ISSUE 27
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What role could AI play in tackling complex issues? How one local authority has used AI to help tackle homelessness How iESE is using design principles to help local authorities Find out how iESE has used design principles for upcoming products
Also inside: • iESE launches new service design tools • Industry thought leaders share their wisdom on digital design, health and social care design and human-centred design • Local authorities urged not to use unsupported CFC product
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How design principles can help create authorities of the future iESE we are seeing a changing focus in local government and other public services away from being the provider of services towards a model of community enablement. We think in the years ahead, 90 per cent of authorities will move away from a service delivery model towards one of community enablement where they analyse and understand demand, then seek to get as much of this demand as possible dealt with before it becomes a need for local public services.
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To get to this place we have to look to the future and how it is becoming a reality a bit at the time in the best local authorities, and use this to build a better picture of what the local public services of the future should look like. Local authorities should no longer have to make decisions based on out-of-date information. Digital systems, the internet of things and data analytics can now provide information in real-time and provide accurate foresight for what is most likely to come. This changing world is providing both opportunities and risks, all of which have to be navigated to get to the best possible future. The likes of robotics, artificial intelligence and drones, are providing opportunities to improve local public services, but we also have unprecedented challenges for the environment and the economy. To become an authority of the future, we need to plan simultaneously for the short, medium and long-term, whilst moving towards turning as many as our services as possible into what the iESE Transformation Framework describes as Level Three transformation. This is where communities are enabled, services are truly reinvented— not just improved upon – and as much demand as possible is prevented or diverted, significantly reducing the demand for local public services and making communities more vibrant, sustainable and resilient. For example, building more hospitals to deal with the sick is right to get the waiting lists down short-term, but the real long-term challenge is increasing wellbeing so less people get sick in the first place. In the medium-term we might help people adopt healthier lifestyles whilst introducing Level Three transformations – one such idea could be increasing the level of first aid knowledge taught in the education curriculum to reduce the strain on the health service of minor injuries. Rather than wait for Government to bail the industry out, local
John Comber, iESE’s lead researcher for Digital & Technology
government needs to do what it does best and get on with delivering its own solutions. For local authorities to enable their communities they need to adopt this as the key purpose and look to reinvent their services. Working with their communities and stakeholders to provide an environment in which they can engage, communicate, be active, and innovate. In this way individuals, communities and stakeholders will find ways to develop their own solutions and create services to meet their own needs and demands. Whilst this type of approach is increasingly being spoken about, the means to achieve it are harder to see. It needs new approaches and design principles are a very powerful tool not currently widely used in public service which can be used to produce such radical change. iESE has developed two new services – one is a strategic look, while the other is a toolkit. The new services draw on design principles, which allow you to take the best of what you are doing and add it to the best of what everyone else is doing worldwide. We want to minimise the risk to local authorities by sharing best and future practice. It involves working closely with the community to understand what their hopes, dreams and aspirations are and getting those embedded into community and corporate plans that the council then works with its communities and stakeholders to deliver together across the whole of their geography. Working on the community plan – living, eating and breathing it – and understanding that Level Three change is absolutely significant is vital. We can help public sector organisations already moving towards community enablement, and authorities looking for solutions to see the community enablement outcomes. What we do know for certain is that the local authority of the future will require the reinvention of almost everything they currently do.
• To get in touch about anything in this edition of Transform, please drop us a line at enquiries@iese.org.uk
EDITORIAL CONTACTS TRANSFORM IS PRODUCED BY: iESE www.iese.org.uk | Email: enquiries@iese.org.uk @iESELtd CREDITS: Editorial by Vicki Arnstein Designed by SMK Design
Views expressed within are those of the iESE editorial team. iESE Transform is distributed to companies and individuals with an interest in reviewing, remodelling and reinventing public services. © Copyright iESE 2021
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Introduction from John Comber, iESE’s lead researcher for Digital & Technology iESE news Feature: How iESE is using design In focus: How AI could help build the local authority of the future Thought leader: Design of digital transformation Thought leader: Design of health and social care transformation Talking heads: Notes from a design discussion Thought leader: Human-centred design of services
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iESE launches community enablement health checks IESE HAS LAUNCHED A NEW SERVICE IN CONJUNCTION WITH PIVOT PROJECTS WHICH MAKES USE OF ARTIFICIAL INTELLIGENCE (AI) TO HELP LOCAL PUBLIC SERVICES CREATE A FUTURE WHERE COMMUNITY ENABLEMENT IS THE FOCUS. With budgets ever tighter and community need ever greater it is clear local public services cannot continue to keep meeting every need of its communities. The two new services will help local public services create a picture of what the future will look like and what future needs will be, without assuming the public service is going to be meeting all of those needs. One key aspect of this work will be involving the local communities and another element will be an AI machine which will conduct in-depth research to allow the organisation to start identifying pivot points that can help start moving it forward to its future goals.
