Archive for January, 2011

A week is a long time in local government!

January 28, 2011

At the end of this week, I think it would be good to reflect on quite a number of reports regarding the future of local government that have been in the news.

The week started with media reports that the Big Society project was in crisis. A report from Deloitte added to that sense of crisis, saying that there was a lack of leadership and this was reinforced by subsequent polling this week showing that the public were equally confused and sceptical. The Deloitte report set out a number of challenges:

  • Significant change to local authority business models. Uncertainty around budgeting, future revenue and capabilities create a series of business change challenges for local authorities.
  • Within communities, there is significant variance in capability and engagement. There is poor strategic understanding of where community capability interfaces with areas facing cuts.
  • There is an urgent need to understand what is possible on a systemic, not just ad hoc or experimental, level. Councils need to build a matrix of organisations to do business with based on their track record, impartiality, corporate structures and their legitimacy.
  • There are no common standards of accountability and governance. There is patchy or limited best practice around the optimum accountability and governance mechanisms for community-led delivery models.

Quite an indictment! When combined with the regularly expressed fears by the voluntary sector regarding a loss of capacity as a result of public spending cuts, one could see where the sense of crisis was coming from. No wonder there were media reports suggesting Ministers were looking at the Big Society afresh.

However as the week went on a more positive agenda emerged. A new report by localism think tank New Local Government Network (NLGN) has set out a vision for more sustainable local public services beyond the current financial settlement and the aims of the government’s Localism Bill. Next Localism: Five trends for the future of local government explored how a new relationship between State and Citizen could make a reality of the freedoms needed to fulfil local government’s ambition, shape the future of local democracy and ‘lock in’ localism into the wider public service reform agenda.

The report demanded three reforms from central government that would herald a new era of localism:

  • Greater financial reform: to reduce local government’s dependency on Westminster by letting councils raise more than half of their own money from local sources, up from less than 40% at present. This is an area that has not yet been addressed by the government, despite many proposed changes in other areas of the public services.
  • New management powers: to improve local services, with councils able to bid to manage elements of budgets currently controlled by Whitehall, such as health, police and Job Centres, so councils can help design more efficient and personalised local services. The DCLG’s Community Budget pilots will hopefully lead to an extension of local budgetary control.
  • Greater Whitehall reform: with central government better joined-up on policy, localism integrated into the decision-making process, and ministers and their officials set more hurdles to stop the micro-management of localities. The Government’s own Essential Guide to the Decentralisation and Localism Bill seems to point to a more joined-up approach.

NLGN  identified five shifts for how councils can be more ambitious:

1. A shift from retrenching to redeveloping. Once the first wave of cuts is over, councils must decide whether they want to become less ambitious, or whether they will transform their services and develop new roles in their communities.

2. Local government needs to move from simply piloting new approaches to transforming services on an industrial scale. Over the coming years, local and central government will need to be much bolder, working together to rapidly bring approaches such as early intervention, prevention and community-based budgeting into the mainstream.

3. A shift from wholesale to retail provision as services are increasingly sold directly to individuals. This trend is most obvious in social care, where the government is preparing to shove councils down the route of personal budgets. But other services such as health and education are also being marketised.

4. A shift in the political role of councils from being primarily service providers to becoming democratic hubs. As the shared or commissioned services approach strips members of their role as elected service managers, they will need to embrace a role that combines traditional voter advocacy with community capacity building and social entrepreneurship.

5. Local government will have to move from place-shaping to community development. Instead of planning better places from the town hall, councils will need to help citizens and communities make better choices for themselves by providing them with information and advice, and by building up intangible assets like trust and social capital.

The last point is something we in TCC have been pioneering with local authorities. In order for public bodies to understand intangible assets such as trust and social capital, they first need deep insight into communities to understand the position they are currently in and not where public bodies might want them to be. Often the public body and its staff may hold very different values to some of the highest users of public services they seek to serve or represent.

The NLGN paper showed that despite the financial difficulties, there was a big agenda that could be developed. Another paper that was published at the end of last week also contributes to that. Graham Allen’s report to the Government on Early Intervention has broad all-party support, but calls for a significant change in how public bodies target their activity.

