Radical Redesign: URGENT

The news keeps on coming about continued pressure on local government finances.  In the article, ”LGA warns councils could face ‘financial meltdown‘”, we see that the Local Government Association suggest an expected “black hole” of around 15% of the required budgets for 2015/16.

Sir Merrick Cockell, LGA Chair is quoted,

Over the past three years [councils] have worked tirelessly to deliver new efficiencies through measures such as sharing services, restructuring the workforce and reducing senior pay

All good I guess (some really excellent work has been done), but in light of the ongoing pressure, he goes on to say,

Ultimately the only way of maintaining public services in the face of proposed long-term cuts is a radical redesign of the way public services are provided and paid for

Service Design

Councils, in concert with other public service agencies in localities simply have to start to look at the challenges of the future in a different way.  This different way is simple and radical and therefore I think it’s unclear how it can emerge very easily from within current structures.

A design approach to problems seeks to really understand how people experience public services.  It does this through research, often including ethnographic work and certainly plenty of time spent with services users and the front line staff operating the service.  The radical part is that a service user’s experience will often cross departmental and even organisational boundaries, and this can feel like service user perspectives will only over-complicate matters!  But the truth is that when we look at things from the service user’s perspective, we see that it is us who have over-complicated things.  Hugely.  We can start to see how things can be radically simplified.  We can start to see how the service we think must surely work, just doesn’t very well.  It is really not the only way to do it.

I had a really interesting couple of pints with a friend who is a product designer last night.  He’s a very clever engineer (he’s building his own plane to give you a sense of it).  He has led several product innovation units in some big private firms and talked to me compellingly about user-centred product design.  In one example he talked about how his team invented a new kind of inhaler for orally dispensing medication.  They produced a prototype and sat behind mirrors watching people interact with the device.  They conducted detailed research on different types of patient – people who always followed the doctor’s instructions, people who never did, and so on.  They sought to understand how to tailor how they needed to support use of the device to suit these different types.  They realised that they should avoid calling it an inhaler, because people know how to use a traditional inhaler and would bring those assumptions and ‘suck then click’ on the new device, even though they were clearly told this new device required ‘click then suck’.  They also looked at how they might encourage people to stick to their medication routines and monitor this.  They had a stick on chest patch (electronic gizmo) that would register a swallowed pill as it passed by.  Problem was, user testing showed that patients weren’t at all good with keeping the patch in place.  Idea binned early and with minimum cost and no reputational damage.

Too often public services have just piled in and implemented their own “chest patch” services, which makes sense to them and appear to be “obviously” helpful.  But what they don’t see is that services often don’t fit at all well with the way people *are* or *are becoming*.  Rather than services being living, changing things based on continuous iteration, guided by service user feedback, they are implemented fully formed – you might say “imposed” – and are run until there’s no money left to fund them any more.  Generally they are not de-commissioned because there is not enough work done to develop alternatives.  Of course there are many examples of great services that are responsive and adaptable – but you get my basic drift.  They are very often not like that, right?

Some of my tweets will make me look like I’m a technology nut.  I pretty much am!  I do think most re-design thinking is going to be powered by the possibilities of new technology.  I even bang on about “cloud computing” in a seemingly abstract, IT guy kind of way.  But actually what drives my thinking and interests me most is how we develop user-centred services and tools.  How we negotiate around existing assumptions and structures.  How we push for radical simplification.  How we come to accept that service delivery will probably be highly distributed (lots of different types of provision and co-production) but strongly networked, with the users at centre stage.

This is not something that will just happen.  We all need to learn about service design, think about ways to start making it happen.

Find a problem, start small.  Get a mixed group of people in the room.  Generate ideas.  Get out and speak to some service users.  Build a prototype, test it, change it.  Don’t wait for it to be fully formed, get it out there.  Start designing the future.

Work/Life Device Scheme?

Devices coming out of your ears?

I’m sure loads of people think the same.  Why have I got a Blackberry *and* and iPhone jangling around in my pockets?  Isn’t it both inconvenient and a serious waste of money and resources?  I’d much prefer it if I could just use my iPhone for work as well as the rest of my life.  And I use my laptop at home alot for work – why can’t I just bring it in with me to the office?