“The starting point is engagement with the community and what the community thinks of its future and its needs and what it aspires to,” explained Dr Andrew Larner, Chief Executive at iESE. “That engagement will identify some wishes, problems, issues that people have and at that point we engage with experts in the local public service but we will also produce a map of how those issues interact supported by an artificial intelligence engine which does six years’ worth of research in about one-and-a-half minutes and gets global best practice, lessons learned about what seems to be working and what to avoid.” One major benefit of the new service is that it creates an agile plan and action points that the local public service can implement straight away rather than acting as the basis to create a long-term plan. “We know that those local services that have been the most innovative and delivered the most significant changes in the way they work have done
so in an agile way and what we mean by that is rapid. This takes the agile method into the community and attacks some of those really wicked issues,” Dr Larner added. Dr Jonathan Huish, iESE Associate, has been working with Pivot Projects to trial the AI machine at Rhondda Cynon Taf County Borough Council in Wales. You can read more about it on pages 6 and 7. “What we are doing is bringing the best of breed together from iESE and Pivot Projects supported by an AI engine to deliver a forwardlooking service that helps build resilient vibrant communities and what that means for the role of local public services and what they should do in the future,” Dr Larner concluded. • To read how one council has used artificial intelligence to work on homelessness and to find out more about how it works, see pages 6 and 7.
Urgent announcement for commissioning authorities and care providers IESE HAS BEEN MADE AWARE THAT SOME COUNCILS AND CARE PROVIDERS ARE CONTINUING TO USE THE CARE FUNDING CALCULATOR (CFC) OR LOCALLY DEVELOPED ADAPTATIONS OF THE NOW DEFUNCT SPREADSHEET. The intellectual property rights and copyright of CFC and any adaptions are owned by iESE and the product is now unsupported and unlicensed. Any outputs should no longer be accepted in negotiations and iESE should be informed if you have received a copy of or suspect use of the CFC.
Having an accurate cost of care is more important now than ever and the CFC is now more than ten years out of date, as are the datasets that are included within it. Using the CFC (or any local iteration of it) carries a legal risk, but also could be compounding some of the issues the sector faces if pricing information is not accurate and up to date. CareCubed was released in 2019 and is the only validated, nationally recognised model that is supported and updated on an ongoing basis by iESE. This new digital tool is being used by a growing number of councils and providers as a
strategic tool to help shape markets, build better relationships between commissioners and providers and ensure the right care is being provided at a fair price for all parties. Please share this information with relevant colleagues and check that your organisation is not using the CFC or any adapted versions of the CFC Excel spreadsheet. • To read about the Care Funding Calculator on our website and to report any misuse, please go to: https://iese.org.uk/carefundingcalculator
iESE partners with PRSB to accelerate adoption of information standards for health and care records IESE HAS BECOME A PARTNER OF THE PROFESSIONAL RECORD STANDARDS BODY (PRSB) WHICH REPRESENTS THOSE WHO RECEIVE AND PROVIDE HEALTH AND SOCIAL CARE IN THE UK, AS WELL AS THOSE PROVIDING THE IT SYSTEMS THAT SUPPORT CARE, SUCH AS IESE’S CARE PRICING TOOL CARECUBED AND THE UPCOMING CASE MANAGEMENT SYSTEM (CMS) FOR SOCIAL CARE CURRENTLY IN DEVELOPMENT. The PRSB works across the public sector and with professional bodies to define the standards needed for good care records and can assure software suppliers’ compliance with the standards. The PRSB’s Standards Partnership Scheme is designed to attract software suppliers committed to best practice. As a Partner, iESE is showing it understands the importance of meeting PRSB standards and the
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importance of the drive for standard information flows and interoperability – the ability of IT systems across health and care to be able to interact to allow health records to be accessed by the right people at the right time. Sherif Attia, Design and Research Lead at iESE, said the partnership helped demonstrate iESE’s commitment to developing digital products that adhere to national and international information standards with a goal of allowing interoperability between systems, which is a key driver behind iESE plans to provide open frameworks within its new CMS platform to enable other providers to integrate their systems with it. “We are really pleased to announce that we are now a Partner of the PRSB,” said Attia. “We are committed to bringing a product to market which addresses the issues which hamper client care, such as a lack of data sharing and interoperability between systems. We look
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forward to working with the PRSB to further assure our users about the high-quality nature of our products, which have been designed in collaboration with those most impacted by these challenges and with clients’ needs front of mind,” he added. Lorraine Foley, CEO of PRSB, said: “We are delighted to welcome iESE as an PRSB Partner, showing their commitment to user-led information standards for better and safer care. This is a significant step forward in demonstrating their intention to innovate at the forefront of driving interoperability in care. We look forward to working with iESE to assess conformance in their systems and understanding where the standards need to improve as a result.” • Find out more about iESE’s partnership with the PRSB here: https://theprsb.org/partnerscheme/ourpartners/
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How iESE is using design principles
iESE has been using design principles to inform its own product design. Here we look at how design has helped shape two upcoming products - a new Case Management System for the social care sector and Alchemy, an online networking platform for public sector professionals.
