Thursday 25 June 2015

How to launch a new preventive service sector

I wrote a blogpost a couple of days ago about new kinds of organisations emerging in the nether world between the public sector and voluntary sector.  I used the Dorset Coast Forum as an example.

But I've had such interesting responses that I can't resist coming back to the issue.  One in particular - I haven't asked whether I can quote her so I'd better not say who it was - complained at the way that, because of the way seed funding for social enterprise works, effective new ideas tend to stay small:

"You can have great results, demonstrate traction but there is nowhere to go to develop something from a 'that's nice' to something real!"

That is quite right. There are so many innovative people working away at solving problems related to ineffective public services, only to find the funders just want 'innovation'.  The moment one of these projects proves itself, the funders lose interest.

So let me say what I think is happening.  Partly because of austerity - one of its few positives - public services are forced to think in revolutionary ways about their effectiveness.  Often they can't think further than a ten per cent cut, which just makes things worse, but that's another story.  But there are imaginative commissioners and managers out there who realise how the system gets in the way.

They ask how services might reach out upstream and 'prevent'? How do they also manage the transition from professional support to nothing?  In both cases, these are often problems of co-production - bringing in patients, their families and neighbours, and asking for their help.

So clustering around these innovative managers are projects which work on a small scale, and may well stay small scale. But you can imagine that small plus small plus small plus small amounts to something much bigger.

The problem is that they are managed as exceptions rather than integrated, and they struggle for funding and are often replaced by something identical and unproven but new.

The answer, I think, is that these clusters will begin to link to GP surgeries, hospitals, police stations, housing estates, schools as a new preventative layer of services - paid for because they work and save money by the organisation they are linking to.

This preventative infrastructure will overlap with each other. It will look untidy, because that is its nature.  It is already involving what seems to me to be a whole new co-production professional - recognisable in time banks, local area co-ordinators in social care, health champion co-ordinators, enterprise coaches, community justice panels. They use a similar set of skills and I know, from experience, that the traditional professions are not suited to it.

The big question is: why will traditional services eventually pay for this, given that they resist doing so now, even when these semi-services are effective?

I think what can shift this is quite simple, though far-reaching. There needs to be a change in the agreements with all public services contractors, inside the public sector and outside.

They all need to set out how they will do the following:
  • Use their beneficiaries as equal partners in the delivery of services.
  • Reduce demand during the lifetime of the contract.
The answer is to broaden and deepen the objective of each service. Often, the most convincing way of explaining how they will do this is to reveal which aspects of the preventative infrastructure they are building partnerships with.

There might be an objection that, by sub-contracting aspects of their work, services will cost more to run.  This is true in the narrow sense, though they are doing it already - especially when they are aware that they can't have the personal impact they need without local organisations.

It is true that while these projects are funded because they are 'nice' then there is more than a possibility that sub-contracting will simply be exploitative.  It depends how seriously those contractors will be held to their assurances that they will reduce demand.  If they have to do that, and are paid accordingly, then they need to nurture the preventative infrastructure very seriously indeed.

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