And, what about tablet devices, like iPad?  I’m sure you could build a very long list of immediate productivity gains involving key tools like email, calendar, video production and Skype calls, along with opening up people’s minds to how it could and should be in the future, creating demand for change.  Even with enterprise systems as they are, being able to type up field notes and paste them into a creaking case management system, or maybe save off a voice file or picture to the corporate shared drive (if you haven’t yet got Huddle or similar) – ok, that would start to save plenty of time.  Staff would get a real feel for the possible too, and creativity would blossom.

Security

But what about government security I hear (some of) you cry.  Well it turns out that CESG, the UK Government’s National Technical Authority for Information Assurance, has said that iOS6 is secure enough for RESTRICTED (personal sensitive) data.  Mark O’Neill, Head of Innovation and Delivery at the Government Digital Service, is helping me confirm what exactly they’ve said and where the guidance is.  HMRC are rolling out 7,000 devices including iPad (at the lower level of data called PROTECT or “IL2″) at the moment.

Sticking with iPads, then,  for the sake of argument, assuming that it’s possible to integrate, secure and deploy them (and it appears so) then the question comes – how might we start to resolve this problem of work Vs life devices and save a shed load of cash to boot?

Salary Sacrifice

I’ve got a nice mountain bike that I get to work on.  I “hired” it through the cycle-to-work scheme, which is a salary sacrifice deal where you pay for the bike before tax from your salary, through instalments over a contract term with your employer.  In theory at the end of the “loan period”, you have to buy the bike from your employer, at a very low “used” cost (13% of the purchase price after two years).  I use my bike during the day to get around town to meetings, saving quite a lot on company expenses.  I maintain the bike and pay for replacement parts.  It’s essentially mine from day one, but it’s convenient to use it for work too.

HMRC have this handy Expenses & Benefits A-Z guide, which tells us about Computers loaned to an employee.  It says that if a device is loaned to an employee for both work and private use then only Class 1A National Insurance is due (13.8%).

Government Device Store

Different scenarios need working through around the construction of the scheme, which would probably include the 3G contract that sends staff mobile.  Maybe rather than the ownership being clearly with the employee as above (where they go off to a participating high street store and buy the device), the organisation (or group of organisations) have access to buy/rent devices from a government “Device Store” at a discounted (bulk) cost (and excluding VAT).  Employees could then rent their personal use of the device for a sum per month as a salary sacrifice.  A two year period for a device is probably about right.  At the end of the period, a new device would be ordered up and the infrastructure folk could drop the old device off the network and that would probably be it.

And of course, if you’re like me and would like some decent devices but just can’t afford them, this may well be the way to get there.  (I pay monthly for my iPhone).

Let’s see what Government Digital Service makes of this and I’d welcome any comments.

@pdbrewer let me have a chat with @liammax as it’s deffo the kind of vision we’d support

— Mark O’Neill (@marxculture) February 15, 2013

Patchwork, Culture Change and an elephant

An overdue post on Patchwork..

As we approach the launch of the next phase of Patchwork in Brighton and Hove, I wanted to reflect on how we have reached the more open and creative engagement we are now seeing with teams of professionals across the city. People are starting to really focus on the potential of Patchwork to disrupt and improve front-line practice. That is incredibly satisfying after a year of hard groundwork.

Before looking back at the groundwork year, I wanted to show you what the next year might look like, so that we can get a sense of the journey Brighton and Hove is on.

Phase 2 (Nov 2012-Mar 2013) – Community Creation

• We’re going to publish a roll-out plan so that agencies and users can see the community of agencies grow over time and understand how Patchwork’s being used. Community and voluntary sector agencies can now join as we have worked through the technical barriers.
• To make sure Patchwork is immediately useful, we’ll ensure all early intervention (Family CAF) and “troubled families” clients are added on Patchwork at launch
• We are finalising a pilot with adult services (and the legal work is well under-way).
• Engagement conversations continue across all children’s and adult services. We’re getting better at helping agencies understand when they should use Patchwork, which is aimed at supporting “vulnerable” service users. For some agencies, all clients will fall into the category. For others, only some of their clients will.
• We’re creating a community of “agency champions” and carefully considering with them if an online community would work.
• Developing leaflets, posters and a website resource to explain Patchwork to both professionals and service users and share documents and news
• Contributing to the design of family/group functionality in Patchwork, for launch in the new year (again, legal work under-way).