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hen iESE was imaging how a new Case Management System (CMS) could revolutionise social work and the way client records are kept it realised input from a wide range of stakeholders was key. Using expert help from service designer Molly Balcom Raleigh, iESE sought to involve users from all areas of care service delivery and create a set of design principles which would underpin the project. According to Balcom Raleigh, if you get the design principles right, the work required to create the product or service should unfold from the principles and provide high-level metrics for evaluating the work because they allow you to assess whether you achieved your goals. “The design principles capture what you understand from your user research as most important to achieve and embody in the service or product you’re creating. In articulating those aspirations, you are also encoding the ability to evaluate the outcomes,” she explains. The reimagined CMS currently being designed and built by iESE aims to give access to real time information from multiple stakeholders, including the recipient of care, allowing social workers to make more informed decisions, spend less time
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inputting data and more time with their clients. “Our design principles have been developed through an iterative process of understanding the problem space, and the key to that is including as many stakeholders in the problem space as possible,” she explains. “You can’t really have design principles from three people sitting at a table, they are the accumulated wisdom of the user research that is understood through collecting and analysing many perspectives on the problem.” There are currently four underlying design principles for the CMS (see the slides opposite). They are top level statements, which anyone working on the project should be able to remember, and then there is a further explanation which drills down to the next level and what they mean. The four top level statements are:
2. CMS 2030 tells the right stories. 3. CMS 2030 empowers people who use care services.
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4. CMS 2030 supports social workers, as they are, and as they will be.
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1. CMS 2030 is a trusted partner in the work.
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Four underlying design principles for the CMS.
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With wider stakeholder involvement being a key factor of design success, Balcom Raleigh encouraged all readers to engage with the CMS project. “More voices included in the development will result in a better product we can bring to the market. I know everyone is busy but CMS 2030 is a really hopeful and significant project in terms of the positive change we want to bring to the sector,” she adds.
Why does IT have to be so complicated and expensive?
Design methodologies: Alchemy While design principles look at the wider underlying goals, iESE has also been using design methodologies to help create new products such as Alchemy, a social networking platform to help public sector professionals seek support and share knowledge with colleagues from other organisations. Sherif Attia, Design and Research Lead at iESE, explained how iESE used design thinking to create Alchemy. “We did a five-day design sprint where we were looking at the problem relating to executive support. We started with a problem definition, took it into a design sprint and then used a series of techniques and strategies drawn down from the human-centred design school of thinking. Some of the early ideas for Alchemy were like ‘Transformation Tinder’,
the idea being that if you had a particular issue you could articulate that and get matched with Five-day design sprint Storyboard. someone who could help solve your problem,” This way of working on products and services is Attia explained. one iESE is embracing. Attia says it allows an The idea of a design sprint is that you rapidly organisation to rapidly try out ideas and see what work through a problem and answer a critical works, learn from it, develop it, or move on. “There question. “What we did was talk about the problem are so many approaches and techniques within the from different perspectives. The point is to get as service design school and way of thinking. We are many different stakeholders impacted by the trying to develop and evolve that methodology problem to the table to describe the experiences internally, so not only doing design sprints but using and issues they have faced in the past. From that a variety of workshops and techniques to achieve we used different techniques that helped identify a different things.” solution. The techniques we used included iESE is bringing some of these techniques into its workshop-style exercises such as Crazy Eights, development of existing products too, such as where you fold a piece of paper into eight and CareCubed, for which it holds regular customer spend eight minutes drawing eight distinct ideas or workshops and conducts live prototype testing. solutions to tackle your challenge,” he added. • The Alchemy product and CMS are still in development. To find out more contact: Sherif.Attia@iese.org.uk
Suggested design reading Designing for Services: Key Issues and New Directions
It really doesn’t! Join our three-part webinar series showcasing one of the BEST IT DECISIONS you can now make for your council.
