Save money by doing the right thing

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ViewsJune 26th, 2014

In social care, it is not demographic change but ‘failure demand’ that is the biggest cause of rising demand according to a report published at a House of Lords launch on the 12th March 2014. 

The study analysed hundreds of thousands of demands placed on the public and third sectors in multiple localities across the UK.  The report can be accessed here: Saving money by doing the right thing: why ‘local by default’ must replace ‘diseconomies of scale’

The report estimates that £16bn of public money could be saved by tackling ‘failure demand’. 

Failure demand is unnecessary demand such as repeat assessments, multiple referrals, delayed discharge, unwanted equipment and unsuitable services – basically all demand caused by a failure of public services to understand people and help them achieve what matters to them.

This failure demand is not free – it costs money when people are forced to access the public and third sector multiple times because they have not achieved what matters to them.

The study, published by Vanguard and Locality, is the first of its kind to discriminate between artificial demand for public services, generated solely as a result of an organisation not taking the right action, and real demand, experienced by the person who needs help.

 There are three key reasons this problem has developed:

  1.  Economies of scale thinking – this has led to ever centralised services, which are making it very difficult to work with individual citizens in the context of their own community.
  2. Standardisation of services – a logic around commissioning large numbers of standard solutions makes it almost impossible for frontline personnel to help citizens achieve what matters to them, as they are limited to standardised packages of support.
  3. A belief that the only way to support citizens to achieve what matters is to deliver services – this creates problems of dependancy, and makes the citizen feel they have less to offer to their own community.

I have written previously on this subject with regard to social care environments.  As the frontline in these systems have a menu of services they can offer, these dedicated individuals find themselves assessing the citizen to fit into this menu.  The system also treats each request for help as a single transaction, without being in a position to understand what really matters to the individual and helping them achieve this.  This, in turn, leads to enormous numbers of re-referrals, as individuals return, as what matters to them has not been achieved. The assumption behind the design of the system is that standardisation and menus are necessary to control the budget – in fact, by constricting the ability of the system to absorb variety and help people achieve what matters to them, costs continue to rise.  This is further exacerbated by delivering services to people, rather than working with them.

Creating a system that helps citizens articulate what a good life looks like to them, and co-producing methods to help them achieve their good life, removes the power imbalance between blog_banner_joincitizen and state. In addition, it saves money.

Below are some of the results achieved by working in this way in social care:

  • 28% reduction in residential and nursing care placements, together with a reduction in domiciliary care hours – average care packages reduced from 12 hours to 9.7 hours per week.
  • 46% reduction in contacts into Social Services.
  • Under-spent community care budget (cost avoidance of £1.5 million in 2013-2014).
  • 30% reduction in assessments.

Rationing through menu-driven standardisation drives up costs, and prevents committed individuals working in these systems supporting citizens to achieve innovative, and cheaper, solutions. 

This can only be done by intervening in these systems directly – we must start by understanding why the system prevents us helping citizens achieve what matters to them.  From this, we can redesign the system along different principles, as below.

Current System – Principles New System – Principles
Identify problems/crises What matters – ‘good life’
Find solutions Look for strengths
Implement them Build support and networks – let solutions emerge
Run by and for professionals Run by citizens who pull for support
‘Customer’ – consumer of services Citizen
Purpose: ‘be safe’ Purpose: resilient citizens

Using the above principles we can transform our public and third sectors and dramatically improve the lives of the citizens of Wales.  We can ill afford not to.

Simon Pickthall is Managing Director at Vanguard Consulting Wales

 

 

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