An Emerging Phase 3 – Design Projects

While the current phase is ratcheting up, I’m thinking about a phase 3 in Brighton & Hove, which is about design projects in places where the right blend of problem and problem-solvers exists. We have a one day workshop coming up involving some young people in care to look at their experiences of the system. We also have work planned around “supporting families” which will directly involve parents alongside front line professionals. This will be sponsored by our Troubled Families initiative, Stronger Families, Stronger Communities. These design projects will help us understand better what we need (and don’t need) from digital tools and where our ways of working are causing problems. But more importantly, it’s also how we are providing more spaces for open and creative innovation from the people who are best placed to do design – service users and front line professionals.

Phase 1 (Nov 2011-Oct 2012) – Creating Safe Ground

At the beginning of phase one of the project, we launched to a big and enthusiastic audience. Multi-agency communication was very clearly a big problem. But there was one huge elephant in the room that didn’t take too long to start charging around, trumpeting loudly, knocking tables over and scaring people. Information governance. It was something we knew would be a key issue, but in all honesty, we didn’t at that stage have a convincing enough answer for people who were nervous about moving what was often standard off-system practice into an auditable online space. We had to respond to this.

As I outlined in my talk at the Patchwork launch, getting a solid answer to the information governance question took absolute priority. In fact it turned out we couldn’t move far with any workstream until this work was done and communicated. Engagement was often difficult, with understandable scepticism in some teams. There were interesting differences between different staff groups and there was a sense at times that other issues might be hiding behind the legal question – stuff that we couldn’t get to until we tamed the elephant. We did the legal work, we answered the questions. We designed a pilot that was appropriate for the cultural stage we were at (limited agencies dealing with less sensitive issues).

Over time we tamed the elephant .. and look at him now ..!

“Tamed”
(Copyright Random House Children’s Books Elmer the Patchwork Elephant)

Now that I’m speaking to people again in preparation for the full launch, there’s a sense that most people have really begun accept that the broad, thin connecting base between public service professionals is legally and technically possible. Indeed, it is necessary! And of course, the fantastic support from decision-makers for phase 2 has sent a clear message. (Big acknowledgement to Steve Barton for that).

Let me digress very quickly to explain the case we made: We have successfully argued – for children so far – that professionals knowing about each other’s existence is the minimum necessary for co-operation. It’s simple isn’t it, which is a great sign.. You can see the main legislation we are relying on here (Children Act 2004, Section 10). And we hope to argue similarly for adults (will let you know!). It should be noted that “minimum necessary” is something that we can keep looking at as we go forward, balancing privacy with the need to be more effective in a multi-agency context.

With our now clear message on information governance, what I have been finding in recent conversations is a much greater willingness to engage on the potential of the tool. We have always had our enthusiasts, but we’re now seeing previously cautious teams get engaged with the possible benefits. We’re also learning how to describe these more clearly, perhaps with a greater sense of confidence!

The other day I had a great conversation with a team that works with children. We were thinking about the impact of them being connected through Patchwork with a professional delivering services to the child’s father. This doesn’t tend to happen at the moment through other means. As the team considered this, there was some trepidation – is that OK? – but quickly winning out was a sense of how useful that conversation might be and how much more effective the work could become with the family. Six months ago I think we would have got stuck on – is it OK. But there’s more confidence now – creative thinking is beginning to flourish on this safe ground we’ve created.

So whilst there will be other wild animals to tame along the way, I think we’ve shown we can do it, and do it by the book. We can open up clear spaces for professionals. This is enormously helpful for a system which has over time invoked fear among professionals and led to a kind of constipation.

I’m looking forward to phase 2, working with professionals in this cleared space and helping create a community. But I’m REALLY looking forward to working with service users in phase 3. We are very conscious of them not being here and know they need to be at the heart of things as soon as possible.