• 18/01/22 – The CEO questions you wish you could answer about low-code
• 08/02/22 – The business case for low-code that evidences ROI delivery
• 01/03/22 – Procurement best practice and how iESE can help To find out more and to register your free place, please go to: www.iese.org.uk/digital-councilsmaking-the-best-it-decisions This online series is brought to you in partnership with:
Good Services: How to design services that work A Civic Technologist's Practice Guide The Service Innovation handbook Crazy Eights.
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What role could AI play in tackling complex issues? AI offers a powerful and fast way to filter global best practice. Here we look at how local authorities could use the technology to make agile process on complex issues.
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Welsh local authority and housing association have been working together with a company called Pivot Projects, together with Dr Jonathan Huish, iESE Associate, to seek new ways to tackle homelessness with the help of Artificial Intelligence (AI). Pivot Projects, set up at the start of the pandemic, brought together more than 400 thought leaders across the world with the aim of finding solutions to social, economic and environmental problems. Kevin Bygate, who works with Pivot Projects, said the organisation was conceived to make faster progress with world issues. One of the tools behind it is an AI engine, Spark Beyond, which allows users to ask big problems and seek potential pivot points based on data available worldwide. To work well, engagement and change management is needed in conjunction with the AI tool. For this reason, Pivot Projects approached Dr Jonathan Huish and Dr Amanda Milliner, iESE Associates, who introduced the concept to Welsh Government. “We went to the Welsh Government to say we have this amazing technology linked to mind maps created from the collective minds of
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more than 400 thought leaders that looks at system change and the notion that we can’t keep tweaking things, we need to make bold strides and find key pivot points to make that change happen properly,” said Dr Huish. “Kevin and the team introduced the platform and the director from Welsh Government was so impressed that she called another meeting quickly so that we could show her in more depth how that would work. There was a drive in Wales to tackle homelessness during Covid, so we jointly posed the question of how we might tackle homelessness in Wales, creating the need to find a Local Authority and Housing Association to work with and explore this in a grounded way. Within a week we were all sat down in a virtual room and they were all signed up at various levels to support working through this as a process,” he explained. The two organisations, Trivallis Housing Association and Rhondda Cynon Taf County Borough Council, were asked to commit to six sessions in a short time frame because the idea is that the work is done quickly, some recommendations are made, ideas are implemented in a small way and then these are learnt from and
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iterated. All sessions took place online. At the first session attendees were asked to come up with 50 words which defined the problem of homelessness. A facilitator inputs the words and the mind map captures the human collective intelligence. The words, which are referred to as nodes, are linked to Wikipedia to provide a defined meaning which can be checked, agreed or altered, if necessary, by participants. Dr Huish said the tool was useful to build consensus on the issues involved, especially when more than one organisation is present: “In a partnership meeting everyone produces evidence that supports their own perceptions of challenges and approach. What the AI platform will do is give you a neutral evidence base for what you are looking at. It gives you a more non-contested starting point for dialogue,” he explains. It can also widen the viewpoint beyond the experts sat in the room. “Using the technology, you can gather experts from around the world to work on a problem and capture their thoughts on a visual map and it gets you a definition consensus which is already very revealing in itself,” explains Kevin Bygate. “From there is we start plugging it into the bigger maps that we created with our 400 experts. The human brain can’t comprehend that but an AI interrogation machine can.” In addition to linking to already embedded mind maps from the thought leaders and other Spark Beyond users, the AI machine searches the internet globally for results, including videos, references, press articles, case studies and peer-reviewed academic research from around the world. In the case of homelessness, a google search returns 176m results. Reading them at rate of one page per minute would take six years. “Using the AI is a bit like having a large cohort of PHD students all working in parallel,” explains Bygate from Pivot Projects. “You don’t have to start from zero, there is lots of stuff out there and this allows you to find it.” In this case, for example, Spark Beyond found a complete map of a model from Canada where they had been working on the problem of homelessness for more than a decade. In this way it can allow users to reach out and make links worldwide. Using the AI, the participants can see the virtuous and vicious circles and come up with proposed interventions. In this case, one thing
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Above: Examples of the mapping generated by the AI engine on homelessness. highlighted was that there were more than 30 third-sector organisations situated geographically close together working on homelessness. A recommendation that came from that was to get the individual to own their own data stored in the cloud and start to join up the efforts of the organisations. “There are distinct things that are starting to be done between the two organisations, separately and jointly as a result of the engagement,” said Dr Huish. “We got to the point where we had three pivots. What we left them thinking about was maybe finding some graduates to write an app, pick a small area and try it,” Bygate added. “It is highly likely to be an iterative process. If it is a simple problem, you don’t use this method because it would be like using a sledgehammer to crack a nut, you use this to solve wicked complex problems that are multicausal and therefore you are never going to have one, two, three steps and you solve the problem. The approach is work to quickly, get some momentum, come up with some recommendations, implement them quickly, in the first instance in a small way, see what happens to the system, learn from it and iterate. The speed and the momentum are important.” Ian Thomas, CEO at Trivallis Housing Association, said the experience of working with the AI platform was unique for the organisation: “With a group of