Early intervention will improve the lives of vulnerable children and in the words of the report will help break the cycle of “dysfunction and under-achievement”. The Allen Report says success or failure in early childhood has “profound economic consequences” and calls for more private money to be channelled into early intervention schemes to help set children on the right path in life. He highlights the Family Nurse Partnership, which has had a lot of success in the United States, and says it should be available to all vulnerable first-time mothers in the UK. The programme sees specially trained nurses regularly visiting young, first-time mothers from pregnancy until their child is two, to promote attachment and positive parenting.

The Allen report recommends:

  • Regular assessments of all pre-school children, focusing on their social and emotional development. We in TCC think this is vital and in order to do this believe that one also needs to understand the social and emotional development of the parent too.
  • A national parenting programme in the UK.
  • Numbering all year groups from birth not just from the start of primary school and that the UK gives the pre-school years – 0 to 5, including pregnancy – the same recognition developmentally as the primary and secondary years of education.
  • The setting up an independent early intervention foundation to drive early intervention forward, assess policies and attract investment

Early intervention along with the new public health role for local government show that there are many new opportunities for local communities and their public representatives to seize on. Indeed with both programmes likely to be led by local authorities, there is a substantial overlap and potential synergies in linking the two programmes together, so they reinforce each other.

On a final positive note, the week ended with the publication today of the Lambeth Cooperative Council report. This goes much further than the principles examined in the NLGN report and sets out many practical approaches to how local authorities can develop mutual and social enterprise solutions to the new challenges facing service delivery. TCC recognises the importance of this and has recently been working with local authorities on capacity building and developing the role of social enterprises and timebanks to ensure poorer communities are not left out of this process.

In the end the best way to build any form of Big Society is to strengthen local capacity and that could take a few years. Instead of crisis headlines, what we really need is patient work at a local level learning both from the successes and failures. We need a deep understanding of local communities, so public services are responsive to social and emotional needs as well as physical ones. We also need to appreciate their current level of motivation and ensure communicating support and change is expressed in the same language as their values. What central and local government can probably best do to contribute to that agenda is to enable a range of different approaches to develop and celebrate and promote the good ideas that emerge from that process.

Charlie Mansell is the Research and Development Officer at The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.


Health and Social Care Bill: the increasing role for local government within health?

January 20, 2011

The Health and Social Care Bill was published yesterday. Clearly there is a lot of controversy over what some might see as “another top down reorganisation” as well as specific issues around tariff variability, competition policy, more private providers and potential for existing hospitals to be allowed to fail. This posting is not about that as other blogs such as the independent King’s Fund and the more critical Paul Corrigan are covering those issues in much more detail.

What I want to look at is where there does seem to be at least some political consensus. That is the enhanced role of local government within the local health economy.

Key responsibilities for Local Councils will include:

  • There will be a legal requirement to create Health and Well-being boards and a duty on the GP consortia, directors of public health, adult social services and children’s services, as well as the local HealthWatch, to participate. Indeed, some Councils like my own in Sutton, have already established a shadow Health and Well-being Board.
  • Health Overview and Scrutiny Committees will not now be abolished and indeed there will be an extension of formal council scrutiny to cover all NHS-funded services.
  • The Public Health Service will be run at the local level by Councils with a ring-fenced budget and local priorities determined by the Health and Well-being Board.
  • Local authorities will fund the work of local HealthWatch organisations and will contract support to help them carry out their work. Local authorities will have a legal duty to ensure that the activities and support for local HealthWatch organisations are effective and value for money. In the event of under-performance, the local authority will be able to intervene and, if necessary re-tender the contract to support the work of HealthWatch. Local authorities will also have to ensure that the focus of local HealthWatch activities is representative of the local community.

This is a significant advance for the role of local government, which along with their new Power of General Competence to do anything not prohibited by law, gives local authorities a significant incentive to take a more powerful role in local health provision at a time when resources in the area are declining less than local government core funding.