Troubled Families, Design & Technology

Despite a good deal of healthy debate about the government’s Troubled Families initiative, councils are now busy identifying families, recruiting new staff and beginning to think about their longer term strategies. Many newly appointed local co-ordinators will be looking for ways to instigate whole system change because they see there is real potential to achieve a lot in the three years of the programme. Some of the reasons for optimism include:

• upfront money, which is paid according to the number of families attaching to the programme
• the policy focus on dealing with the whole family rather than single issues
• strong partnership forming between children’s services, adult services and community safety within councils and with partners
• emphasis in the intervention approach on providing practical support to families, including training and employment

The whole scheme is based on the success of the Family Intervention model (intensive, dedicated support to improve family functioning) which was rolled out in 2006/7 to tackle anti-social behaviour (NATCEN research here) and critiqued here.

Right now, Family Intervention team capacity is being expanded in local authority areas and the Troubled Families Unit have indicated that the group of eligible families with lower level needs will be led by professionals outside of the intensive teams. And beyond the “troubled families” we know there will be a significant number of other families who may be at risk without good quality, persistent early help. This larger group could be around 4% of families in an area (1,000s often).

Troubled Families projects will need to find ways to help professionals in a range of services think about the whole family (or group of people in a household) and support more than just the “presenting” client, but address family functioning, relationships and the context people are in. This is likely to be a shared endeavour, requiring very closely connected teams of professionals around families over a long period of time, and hopefully look carefully about the possiblities beyond services, such as peer support, community support and so on.

Whilst multi-disciplinary “patch” teams might appear to be the answer, we can’t really expect organisations to have the appetite or money to release the amount of staff needed into new teams, with all the practical difficulties and costs associated with accommodation, ICT etc. Major re-structures are no longer sensible or viable.

If we are to have strong, effective teams around families, able to maintain long-term support to the numbers indicated, we have to look at secure web collaboration in my view. A design process is needed that places an absolute focus on the need for families to be fully involved, and practical day-to-day help for front line professionals. An approach that promotes simplicity and minimalism over complexity and exhaustive (and exhausting) functionality.

I rather like this quote:

“The aggregate size of networked resources is much greater than the centralised resources of yesterday” (from Why collaboration is the new oil & gas).

I think Patchwork, being launched tomorrow, shows how design and technology can be used to build useful tools fit for the “networked” future, pushing significant service and culture change in the process. The new generation of tools will help people do their work, not hinder it; and help inform and empower families.

If any Troubled Families teams would like to talk to me about collaborating on this, please do get in touch paul.brewer@brighton-hove.gov.uk

Open Space South West helped me understand more

I’ve been having a think about the talks given at the super Open Space South West conference in Exeter last Friday. Carl Haggerty deserves a big thanks for pulling together a really good set of speakers.

It takes time to absorb the messages of the world view outlined so well in Exeter.  As the networked society emerges (I think of Catherine Howe among several others), things will change ALOT!

Open by default, digital by design (attributable to Carrie Bishop).  Simplicity over complexity.  Open practice.  Understanding need by just talking to people! (well done redfront).  Simple, human centric design.  I love it!

Ivan Illich, the fascinating anti-institutionalist, pondered thus back in 1971 in his seminal work “Deschooling Society”:

“The operation of a peer-matching network would be simple. The user would identify himself by name and address and describe the activity for which he sought a peer. A computer would send him back the names and addresses of all those who had inserted the same description. It is amazing that such a simple utility has never been used on a broad scale for publicly valued activity.”

—Ivan Illich (1971)

I feel totally excited but also very dizzy by the clear truth that digital technologies are now ready (enough) to make this happen in public services.  I have been so fortunate in the last 18 months to have been involved in projects that address the two key spaces here (which will end up interacting).  The democratic citizen network (We Live Here) and the public service professional network (Patchwork).  Both projects are about human agency – where technology is used to allow deeper communication and the development of understanding and action.

We must continue to find ways to spread understanding of the immense and transformational opportunity digital offers to improve and transform public services, given the right development approach.  And we need to find ways to share practical tips on how to get projects up and running because it is very difficult.

I was so impressed with Andrea Siodmok and her work in Cornwall on Shaped By Us (particularly the off-line engagement which included setting up armchairs outside Asda as a way to talk to residents).  I think local government officers making change happen in this way need to share their experiences of getting stuff done.  Which reminds me I have a blog series to continue..

