But much of the research I have seen shows clearly that any project – in-house or outsourced, contracted or grant funded, outcomes-based or conventionally measured – is crucially dependent on the effectiveness of those charged with its implementation. At one level this is a statement of the obvious, but it is arguable that one of the biggest failures of the top-down, private sector-style management approaches we have adopted is that they still tolerate far too much poor performance; and one of the benefits of outcomes-based contracts appears to be that they encourage swifter and more radical action to address under-performance, often by strengthening and sometimes replacing existing operational management.
My big picture thought is to wonder whether government should start to treat spending to improve social outcomes truly as investment – and therefore closer to capital spending on infrastructure than current spending on services? Many of the projects in which I have been involved in recent years have been supported by what is effectively an investment case – that spending on a preventative intervention will avoid or even reduce spending on a later, crisis-driven intervention. The problem is that such projects are far too small to make much difference, and as a nation we never seem to have the resources to twin-track to scale – to spend enough on prevention to make a real dent in the long-term costs of poor outcomes, alongside the ongoing expenditure needed to deal with those outcomes.
But if outcomes-based contracts can be funded by external investors – and deliver them a return when they succeed – it should not be beyond the wit of government to adopt the same approach, and fund much larger programmes from borrowing rather than from taxation, underpinned by a business case that shows a return on that capital. There are numerous areas where this approach could be adopted but how about targeted public health programmes, support to families with complex needs, and interventions to reduce substance misuse for starters? Done properly, such investment could be at least as justifiable as spending on infrastructure.
And yes of course I know that the Treasury would, to coin a phrase, rather ‘die in a ditch’ than allow this, but even an old cynic like me should be allowed to dream sometimes.
- December 2, 2019
The current general election campaign has brought commitments from both main parties to increase levels of public spending to historically high levels – dramatically in Labour’s case.
How does Government ensure that any new monies for front-line public services are spent effectively and not wasted?
With the introduction of additional money, there are two possible ways ahead. It is either a great opportunity for public services to invest in change and improve service outcomes or it can simply release the pressure and allow change to be put back into the ‘too difficult’ tray.
Necessity should be the mother of invention
In other spheres of activity, necessity is the mother of invention which drives innovation and changes in the way things get done.
In the public services arena, necessity doesn’t drive change in the same way. This is because the spending taps have either not been turned off for that long or, as currently after 10 years of austerity, have arguably been turned off for too long. Let me explain.
Public service managers act rationally. Historically, spending cuts have been temporary within the usual five-year election cycle. This means that the default response is salami slicing – implementing small incremental cost savings, avoiding making any potentially significant changes in the way things are done and reverting to ‘normal’ when spending taps are turned on again.
The period from 2010 to 2015 can be characterised in this way, with most managers hoping/expecting that the next government would relax austerity. Unfortunately for all of us, public finance conditions didn’t improve and austerity budgeting has continued up to now (late 2019).
So what effect did this have? On the ground, front line public services have consistently reduced scope to meet only acute or statutory needs e.g. qualification for social care support, and change comes about largely through closure of provision and services e.g. Sure Start, youth centres, elderly care day centres, libraries etc.
At the risk of oversimplification, after five years of salami slicing there was not enough capacity left to plan, consult on and implement significant services transformation. High staff turnover in times of low morale is another factor. There have, of course, been some changes such as joining up between local authority teams in for example children’s services. There has also been some innovative use of outcomes-based commissioning – something with which I have personally been involved.
However, these have been small scale. The overall picture is one of services that are hunkered down coping with day to day demands with only limited commissioning and back office support to help introduce any changes.
So what should we do now the taps are about to be turned on again? I have previously advocated three ideas for introducing change across the public services landscape.
Use an overarching theme – presumption of prevention – to drive change
For all public-sector organisations, I would argue for a presumption towards prevention as a sensible overarching hook or theme. Every organisation should be encouraged to ask:
“what would we spend this budget on if the aim was to prevent the problem arising or getting worse?”
One of the positive consequences of looking at a social challenge from a preventative basis is that it forces organisations to look at outcomes and work out how to collaborate with other spending bodies to find ways of combining resources differently to now. Equally importantly, it should be cheaper – but only if we can break the ‘safety first’ mindset of waiting until action is mandatory, and almost always much more expensive.