In the past it has been said that health professionals would object to local government interference, However from research we have conducted with GPs in various areas, we detect the exact opposite and many of those most active in pathfinder GP consortia are looking forward to greater collaboration.

Apart form the formal structural role outlined above, local authorities may want to seize the opportunity to both support and contribute to greater commissioning for preventative health. As many as one in three hospital beds are occupied by people with diabetes, asthma and emphysema who were admitted as emergency patients. This was a point made recently by NHS Chief Executive, David Nicholson. He recently said:

“Their care has not been properly managed in the community. The trend towards emergency admissions will be reversed. Better management of these patients can restrict significantly the number of emergency admissions, for the benefit of the patients and the NHS as a whole, enabling you to reduce your bed stock in acute hospitals…The NHS is devising a comprehensive mechanism to enable them to better manage their own care.”

The question is can this be delivered by GPs who are also commissioners? This sounds like something where local authorities working in partnership with voluntary and private sectors could be commissioned to deliver a stronger “preventative service”, which also includes building on currently developing re-ablement strategies.

In view of the budgetary measures, this could also be a relatively non-contentious area to develop Big Society approaches as this would be all about a new service that reflects modern trends in health care. This could include a mix of local authority led enablers and trainers along with trained volunteers or front line staff to pop round to people or phone them to see how they were doing and give them the advice and support they needed on self-care.

Often people end up in A&E for a complex range of emotional as well as physical reasons, sometimes because their personal and local social networks and social capital is poor. Mapping the community to understand not just its physical needs but also its psychological needs, emotions, motivations and values is important too in order to prioritise limited resources. This could then lead to targeted interventions; following up regularly on the most vulnerable with the right form of communication, contact and support.

There could be all sorts of models commissioned by GP consortia through forthcoming pilots, including a buddy model, even radical ones utilising Police community support officers in a dual function?

Much of the debate on the Bill so far has been about commissioning a range of acute and community curative services. This is of course likely to dominate the health debate at Westminster in the coming months. In the meantime local authorities will start looking as to how they can join-up their social care activity with health to make a preventative offer for GP consortia to commission that adds to the other health roles they will be developing.

Charlie Mansell is the Research and Development Officer at The Campaign Company. I would like to thank my colleague Nick Pecorelli for some helpful comments that contributed to the development of this posting. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

David and Ed set out a debate: BigSociety or Local Institutions?

January 17, 2011

David Cameron spoke today about the pace of public service modernisation. Whatever one’s view on that pace of change, his coalition government has a majority and a commitment to a fixed term parliament so some change is likely to happen. Talking about the stability of that coalition, the Prime Minster said:

“politics should be no different from the rest of life, where rational people find a way of overcoming their disagreements”.

However, as we know, many debates are driven by emotion as much as they are by rational discourse! On Wednesday the Health and Social Care Bill is published and the debate is likely to not just be about the rational delivery of services through some form of objective prioritisation. When lives are perceived to be at risk or people are in pain, emotions will also be likely to drive the subsequent debate. We need to consider both the rational aspects and the emotions in this debate and be mindful of them. People’s perception of “fairness” does not come out of any exact calculation, but out of perceptions shaped by our reflective and reflexive reactions.

Opposition Leader, Ed Miliband also set out his views on the role of society in relation to the state and markets over the weekend. The difference seemed to be that he saw the explicit need to protect local institutions, whatever their ownership. Press coverage over the weekend also referred to the work of academic and Citizen’s UK community organiser, the recently ennobled Lord Maurice Glasman and his conception of “cherished local institutions – everything from churches to post offices, banks, hospitals, schools and football clubs”.

Where does this difference in emphasis take us? Probably by this Spring into a minimum of 152 local debates starting in England at big-spending principal local authority level.

Will the debate be a theoretical one about “state-society-market” or will it more likely be about “xxx hospital”, “xxx library” and “xxx forest”? In the end the Big Society has to be grounded in the emotional local reality as much as the theoretical aspects, or even the rationality of a commissioning contract; because people will, through their values, focus on these three aspects in different ways.