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others, including innovators, local authority representatives and data analysts, we set out to look at how homelessness could be understood and how we could potentially develop new solutions locally by understanding global data and the effectiveness of already existing solutions and services. “The experience was rewarding, and the results surprising in many aspects. Artificial Intelligence tools with such powerful capability to capture and analyse high data are clearly going to have a place in how organisations, communities and societies will develop both understanding and solutions to problems in the future. The outcomes shed light upon the complexities and complications inherent in contemporary approaches to homelessness. The outcomes were clear in many areas around how services should be organised earlier to attempt prevention, but also shed light on the most effective interventions. This means that our role as a largescale social housing provider working in conjunction with the local authority homeless team will change to look at solutions to homelessness prevention and provision in the future.” Amanda Milliner heralded this new and agile way of working, describing this agile approach as wonderful to see in local government and public service organisations. “It has introduced a new or adapted way of working for local authorities, which
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is at pace. The commitment we ask for at the beginning of a project is for weekly sessions with engagement and activity in between to input into and build the mind maps, which feels a different way of working for local authorities.” One thing future projects will look to include is input from people with lived experience of the situation. “Every organisation says they do community engagement but the number who do it well are few and far between so it is about instructing a real community engagement piece that fits around this where the community can see when they are being interviewed that the mind maps are dynamically changing,” Dr Milliner added. Impressed by the results, the Welsh Government has asked to look at the problem of decarbonisation in the same way. “The feedback that we have had is that looking at a similar issue took the same local authority two-and-a-half years to get where we have with homelessness in five weeks. The model gives strength to process and will have impact on the ground by allowing organisations to be cognisant for the first time of the vicious and virtual circles,” Dr Huish added. • To find out more about how iESE and Pivot Projects are partnering to use AI as part of a community enablement tool, see the news piece on page 2.
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Why digital has a ‘massive’ role to play in transformation Dave Briggs is former Head of Digital Operations at Croydon Council, was also Head of Digital and Design at Adur District & Worthing Borough Councils and has held various consulting and interim roles, including at Horsham District Council. He now heads up his own company, Sensible Tech, which aims to share digital and technology know-how. Here, we speak to him about digital transformation: what he’s seen, what councils should be doing and why digital is so vital for the future of public service. hile Dave Briggs doesn’t believe there is a one-size-fits-all approach to digital transformation, there is one over-riding factor he believes public sector organisations need to succeed over and above the technology they invest in. “You can do an awful lot with poor tech if you have the right culture, skills and strategic direction. If you have really good tech but you don’t have the buy-in, culture and skills you are probably going to fail no matter what,” Briggs says. He has been involved in the modernisation of two different council IT departments to enable them to catalyse digital change across their organisations – Adur & Worthing and Croydon. While the IT department at Adur & Worthing employed around 15 people and Croydon cut down from 125 to 75 while Briggs was there, he says many of the challenges and opportunities were the same in both organisations. “One of the key drivers at Adur & Worthing was modernising the technology. We were one of the first councils to roll out Google for our email and collaboration technology. We also were one of the first users of low code using Netcall Liberty Create. In Croydon, previous digital transformation initiatives had made some progress but left a little to be desired in terms of resident experience,” he says. While cost cutting in Croydon took the team from 125 people to 75, new people were recruited to new roles within this, such as user research, content design and product managers. “Not huge numbers but just enough that we could start to turn the culture around,” says Briggs. With a new head of service in place and Briggs as his number two they turned the department from a “really moribund IT department” into “a vibrant digital service” in around six-to-twelve months. “That was a mixture of some quite big structural and strategic changes but also some frippery that is really important in terms of that cultural shift. We did things like putting bunting up in our part of the office, we made posters about busting bureaucracy which we stuck up around the building and people realized that something different was happening. We changed the policy so that people could put stickers on their laptops and we started wearing trainers to meetings. It sounds superficial but it was a very
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different vibe to what had happened before and it made the rest of the organisation take notice that we meant business,” he explains. Again, Briggs introduced low code, which he says paid dividends during Covid. “We built a case management system for shielding residents in about two weeks and we were able to do it with agile iterative effort, so we got it working in two weeks as a minimum viable product and it got improved as bits got added. If we hadn’t had the technology, the new roles we brought in and that new can-do culture I don’t know what we would have done.”