Explicitly invest in services R&D
If the answer in the private sector is R&D, why not the public sector too? One remedy could be to set an explicit Government services R&D budget allocation. If say 1% of Departmental expenditure were top-sliced and allocated to R&D, this would be around £3bn per annum aimed at improving public service innovation and productivity gains.
This would require a complete rethink of the way we test and implement change. Instead of scrutiny of policy initiatives after implementation with 20:20 hindsight, by the Public Accounts Committee, National Audit Office et al, we would be asking these or potentially different organisations to review an experimental spend and deciding whether to implement at scale.
Extend Individualisation and co-design
Essentially give service users a voice in designing the services they receive. Give them ownership of the budget and how it is spent. The ideas of personalisation and choice have been around for over 10 years now but they have not gone anywhere near far enough, with control of budgets remaining largely with government bodies.
With some imagination, this principle could and should be more widely encouraged and extended to areas such as employability and skills (especially re-training), management of long-term health conditions, and parental support.
Conclusion
If 2020 onwards is going to be a great opportunity for public services to invest in change and improve service outcomes then, whatever colour the new Government, it needs to set the change agenda from the centre and quite possibly reinforce it with legislation.
- August 5, 2019
Since he became Prime Minister Johnson’s chief advisor there has been much attention on the musings of Dominic Cummings. In one of his long and detailed blogs criticising Whitehall, he observes that:
“Whitehall …….is parochial about its own past. One of the most useful questions one can ask is not only ‘who has already solved this problem?’ but ‘have we already tried to do X and failed?’ In the DfE there is no system to answer this question reliably. Unless you get lucky with an old-timer, you cannot know and because they abolished their own library you can’t even go and study it.”
There is perhaps much to disagree with in Mr Cummings’ musings, but this strikes a chord. I have written before about the impact of lost institutional memory in the context of public sector productivity performance, and a couple of recent ‘lived experiences’ have prompted me to think further about this particular bugbear of mine.
It is perhaps a function of being 50-something years old that I am often by far the oldest person in the room – that old timer that Cummings writes about – and consequently have nearly always come across challenges that others appear to be encountering for the first time.
But it turns out it is not just a function of age – it’s a question of having any kind of institutional memory.
Lived experience #1:
At a recent meeting of around 30 commissioners and providers of children and young people’s (CYP) services, there was a presentation by a government policy lead which outlined what the policy team had found out over the preceding two years about effective CYP interventions. After around half-an-hour of discussion it emerged from the 30 or so professionals in the room that this two years of policy research and development had done little more than identify as best practice what everyone involved in youth work used to practice.
But as this kind of discretionary public expenditure had been cut back since 2008, much of this knowledge had been dissipated: there was no ‘institutional memory’ of youth work best practice and the policy team had to find it out all for themselves again. In fairness, the policy team were from a different Department of State to the one that led on youth work policy (and different again to the one that reduced local government spending on youth work) – but the effect of silos on cross-government learning is a whole other topic.
Lived experience #2:
Senior staff turnover at an organisation I have worked with for over five years means that I am one of only two members of the project team left with some ‘institutional memory’ of the detailed reasons why previous decisions were taken. In fact, and not unusually, both of us operate in external roles to the organisation and are the only ones providing any form of continuity.
What to do about it?
There is a huge amount of energy wasted when organisations find themselves having to invest time and resources re-learning lessons from before. Loss of institutional memory has to be a drag on productivity and innovation.
In my view, one of the keys is to ensure that there is a succession plan so that when staff move on from teams (usually through public sector promotion or role change), there is a successor who knows what’s what in that team or area of the organisation.
I call this my succession obsession and work with all my clients to ensure that they have identified individuals to develop and bring along as a way of ensuring at least some continuity.
Another good practice is to ensure that decisions are fully documented as projects and programmes progress. This is especially for when things go wrong as well as when they go right. Post implementation reviews are also an essential part of good project management and delivery but are often overlooked or done in only a cursory fashion – often because project teams have already moved on to the next challenge.
Finally, maybe part of the answer is to incentivise staff to stay in post longer and reduce some of the incentives to move so regularly in order to advance their careers. Would it be possible only to allow a staff move when they can apply what they have learnt elsewhere? In other words, when they start to become useful institutional memory themselves.
