This post is the last in our series about the steps places can take to make inclusive growth happen. We started with the importance of having a shared vision and worked through to understanding barriers and metrics, innovative finance options as well as the importance of working across institutions and the role of businesses. We now turn to the role of public services in achieving one of the key pillars of inclusive growth, integrating and investing in social and economic infrastructure.
The ultimate objective here is to integrate social and economic services locally, and in doing so, move from reactive to preventative investment which helps to tackle problems at their root, fostering inclusive growth.
Co-location and beyond
Co-location of services can reduce costs through improved effectiveness. Healthcare is an excellent example. Greater Manchester, along with a devolved health budget, has re-organised the way they deliver primary care to integrate different types of health care services. An example of their re-organisation of delivery is the co-location of mental health specialists with musculo-skeletal specialists, given many of those out of work suffer from a combination of issues around both. Similarly for chronic disease management, it has been shown that co-location of practitioners can improve access to services and equipment.
New ways of organising services and the people they serve across boundaries can facilitate working together, beyond the co-location of health services. Addressing place-based social determinants of poor health, underpinned by the development of complementary governance arrangements, financial and accountability mechanisms, is critical in improving the health of the population (and is the focus of CPP’s year-long healthcare inquiry). This approach is supported by Andy Burnham, Mayor of Greater Manchester, as he set out in our most recent healthcare report:
“People forget that Bevan was minister of state for housing and health. CPP’s analysis has shown that housing is one of the most important factors in variation in life expectancy. We need to consider radical new ways to narrow this inequality ‐ maybe, even, the right to housing becoming a universal entitlement."
Greater Manchester has been integrating all health and social care services around geographical hubs that each cover up to 50,000 people.
Link up with a wider set of complementary services
Thinking beyond healthcare, Barking and Dagenham, under the title ‘Community Solutions’, has reconsidered how the social systems can interact and deliver. The Community Solutions method brings together local authority teams which used to be responsible for worklessness, skills, poverty, debt, mental health, homelessness, domestic violence, antisocial behaviour and family support, all of which used to be tackled separately and at greater cost. Jobs roles have been reconfigured entirely to be organised by level of intervention, as opposed to area of specialism.
Community Solutions is based on re-orientating services around the real causes of poverty, rather than the ones which justify existing structures. Community Solutions Account Managers bring together the services on offer across the range of challenges an individual may face to make sense of the overall range of solutions needed. It is systems thinking in practice. By 2020/1 Barking and Dagenham are looking to have fully transformed their service delivery model.
Preventative infrastructure and spend
Integrating institutional structures and public service delivery provides the basis for a system that focuses on prevention and preventative spend, as the impacts of one service on another becomes clearer. When this happens, the interdependency between social and economic policy is demonstrated.
As Greater Manchester continues the integration of health and social care, they are shifting their focus to preventative spend to both deliver better services and make required savings. The Manchester Model is predicated on a life‐course approach with a focus on key moments of transition including school‐readiness, life‐readiness, ending homelessness and active ageing. This is facilitated by the integration of commissioning, a shift to a single budget and place‐based commissioning and collocated professionals in each neighbourhood.
Prevention can sometimes mean not even using government provided infrastructure at all. The Australian social care pioneer methodology, known as Local Area Co-ordination (LAC) where “Coordinators try to support local or non-service solutions and focus on what the person can do for themselves using their skills and experience; as well as the help that friends, family and the local community can provide”, has been adapted in Derby and Middlesborough amongst other places in the UK. An evaluation in 2015 of the Derby’s use of LAC found that “for every £1 invested in the service, £4 of social value is created”, with qualitative assessment citing improved well-being through reduced isolation and improved sense of empowerment.
Headline targets for public service delivery set by the central government need reassessment if central is going to support local government in joining up public services. It may be that, setting up testing areas to allow innovators to experiment should be encouraged on a more systematic basis.
Similarly, to move across to preventative spend will require some double running, where money is being spent on both prevention and cure, before prevention reduces demand on the system. This will require acknowledgement from central government that short term investment in the transition to prevention can reduce demand in the longer term. The difficulty of the Troubled Families programme launched in 2011 to, so far, demonstrate any financial savings speaks exactly to this problem, although this must not be confused with the need to integrate services from the perspective of a service user.
In a time of an increasingly tight spending framework on local government, it is not reasonable to expect local areas to sacrifice delivering services today for savings tomorrow. To move towards more prevention, local areas should come forward with proposals to be used as additionally funded test cases, with expected future benefits quantified as far as possible. Social investors could be the vehicle. Equally, departments at local or national level, who recognise the positive spill over of their spend onto other departments should be measuring their impact and making a cross-department proposal – perhaps there is a deal to be done.
Fragmentation of services can be detrimental to outcomes, as CPP’s latest health report shows. Taking a whole system approach and introducing preventative spend requires a significant shift in the approach to public service infrastructure and delivery, as well as looking at drivers outside of the usual remits.
We must remember that social and economic policy are the flip sides of the same coin. Collaborative and joined up public services are a key driver of quality and inclusive growth and they need to be delivered through a whole systems approach. This is not easy, it will take understanding of increased short-term costs, but ultimately, we know that prevention may be the only cure.
We at CPP look forward to working with our partner places and many more across the UK and beyond in delivering inclusive growth – identifying the root causes, setting the vision, finding the funding, setting up the institutions and measuring the outcomes on the ground. This is our core mission and primary goal, to win the ultimate prize of helping to tackle inequality by design.