Let digital teams in at the start One thing that could stop councils meeting their digital potential, Briggs warns, is the reluctance to include IT in transformation conversations at the beginning. “One of the frustrations is that digital folk often don’t have a seat at the transformation table, they are seen as a supplier in a sense – the council goes away, figures out an operating model for a service and then just before it is due to go live, they will ask for a web form to make it happen. The understanding the rest of the organisation has
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Pictured: Dave Briggs.
about IT and digital is that they deal with the laptops and the websites, they don’t let them into the conversations about how to radically redesign services using digital as a foundation stone.” Briggs says the key is designing an operating model from the ground up based on the principle that the vast majority of people have access to the internet all the time no matter where they are. “Thinking about how we can deliver a service based on those principles is the kind of thinking councils need to be doing and they can only do that if they have the right people in the room while they are having those conversations. Digital has a massive role to play and is not currently playing anywhere near the role it needs to – a big part of that is probably because people in senior leadership positions lack confidence in terms of understanding the full strategic impact of what is happening. They are, for whatever reason, unwilling to let these weirdos with stickers on their laptops and trainers turn up to some of those meetings,” he adds. As for the future, Briggs says councils should not be getting excited about new technologies on the horizon because they are already playing catch up. But he notes there are opportunities around moving IT into the cloud to help organisations become more agile. Better use of data might also play a role in future digital transformation, but only if councils are willing to respond when given an actionable insight. “Technology can now liberate data out of line of business systems and bring it together in meaningful ways, but you have got to want to take some action on your insights and that is not where a lot of councils are right now,” he notes. • You can contact Dave Briggs at: dave@sensibletech.co.uk or visit www.sensibletech.co.uk for more information. • Dave/Briggs will be talking in depth about how the UK leading digital councils are creating software and sharing it with the sector in a series of online events, hosted by iESE and Netcall. If you’re interested in joining us online or catching up on this content, you can register your free place here: https://iese.org.uk/digitalcouncils-making-the-best-it-decisions
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Why community enablement matters
Community engagement is a term local government is rapidly becoming familiar with. Here, Professor Donna Hall CBE, explains why it works and is now a necessary shift rather than a radical option. rofessor Donna Hall CBE is the former Chief Executive Officer at Wigan Council where she introduced the well-known partnership with residents called The Deal. While community engagement is now a term the whole of local government is becoming familiar with, the partnership Wigan sought to make with its residents in 2014 was then ground-breaking. Hall is currently Chair of the think-tank New Local which works with a network of around 70 local authorities which she says are all keen to “unlock community power” and also Chair of the Bolton NHS Foundation Trust which works closely with the community and voluntary sector to harness engagement. For Hall, this way of working is what comes naturally, having always had a passion for personcentred approaches. “It works. People think ‘I haven’t got time to do all that community engagement, I’ll just do things to them’ but then you can end up doing the wrong things. We’ve got to start thinking person-centred and applying it to all aspects of transformation and policy making rather than just coming up with new projects that overlay on the existing dysfunctional system,” she explains. For Hall, it starts with listening to people with lived experience and finding out what is going wrong.
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Community models in healthcare
Pictured: Donna Hall.
The Deal began when Wigan Council commissioned Hilary Cottam, author of Radical Help, to look at 25 families in one of the more deprived parts of Wigan and map out the interventions they’d had over a ten-year period. “We were spending around a quarter of a million per year per family and the worst thing was that at the end of the year they were in a worse position than they were at the beginning. What we had done was process them through a very fractured system and continually reassess and refer them to other bits of the system, whether it was the NHS, mental health, drug and alcohol services, criminal justice, housing. We had spent 80 per cent of our time on the assessment and referral of them, rather than building a relationship with them, finding their strengths, and building on those strengths and taking that asset-based approach that we know works.” As part of The Deal every public servant was trained how to deeply listen to citizens and in anthropology and ethnology – the study of why people do things and how communities work. “Very often we process people in our minds before we even meet them, we think ‘I know what you need, you need a day centre or a minibus to pick you up’ without even meeting them or asking them,” Hall says.