- January 15, 2014
Now that we are in a New Year, it’s apparent that both government and opposition are already thinking about the next election, and starting to make policy announcements and commitments. For those of us who are focused on the world of government commissioning and contracting, one of the intriguing aspects of the next election is what an incoming government (if different) will do about this government’s major contracts for the delivery of public services.
Contracts which straddle governments are nothing new, of course, but what has changed is the type of contracts and the extent to which they impinge directly on policy. While the outsourcing of any service can be controversial, in general few people tend to get too worked up these days about a contract for the delivery of back office support processes or information technology. A new government will almost certainly continue such contracts largely unchanged, at least until the contract ends or reaches a suitable break point.
But in recent years, we have started to see governments use the private and third sectors to deliver social policies which a new government may want to change radically, or discontinue altogether. The two obvious and large areas where this may be the case in 2015 are employability support and offender rehabilitation. A brief look at both these areas shows some of the tricky dilemmas that are likely to arise for both the current government and the opposition.
To take employability first, the use of external contractors to deliver policy in this area is long established, and we have already seen what can happen to contracts after a change of government. When the new government entered power in May 2010, it implemented the Conservative’s proposals for the Work Programme. Since this was effectively an extension – to more client groups and with a larger role for external providers – of the Labour government’s Flexible New Deal (FnD), the policy was in the same “direction of travel”, as the saying goes. But even so, all the existing contracts had to be terminated and an entirely new procurement process started. So there was a significant cost – in both time and money – to put in place a very similar set of policy tools.
Since then the Work Programme has been heavily criticised by the opposition, and it can hardly leave it in place and untouched if elected. But the cost of contract termination means that it may well continue the Programme at least until current contracts expire in March 2016 – although it will need to make clear its intentions well before that.
Offender rehabilitation is different, because there is no cross-party history of using external providers in this sector on a large scale. The previous government dabbled in this area, but had little in place by way of contracted out provision. In opposition the Labour Party seems to be broadly in favour of policies to reduce reoffending and rehabilitate offenders, but is strongly opposed to the means this government has adopted to achieve it, through its Transforming Rehabilitation proposals, which involve a mixed economy of public, private and voluntary sector provision that effectively outsources much of the current Probation Service.
So both government and opposition have big challenges ahead. The government plans to have Transforming Rehabilitation contracts in place by April 2015, and knows that, with the next election fixed for May of the same year, it cannot afford any delay. If contracts are not in place, it will be easier (though by no means painless) for a new government to reverse or significantly modify the policy.
However the opposition also has difficult issues to wrestle with. If the government does meet its timetable, new Labour Ministers will have to decide whether they want to incur another large bill for contract termination, or can live with and try to modify the contracts to meet their policy objectives. And as the election looms Labour will come under pressure to set out clearly what its policy is in this area – in a way that it probably would not have to do if private and third sector providers – and their investors – were not gearing up to deliver services.
In the longer term and if (as seems likely) the use of external providers in complex policy areas continues and grows, there are some bigger questions for government as a whole about how we avoid undermining the democratic process. Politicians will rightly complain if their ability to change policy which is contentious is unduly constrained by the decisions of predecessors effectively to outsource delivery of said policy. But those who are being asked to invest heavily in new provision – whether as providers or financiers – will be very reluctant to do so if there is no guarantee of continuity beyond each election cycle. Some may say of the latter “so be it and good riddance” but most will not.
What may happen is one of two things, or possibly both. First, more contracts will be awarded that are coterminous with general elections – something made easier if we stick with fixed five year terms. The second is that all parties will have to seek broader consensus on policy and the means to deliver it, before major programmes of service delivery outside the public sector are implemented. This may be no bad thing, and has some precedent in our approach to major infrastructure projects, such as the 2012 Olympics and, more recently, HS2. However since some in the Labour Party have been making noises about withdrawing support for HS2, a project which they first proposed, the auguries for the development of such consensus may not be that encouraging.
- March 23, 2013
In this week’s budget statement, the Chancellor announced no change of direction for his deficit reduction strategy.
Analysis by respected commentators such as the Institute for Fiscal Studies (IFS) has pointed out the implications of further reductions in spending, particularly by those Departments of State which have not been ring-fenced to 2015 i.e. all those except health, education and international development.