It is important to point out that both leaders gave political speeches seeking the difficult balance between the creation of “dividing lines” with their opponents and the need to build broad “coalitions of support” for their own view. However public, voluntary or even the private sector working in partnership with the others, to administer public money in a “universal” and “impartial” way – as the Prime Minister rightly stated in his speech – do not, therefore, have the luxury of defining those who are “for” or “against” them. They have to engage with everyone in their community.

How do they communicate these challenges to people who may react in different ways to whatever change emerges from this debate?

As I have blogged before, it is vital to understand what the needs, motivations and values of the various segments of people within the local community are. These are unlikely to be a single mono-cultural set of values. Public bodies, unlike politicians, have to reach out to all.

For some people, who are not driven primarily by inner directed or even outer directed values, much of this debate can come across as a threat.  Whilst someone amongst the 28% in the UK with primarily outer directed values would no doubt vastly welcome the end of “one size fits all” or even the end of “all Council house doors painted the same colour”; nevertheless for some others – in particular the 32% in the UK with primarily safety and security values and needs – their values prefer familiarity and little change. So those phrases will have a lot less resonance to some than others.

Once the politicians have had their moment, it is important not to think in terms of the speeches we have just heard about, but instead be mindful of all the various values in the community.

Charlie Mansell is the Research and Development Officer at The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

Public Health White Paper: Applying behavioural insight to health

January 13, 2011

A new Government paper on Behavioural insight was published just at the tail end of last year. It may well have been missed by many working in this field because of the Christmas and New Year holidays. It builds on David Halpern’s previous Mindspace behaviour change work for the Cabinet Office.

It is quite an important paper as it will influence Government attitudes regarding priorities within public health following the publication of the White Paper on the subject. Government policy  towards the use of behaviour change within public policy was recently summed up by this recent Frances Maude article in the Guardian. The concluding sentence to the article is important:

“one thing we can be certain about: between banning and doing nothing there are many choices.”

The Government’s aim seems to be to act as a bully pulpit, suggesting rather than instructing. On page 7 of the paper it says:

“In a world where general practitioners, public health professionals and local communities increasingly hold the budgets and power, we hope that some of the ideas contained here will spark interest well beyond Whitehall”.

Cynics might also add that they will no doubt also be claiming the credit when something local goes right! In terms of methodology, there seems to be a strong focus on Salience from the Mindspace report – making sure people are aware of their choices.

The paper sets out the following case studies:

  • Smoking: drawing on commitment and incentive devices, we are launching a new smoking cessation trial with Boots.
  • Organ donation: we are introducing a trial of ‘prompted choice’ for organ donation, which we believe will significantly increase the number of donor registrations.
  • Teenage pregnancy: how teenagers who mentor toddlers are significantly less likely to become teen parents themselves.
  • Alcohol: Welsh universities will be trialling new methods to encourage students to drink less alcohol using social norm techniques.
  • Diet and weight: we will be establishing a partnership with LazyTown, the popular children’s TV show, which will encourage healthier behaviour in children.
  • Diabetes: new devices are helping children to manage their conditions in ways that are practical and fun.
  • Food hygiene: how the new National Food Hygiene Rating Scheme will empower people to make better choices when it comes to the hygiene standards of food.
  • Physical activity: numerous innovative schemes have been set up, including the ‘Step2Get’ initiative in London, which incentivises pupils to walk to school.
  • Social care: we have established a partnership to develop a reciprocal time credit scheme to help catalyse peer-to-peer provision of social care.

An interesting new example they refer to on pages 23 and 24 of the report is the “reciprocal” and “making a commitment” ‘Fureai Kippu’ social care credits for helping the elderly that has been pioneered in Japan. This has a unit of account of one hour’s help and has similarities to Local Exchange Trading Systems (LETS). TCC is currently working on projects in the North of England in this area of health and social care, so will be exploring how approaches like this might connect behaviour change with Big Society activity in an effective way – perhaps through the use of Time Banks?

Most of the above areas – apart from perhaps Organ Donation in the short-term – will be local issues for each new Heath and Well-being Board that will be established as a result of the forthcoming Health Bill. Many of them are the sort of issue where there will often be differing outlooks about them due to people’s differing values.