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The Deal also sought to transfer council-owned assets to the community and build a more trusting relationship with the community and voluntary sector. “A swimming club came to us and asked if they could take over a pool we were going to close. It was amazing because they knew where to target to market and how to diversify their offer to meet community need. With support they were able to make a profit where we might have made a loss for ten years,” she adds. “We completely shifted the relationship we had with the community and voluntary sector in Wigan. We micromanaged them before The Deal for tiny amounts of money, we spent more monitoring them than we had given them and we made judgments about what we thought was needed in a local community without really asking the sector for their ideas. We would write a commission specification and get them to bid for it, but they didn’t have the skills or time because they were busy helping people in a very practical way. Then we basically turned it on its head and said we will trust you to deliver this, we will give you the money upfront and it completely changed the nature of the relationship between public services in Wigan and the community and voluntary sector and for the first time they could see that trust was there,” she says.
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Now Hall is Chair of the Bolton NHS Foundation Trust where she is working on Integrated Care Systems, which is about giving people the support they need, joined up across local councils, the NHS, and other partners. Bolton is also set to become a Local Care Trust, which delivers more integration between social care and the council, mental health and the hospital foundation trust so it acts as one team. “We have created something called the Home First team which is a team of people in the hospital whose job it is to get people home as soon as they are medically well enough and to make sure they have the help they need, whether that is home adjustments or someone helping them in a practical way, re-enablement services or connecting them into local community and voluntary groups that they might be interested in – things that will keep them socially connected and feeling like they are part of the local area. It is very much a community-based model and we work very closely with the community and voluntary sector to do this. “We also have a lived-experience panel at the hospital and people who have had had issues with drugs and alcohol or experienced homelessness, for example, we will involve them in the design so rather than just take the complaints when we get it wrong, we really proactively upfront involve them in the service design, the commissioning specifications, working with the clinical commissioning group, the NHS foundation trust and the council so it is informed by actual lived experience,” Hall adds. Hall believes the shift in relationship between public service bodies and its residents and the community and voluntary sector is essential. “I think the idea of unlocking the power of communities is growing and becoming a big thing. This is definitely the future of local authorities,” she concludes.
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Joining heads on design in public services In a recent online panel discussion, Dr Andrew Larner, Chief Executive of iESE, John Comber, iESE’s lead researcher for Digital & Technology, and service design expert Molly Balcom Raleigh discussed design principles and how they can benefit the reinvention of public services.
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ohn Comber (JC): We are here to talk about the redesign of local authorities using design principles and design principle methodologies and what some of the critical success factors are to using those methodologies. We are going to look at what design principles are, how they are and can be used in a local authority setting and what advantages they can bring to the transformation and the reinvention of public services. We are living through challenging time for the planet and local challenges around the economy, jobs, housing and the supporting the vulnerable in our communities along with issues impacting on transport, infrastructure and mobility, struggling even to get the goods we need into the shops and on the shelves.
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Dr Andrew Larner, Chief Executive of iESE.
Andrew Larner (AL): There are increasingly ranges of very interesting solutions out there, the danger is getting trapped by the problem and trying to find a solution that fits it. The amount of funding that has been taken out of local public service in the UK is phenomenal. We haven’t started to pay the pandemic bill yet and issues like people living longer with complex care needs, those issues are still maturing as problems. We knew there would come a point where efficiency gains would not work, there is just not enough money in the system. If you just projected forward the cost of social care and the cost of waste management, there came a point in time when they absorbed the whole budget of local government and there was no money for anything
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John Comber, iESE’s lead researcher for Digital & Technology.
Molly Balcom Raleigh, service design expert.
else left. We have passed the point where that would have been true if we had carried on delivering things the way that we have, so we need to continue to transform to increase impact but also to find new ways of doing things that deliver outcomes that don’t require the levels of funding we have currently got, doing this at a time when there is no financial headroom to make a mistake. We very easily get trapped into asking people about their experience of the current service and what they want and of course they can only imagine their current experience of the current service without the holes in it, a bit shinier and a lot faster. What you don’t think about is what is causing them to need the service in the first place and addressing that issue. By thinking about that you are no longer
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thinking about redesigning the service, you might be thinking about a new service, but even then you shouldn’t assume that the local authority is going to deliver it. What we can do collectively is imagine the future and then together we can work on reaching that future minimising the risks of failure and the cost of getting there. Molly Balcom Raleigh (MBR): Design is an approach and a set of capabilities that can really connect what the needs are that are present in communities that you are serving with the services you can offer. Design principles can help as a method to bring in the capacity from the community to actualise the vision and values and goals of the community. Through a human-centred design process you are really looking at uncovering what those values, intentions and needs are. We talk a lot about serving needs and the demand for services in local government but it can also help you understand what the strengths are that are present in your community and how those can be activated to help curb the demand and reduce the needs in the first place. If you are thinking about how design operates in that, you have this potential in your community and a vision or goal of where you want to be. Design provides tools, methods and capacities for connecting those two and getting you from those needs and strengths to what you want to achieve.