According to the FT article covering this story: “On current plans, departmental spending is set to drop by 2018 to the lowest level since 2002-03 in real terms and to the lowest as a proportion of national income since at least 1998, resulting in a radical reshaping of the state.”
How radical is this reshaping going to be?
It can be argued that, to date, reforms of public services designed to drive out savings have been in the ‘salami slice’ category. In other words, the easiest areas of non-statutory expenditures have been cut back, staff numbers have been allowed to fall through natural wastage without replacements and such like.
Widespread reshaping of service delivery models and more radical reforms have not been evident. However, the ability of public service delivery organisations to muddle along with more salami slicing, in the hope that the public funding taps will be turned on again soon, must be diminishing.
With such a long period of austerity ahead, some more imaginative responses will have to emerge. There are some pointers as to the direction of travel.
Another article following the budget, this time in the Guardian, discusses plans to de-duplicate public service activities – extending the findings of the Total Place initiatives piloted under the previous Government and Whole Place Community Budgets trialled by this Government. The service areas highlighted are: families with complex needs; health and social care for adults; economic growth, work and skills; reducing re-offending and domestic abuse; and early years.
In another part of the Guardian was a different article discussing how mutual models could be more widely applied in the delivery of local government services, providing an alternative model to either in-house or outsourced to private sector providers.
Finally, if the Government’s acceptance of almost all of Lord Heseltine’s ‘No Stone Unturned’ recommendations leads to any genuine devolution of budgets and decision making authority away from Whitehall’s control, then there will undoubtedly be scope for very different thinking to emerge.
Perhaps it is only when faced with the kind of long term austerity picture which we now have that public service reforms gain genuine traction rather than lip service.
- March 7, 2013
Last Monday the Cabinet Office launched “What Works” a new initiative to improve evidence-based policy development. The Cabinet Office Press Release, with detailed documents attached, is here. A useful summary from the Guardian is here.
As the press release explains “The What Works Network, a key action in the Civil Service reform plan, will consist of two existing centres of excellence – the National Institute for Health and Clinical Excellence (NICE) and the Educational Endowment Foundation – plus four new independent institutions responsible for gathering, assessing and sharing the most robust evidence to inform policy and service delivery in tackling crime, promoting active and independent ageing, effective early intervention, and fostering local economic growth.”
In simple terms, the aim is to do for evidence-based programmes and interventions, what NICE does for drugs. If NICE approves a drug or treatment, the NHS will prescribe it (provided local commissioners can afford it). If an intervention has a similar seal of approval, commissioners and others are more likely to use it.
As the Guardian observes, this has been something of a pet project for the Cabinet Secretary, Sir Jeremy Heywood, since he was merely head of the Cabinet Office. It is an important element in payment by results and social impact bonds, where it is hard to design such schemes (and especially assess the risk for providers and investors) if you do not have a reasonable confidence that the interventions proposed will improve outcomes and achieve the results required.
But it seems to me that this has much wider implications. First, as critics have already observed, it should make it harder for ministers to base policy on whim or ideology. There is a long standing joke among Whitehall watchers that Ministers prefer policy-based evidence making to evidence-based policy-making – i.e. getting the facts to fit the policy rather than the other way round. If the new policy centres do start to become as established as NICE, this will probably be harder to do.
But something else that intrigues me is whether it will become much more the norm to attach a monetary value to social policy. This is very much the way that NICE works – which leads to increasing controversy when it rules against the use of an expensive drug that might extend the life of a loved one for a few weeks or months, on the grounds that it is not worth the money.
In social policy, there is still a strong view among many providers that we should not concern ourselves with whether something works in financial terms, but should intervene simply because it is “a good thing” or “the right thing to do”.
I have always found this a difficult argument to sustain if the thing that is being done requires public money. There are only two reasons for any intervention which requires investment by the state. It achieves a better result – for the person themselves and/or for society as a whole – than doing nothing. This requires measurement against what would have happened without the intervention, through some form of control or baselining.
The other is that doing something costs less than doing nothing, usually because it avoids higher costs later. On almost a daily basis, it seems that we have a new study or report which argues the case for public investment on these grounds. Yet many of those who advocate such policies seem reluctant to go the extra mile and resist attempts to properly measure the value that they add in financial terms.
