Delivering digital differently: how should we provide public services in the future?

 

By Steven McGinty

On April 21st, Socitm (the Society of Information Technology Management) will be having their annual spring conference. This year, the agenda reflects the challenges facing technology leaders, who are under increasing pressure to radically transform services and deliver financial savings.

The event will open with a discussion on how digital technology should be used to provide the public services of the future. In anticipation of this, I thought I’d highlight some of the issues that may be discussed.

Open architecture and platforms

In 2012, the Government Digital Service (GDS), the body responsible for digital transformation in central government, launched GOV.UK. Within 15 months this project brought together over 300 government agency and arm’s length body websites into just one single platform. Similarly, they also introduced GOV.UK Verify, a platform rolled out across a number of departments, which allows citizens to prove who they are when using government services.

These platforms exemplify the UK Government’s new ambition for public services, i.e. that services should be simple, user-centric, and built on ‘a common core infrastructure of shared digital systems, technologies, and processes’. In theory, this should provide users with a seamless experience as they move between different government services. This approach has been referred to as ‘Government as a Platform’.

We have also seen examples of this approach adopted in local authorities. For instance, Manchester City Council’s award winning website clearly follows some of the GDS’ design principles.

Collaboration

Historically, the public sector has worked in silos, with individual departments and local authorities responsible for their own digital projects.

However, Matt Hancock, Minister for the Cabinet Office, appears keen on greater levels of collaboration, particularly with the private sector, as he believes this will lead to financial savings. For example, he highlights the joint-venture between the UK Government and Ark Data Centres to provide hosting services for the whole government. Previously, each government department would have had to agree their own bespoke contract. This joint-venture could potentially save the UK government £105 million.

Local councils have also shown a willingness to collaborate, with many joining together to sign shared information and communications technologies (ICT) service contracts with suppliers. Usually these councils are neighbours; however we’ve recently seen ‘pioneering agreements’ between councils from different regions in England. Like the hosting agreement, this collaborative approach is expected to provide better value for councils.

Data

Eddie Copeland, Director of Government Innovation at NESTA, has written widely on the need for the public sector to make better use of its data. Although this is certainly true, there have been some successful data projects, such as the London Datastore, a free and open data-sharing portal for Greater London.

Eddie Copeland has proposed that London, as well as other devolved regions, should introduce a New York style ‘Office of Analytics’. This would be led by a Chief Data Officer who would have overall responsibility for managing and coordinating data projects. He suggests that having a central office to manage data could help UK cities in a number of areas, including increasing business growth, identifying illegal housing, and predicting possible fraud.

The Greater Manchester Combined Authority (GMCA) has also announced plans to introduce a data service called GM-Connect. The service’s main purpose will be to help break down the barriers that prevent public services sharing information.

User-led approach

There is now a recognition that public services should be determined, not by the organisational and legal constraints of government departments, but by the needs of citizens. For instance, in a podcast in 2012, Mike Bracken, former head of the GDS, stated that “everything we do is based on users and user-testing.”

In the US, the city of Oakland has introduced an innovative pilot programme that assigns an ‘MVP’ (most valuable player), whose sole responsibility is to ensure that digital initiatives consider how users, outside of city hall, approach finding new services. In addition, it also uses surveys to understand how services are used, digital dashboards that display current activity on the city website, and virtual town halls, which provide an opportunity to receive direct feedback.

Multi-channel, cross platform

As technology has changed, citizens are now expecting to access public services via a range of devices, including smartphones and tablet computers. There is also the expectation that government services are able to match the experiences provided by private sector organisations such as Facebook and Google. Social media has also become so pervasive that some organisations receive more visits to their social media pages than their main websites. Public services, therefore, need to be optimised for mobility, as well as providing a consistent multi-channel service.

Conclusion

At the moment, public sector organisations are using digital technology to improve public services. However, if they are to make the savings highlighted by last year’s Spending Review, they will need to refocus their efforts on digital initiatives.

The public services of the future will need to:

  • be based on a common set of shared platforms, processes and technologies
  • involve a number of stakeholders working together (whether private or public sector)
  • focus on the needs of users
  • harness data to provide targeted interventions and optimise services
  • be optimised for mobility
  • provide a consistent multi-channel experience.

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What is Reablement in healthcare and how is it done?

By Rebecca Jackson

Reablement, or enablement is the process of rehabilitating people to allow them to regain some or all of their independence. Often promoted as a form of intermediary care, reablement programmes are recommended for patients who have had a stay in hospital, in order to reduce dependence on the local social care system or traditional ‘care at home’ programmes.

They often result in longer periods of one-to-one contact than ‘care at home’ programmes  – trained professionals work with patients and their family to encourage and promote the achievement of personal goals. It also provides an intermediary stage between health care and social care, which can help the patient transition. Effective reablement programmes are an example of health and social care bodies working together to deliver holistic, person-centred care.

Cooking Together

What makes an effective reablement programme?

Reablement programmes cover a range of everyday tasks such as how to tackle stairs, how to wash and dress and how to prepare and cook meals. It encourages service users to develop the confidence and skills to carry out these activities themselves in order to continue to live at home.

The programmes are planned and delivered by trained reablement professionals – they involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.

Much of the literature around reablement (enablement) practice centres on core issues which are vital to ensure success:

  • focus on early intervention and prevention;
  • a positive, enabling, co-productive approach adopted by all;
  • a workforce with an ethos of working with people, rather than doing something to them;
  • the active participation of the service user and their family in reablement;
  • ongoing training for staff;
  • information and support for families and carers;
  • integration and collaborative working between health, housing and social services;
  • strong leadership in commissioning, and adequate funding of services to deliver sustainable outcomes;
  • evaluation that incorporates both social and financial service outcomes to demonstrate value;
  • good quality assessment by a practitioner with the right skills and abilities to determine an effective programme.

Senior resting in a wheelchair

Reablement in local authorities

Research has shown that these intensive programmes are effective. A 2007 study for the Department of Health’s Care Services Efficiency Delivery Network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.

Almost all of England’s councils are planning, implementing or running a reablement service. One driver is that it is seen as a tool for managing the costs of an ageing population. In the UK, reablement programmes usually last for 6 weeks, at which time care is either passed to a social worker, adult social care team, or patients are asked to pay for the continuation of the programme themselves.

Reablement has been criticised as expensive, and time- and resource-intensive. Like any service working with vulnerable people, it can also be difficult to demonstrate value as there are differing success rates for different patients. However, interviews conducted with people who have received reablement packages have suggested the emotional and long term benefits are significant as are potential savings to care budgets in the future. This is especially the case in terms of the cost of readmission to hospital, which studies have found is reduced in cases where people received effective reablement care.

The local authority in Croydon was recognised in 2013 for its work in promoting and expanding reablement practices. They also developed a programme of pre-ablement, which saw training delivered to vulnerable people before they became unable to carry out tasks. By showing them alternative ways to do tasks, they were able to change things before being forced to. This preventative approach worked within the local authority and is something which could be considered more widely as pressure increases on local authority funding and care capacity.

There is a growing consensus that properly funded and effective preventative services, such as reablement, can deliver cost-savings to health and social care services, as well as improving the lives of patients.


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