Disintermediation, Striations and Open Space South West

I’m really looking forward to seeing old and new faces at Open Space South West tomorrow.

It’s been a busy old day, but I did manage to read Catherine Howe’s blog about disintermediation, which is probably an idea that’s up there with Dan Mcquillan’s “striations”. If I understand it right, the former is about cutting out the middle man, and the latter is about how people, organisations and thinking gets stuck in ruts. That’ll do me for now any way.

I’d like to explore these ideas further tomorrow. How do we work with the middle men transparently, knowing they could be in the way of more direct, simple solutions to social issues? And how do we work to design stuff around the citizen or client, when the services with the budgets all have quite separate “reasons for being” like addressing housing issues or offending behaviour or .. whatever.

Digital design work will create more direct transactions between people, cutting out the need for some public sector functions (or radically changing them). And, being citizen centred, it will challenge the configuration of services, creating more holistic services around “cohorts” or types of people, or life stages or something.

That’s all a bit threatening to the status quo. What’s the recipe for these design projects. How are people handling it?

Look forward to it. And sorry about the lack of links. Blogging from a phone ..

And I didn’t put [sic] earlier on but I expect you noticed where it should go.

From case management to client support

Standardisation and Compliance

Over the past few years, I’ve been increasingly concerned about how the work systems in many public service agencies hamper professionals’ ability to really focus on relationships with clients in need and helping them make positive changes in their lives.  New Public Management practices since the 80s introduced high levels of standardisation into public services, intended to increase efficiency, but the results have been very mixed, at best.  Systems focussed on compliance have stymied innovation and downgraded professional judgement.  Much worse, they have misunderstood what counts when delivering services to people, especially the vulnerable.  The Munro Review of Child Protection First Report provides a good analysis of the issues that can be applied more widely.

Services are continually under pressure and tend to manage by getting “cases” through and out of their system.  There are high levels of process standardisation built in, designed to guarantee quality of service, by measuring process as a proxy.  Assessment and review tools are highly prescriptive, aimed at ensuring minumum standards, but have actually forced professionals into a “paper-trail” mentality.  Rather than the tools being used as part of practice, they are often filled in retrospectively, because they “get in the way” of working sensitively with clients.

When you look at these processes and forms, they do, of course, contain very sensible prompts and questions for professionals.  So where’s the problem?

Human Relationships

The case management approach assumes “cases” can be understood, categorised, assessed and planned at given points in a ”workflow”.  And that ”types” of people need the same thing at the same point.  ”Case management” doesn’t generally support a more human process where good relationships are nurtured and the skill of the professional helps develop shared understanding and shape useful plans at the right time, in partnership with clients, their families and other professionals known to the client.  Whilst joint working currently happens through a range multi-agency panel arrangements, or through co-location, the case management IT systems the professionals go back to do not reflect or support this collaboration.  Systems are not supporting human networks and relationships.

Confusing Picture

It’s amazing that when you look up a “case” on a case management IT system, it’s often so difficult to quickly get a sense of the client, who’s working with them and what’s happening for them.  You have to dig around and piece the story together.  These systems, and by extension sometimes the professional practice, is not client-centred.  Odd to say really, but true.

A key role for technology

It doesn’t have to be this way.  There are some encouraging signs.  The beginnings of a very significant shift, I hope.  These problems are beginning to be understood and accepted by local managers who are gradually getting some room to innovate and design for themselves.  The removal of some central government prescription is helping.

Technology is going to play a vital role in shifting the focus onto the client, the help – often delivered by a range of professionals – and whether it’s working.  New tools will be built using an approach to design which involves front line professionals, clients and their families every step of the way.  The powers of the web to connect people together will be harnessed.  Professionals working with the same client will be able to collaborate together – sharing, sense-making, planning.  And the client and their family will be involved in the network too, as appropriate.  Work will still be well-managed but tools will be client-centric and support day-to-day practice.  We will move from “case management” to “client support”.

Pie in the sky?  I don’t think so, but it might be a tough gig ..

Why not come and discuss this with me and others at Futuregov’s launch of Patchwork (one of the tools for the future) over a coffee, or maybe a beer?

http://patchworklaunch.eventbrite.com/

Paul