But if “What Works” mirrors existing, similar work in the US – notably by Washington State Institute for Public Policy – it will become very much about this intervention costs X and saves Y, that intervention costs A and saves B – as well as about whether it is effective in reducing or solving a social problem.
No, we cannot reduce everything to pounds and pence. But if the public sector is being asked to put money to work to make things happen, It seems reasonable to ask for some evidence that those things add value.
- January 25, 2013
We are now a bit more than half way through this Parliament, and right on cue a debate has started about whether the civil service is fit for purpose, in need of radical reform, and a block on wider change across government. The BBC ran a series of reports leading up to a programme in Nick Robinson’s Decision Time series; the PM’s former advisor Steve Hilton has weighed in (and is said to have left for the US in frustration at the way his blue sky thinking was frustrated by the bureaucracy); and Tony Blair has added his six penn’orth.
It’s hard to discern what the advocates of reform actually want (as opposed to what they don’t like), but is seems to centre on the need for a new government to be able to bring in its own team of committed advisors, rather than rely on the standing civil service machine.
As a former civil servant who has since worked closely with civil servants – at all levels – for more than 20 years I confess I find some of the arguments of both sides unconvincing. The defenders of the status quo argue that:
- There must be evidence and new Ministers cannot expect the civil service to implement change unless and until the case for it is proven by that evidence. This argument has been strongly pushed by former Cabinet Secretary Lord (Gus) O’Donnell – notably on Robinson’s programme. My response is: if only! Examples of policy being implemented – and maintained – in the absence of (or in the face of evidence are too numerous to mention. To take one example, how many people could seriously argue that current policy on the classification of prohibited substances is based in evidence? If you think it is, just ask Professor David Nutt.
- Hand-picked advisors who came in on a change of government would be cronies and yes men, telling Ministers what they wanted to hear. This might happen, but is it not equally likely that a trusted advisor would be more willing to give challenging advice when it was needed – and more likely to be listened to if they did? And is it seriously being suggested that no civil servant ever trims their advice to suit their audience; or that civil servants – alone in the corporate world, in any sector – are always willing to challenge fearlessly those who have power, authority and influence over their careers?
But the advocates of change are also on shaky ground. They argue that:
- The bureaucracy hinders change and swamps everyone in paperwork. This might be true but is that solely the fault of the civil service? In my experience decisions can be made very quickly in central government, certainly much quicker than they can in local government, for example; and if decisions on major policy change have got slower across government it is often because there is more legislation to consider – such as that governing equality and human rights. If we think such legislation is a good thing (and most do) then Minister have to be doubly sure they have complied with it – because lf not, a legal challenge will follow rapidly.
- The permanence of civil servants is a block on change, and means they can out-think and out manoeuvre “here today, gone tomorrow” Ministers and their political advisors. There is some truth in this, but how permanent are civil servants these days? Research by the Institute for Government shows that only two Departments have the same Permanent Secretary (sic) that they had in May 2010, and that turnover across departments at all levels is also considerable. My impression of working with civil servants in recent years is that they often become expert in complex areas and then move on. Arguably they could do with a bit more stability – and a few more wise old heads – not less.
- It is very hard to bring in expert advice from outside. The only sense in which this is true – on which I do agree with Lord O’Donnell – is that Ministers have cut back drastically on the use of external consultants. But it is much easier than it used to be to move in an out of the service, and many of the excellent civil servants I have worked with in the last few years have come into the service relatively late in their careers from other sectors. And it doesn’t seem to be that difficult for Ministers to bring in selected advisors when they want or need to.
So in short I think we need seem more careful thought on what the problem is (if there is one) and how it might be solved. Perhaps the study currently being conducted by the IPPR, on international civil service models from which we might learn, will suggest some answers.
- November 7, 2012
Welcome to the blog of ATQ Consultants. We are a new start-up but we have an embarrassing number of years’ experience between us working in the public sector, as advisors to the public sector, and in a variety of other roles which sit at the boundaries between the public and private sectors.
We have just launched our website but wanted to have a blog as well where we can offer views and comments on issues which interest us and about which we (hopefully) have some relevant knowledge and experience. More importantly, we want others to have the opportunity to add their own views and comments, and no doubt challenge and disagree with us.