The conclusion to the paper on Page 25 is promising. It refers to experimentation. Expect to see groups of Health and Well-being Boards band together to test slight variations in approaches. This should lead to lots more useful insight coming out of the field of health behaviour change.

Charlie Mansell is the Research and Development Officer at The Campaign Company.

The 120 days of Christmas? Are there psychological benefits to extending Christmas lights?

January 10, 2011

Three years ago I wrote the blog here about the way we as a society make January and February so miserable after the mid-winter celebrations of Christmas and the New Year. I said:

Heading back to the office in the cold wind today, it struck me that why do we have such an excellent mid-winter festival and then make our January and February’s look so dreary?

A simple solution that struck me was that people and organisations should keep up their Christmas lights until the end of February. Indeed I think Christmas lights should be on from the beginning of November so the 4 darkest months are lit up!

Now I know that some might argue that in an era of climate change we should not be so wasteful, but the costs to the economy of sickness and mental illness in January and February should make us see the bigger picture. In any case we are rapidly moving to low energy lightbulbs so I think the level of energy usage should not increase for the extra time lights are on.

Richard Layard has written extensively about the science of happiness and has been successful in campaigning for extra government support for Talking Therapies. I don’t necessarily agree with him that you can substantially increase overall happiness for everyone in a competitive market economy where change and innovation will always make some people unhappy at any given point. However I do agree with Layard’s case that we can make things better for those who may suffer depressive illness. It is also well known that the middle of January is the worst time of the year for this.

Little things such as lighting up the dark days of winter with a continuing display of lights should make everyone feel a little better as they head back from the office in the 8 weeks after the Christmas holidays!

Since writing that blog there have been further articles and studies about the worst point of the winter; Blue Monday in the third week of January; with Mental Health charities even operating a support website. Also, since writing my earlier posting, the UK has now gone into recession and the VAT rise and rise in public sector charges for services is likely to be impacting on people harder this year than it was when I wrote the blog above in early 2008. One option might be to set the clocks on British Summer Time all year round for lighter evenings as the Lighter Later campaign advocates, however this is likely to require ‘upstream’ activity such as legislation, so may take a number of years to achieve. In the meantime perhaps individuals can develop ‘downstream’ approaches as I suggested in my earlier blog posting.

If anyone wants evidence of how nice keeping the lighting up would be, they should go this evening to the Queen’s Walk along the Thames between the National Theatre and the Oxo Tower on the South Bank in London established in 2005. It is a beautiful place most evenings because of the lighting. Why can’t we see more lighting like this, at least for the Winter months?

I don’t think I am even being that radical here. It is interesting to note that the ‘tradition’ of taking lights down by Twelfth Night seems to be a recent superstition and Candlemas (2 Feb) was the day decorations should come down:

“Down with the rosemary, and so
Down with the bays and mistletoe;
Down with the holly, ivy, all,
Wherewith ye dress’d the Christmas Hall”

— Robert Herrick (1591–1674), “Ceremony upon Candlemas Eve”

Of course in this modern age one might even take the risk of breaking the superstition of bad luck by keeping decorations up longer?

How could we change behaviour here? Values will count and people may hold different views because of that. Some might see the rational case for psychological well-being or enjoy the intrinsic beauty of winter lighting, but some may be loath to move from their perception of ‘tradition’ and emotionally consider a change ‘bad luck’. Some might go along with a change if they see others do so and to follow a new trend.

One idea that might chime with ‘traditionalists’ might be to utilise the Royal Family to set a new trend? After all it was copying the actions of Prince Albert that the Christmas Tree became a ‘tradition’ in the UK less than 150 years ago. It might even be a campaign that Prince Charles or Prince William might relish to improve the lives of people in future? A ‘Keep the Lights Up’ campaign might be something that could be organised for 2012? Indeed the band Coldplay with their recent Christmas single – which interestingly was actually filmed amongst the permanent lights at the Queen’s Walk at the South Bank – might even have given the campaign a theme tune by asking that “those Christmas Lights keep shining on“!

Charlie Mansell is the Research and Development Officer at The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.