Total Place – integrated public services or more cost cutting?

Total Place is a scheme to join-up public services in an area or a city. Trials have been run in Kent and Birmingham.

It may be useful to read the report of the Total Place Roundtable in The Guardian since I will reference some comments from it there.

The sub-title of the article is:

Total Place is a new initiative to examine how cutting out duplication in public service delivery can improve quality and reduce costs. But is this really a ‘magic bullet’ solution?

Well nothing is ever a silver bullet. As W. Edwards Deming said, “There is no such thing as instant pudding.” But the general idea to join up services to remove duplication and concentrate more on prevention than cure, is a a good one that most people would agree with. There are some encouraging comments, such as:

Hospitals have been trialling specific units for patients with alcohol related problems, where they can be given preventive treatment, with co-ordinated interventions from across a range of agencies.

Figures from the police reveal that a single murder costs around £1.1m in services, from investigation to the legal and social services work, so the scale of preventive cost savings – especially in reducing gang violence, for example – is parallel with the moral gains.

“The focus needs to be on changing the culture and behaviour within public services, rather than fixating on financial outcomes.”

These are encouraging but one comment from one of the participants worries me.

The table first heard an account of the Birmingham pilot, where £7.5bn of public sector cash had been mapped out. “The idea was to follow the money, and see where it led us,” a participant explained. “Families are facing a range of issues, some not interconnected, but the challenge was to dismiss short-term thinking to analyse the £7.5bn coming into Birmingham every year.”

If you follow the money, then you will come to the wrong answer. Budgets and costs are an output. First you should seek to understand the demand on the system and if you do that with the whole system in mind, for example how mental health services, social services and hospitals can work together on chronic alcohol problems, then that is all the better. But we shouldn’t be starting with the money. That is using the tail to wag the dog.

Efficiencies in the these type of systems can be made, but we must ask,

  • What is our purpose?
  • What is of value to the public?
  • How can understand demand for that?
  • How can we design service to meet the demand, designed for the value and removing the waste?

If you do this properly you design public services that the public like and as an output you save money. You also get improvements in results that far outstrip anything that anyone would have dared to set as a target.

One more little niggle from the article:

Kent, a two-tier authority with a £10bn budget, now has a single phone number and single web portal for all local government services.

It goes on to say that “getting even this far was an uphill struggle”. Well instituting a call centre isn’t providing value but it is certainly following the money. Trouble is the failure demand that will ensue will cause costs to rise, not to fall. Having one place to call does not mean that the services delivered will be joined-up, in fact quite the reverse. Whereas, previously you might have had the call answered by someone who did the work in the department you called, now you get a call centre agent who is, by construction, removed from the work and only connected to it by workflow systems.

I wish the Total Place idea well. I just hope the practice would match the intent.



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