JC: Are there developments in the design thinking approach or elements of academic research into design that are yet to be exploited? MBR: There is an emerging critique about using service design and design thinking in particular in the design and delivery of public services, which is very powerful. When these processes are used they have quite a big impact and with that power comes responsibility. If you do these design processes without interrogating who is at the table what you end up with is just an elegantly redesigned version of the same problem. The superpower of design is something that needs to be handled with a lot of concern for who is involved in the co-design processes, whose voices are at the table, and who is not only participating in evaluating processes and using services but who is defining the problem space, what is actually the problem to solve? It is one of the most important places to include people as widely as possible in the process and without a vigorous approach to uncovering hidden stakeholders in a problem space and understanding the complexity of needs that are creating this problem then the solution that comes out of that process will not address what is really needed.
JC: What would you say are the characteristics and success factors in applying this design approach? MBR: In an iESE project with a Care Management System we are developing these ideas about how to help people within the community achieve their goals through listening and understanding. We are building this system with the idea that the people who use services should be able to make sense of their data and that they should be empowered to make decisions about their data and that is coming from listening to practitioners and care users. This process we are engaged in is a great example of listening to goals and capacities, not only to needs,
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and trying to put as much of our resources into activating things that are already working and capacity that is already at hand.
AL to JC: What is it about the iESE Transformation Model that appeals to you? JC: It is a methodology that is born of userresearch not just academia. It provides holistic outcomes, not just reinvention or total transformation. It actually picks up on all of the levels of change within an authority acknowledging you are never going to get one authority that is at one level. It deals with reinvention and asks the impossible question which is as it were the litmus test that if a local authority is to create vibrant communities it is saying that it needs to be needed as little as possible. That is not a business model but it is a model which works to empower communities to meet as many of their own needs other than where it is essential perhaps involving vulnerable or complex needs.
AL: John, you led the iESE research on the Digital White Paper. What are the things looking at the future that you think will be important in designing the next level of local government? JC: From the research it was clear that it has to be a holistic approach and include all the stakeholders but actually all the individuals too. It isn’t just about becoming an intelligent council, it is about becoming an intelligent geography. We are increasingly seeing drones and robotics. It is interesting to see how that is moving forward. It is acknowledging you don’t have all the answers and that is okay. The community are part of the answer and we have got to be comfortable in sometimes getting out of the way and letting them deal with their own problems. We are a stone’s throw away from authorities using real-time information to make decisions, not using historic data like the census to make strategic decisions. AL: Even if you are doing the design well and creation well, sometimes you do trap yourself in thinking about the problem as it currently presents and real-time changes the nature of that. Because our budgets have shrunk we think about people in our direct line of sight but what about people who we don’t have responsibility for because we might have a responsibility for them when money disappears. Eighty per cent of people self-fund their care. It is that broader view of time, short-term events, such a storm, to long-term events like fuel poverty and what that does to the shopping basket of the community, including those that we don’t have a direct line of sight to is a really important approach. Thinking of expanding our minds and challenging ourselves on the time period is probably the one fundamental key design challenges that came out of our digital and technology work for me.
JC: What are the next steps for iESE in using design in public services? We have developed a Vibrant Community Health Check which uses the design methodology, an agile design approach, and goes through stages of
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looking at the needs of the community, how is that reflected in problems that might be addressed and the critical bit is that we should be looking globally but we are all limited by what we know and who we know. What we have now is an artificial intelligence engine that can do six years’ worth of research in one-and-a-half minutes. What it does is it puts global firepower underneath to help ensure no stone is left unturned. Once you’ve got that you can look at your community plan or overlap that with the council’s own plan about how it can support its community to achieve its goals. The next step is looking for volunteer councils to join on that from around the UK which we think is another positive contribution to sector-led improvement. • To read more about Design Principles or to get in touch with iESE, please go to: https://iese.org.uk/transform-talks/ design-principles
This is a partial transcript of the talk. To view a full version visit: https://www.youtube.com/ watch?v=yNw_qvKPw10
LEVEL 1 LEVEL 2 LEVEL 3
About the iESE Transformation model iESE’s three-level Transformation Model highlights where local authorities are operating in terms of their transformation strategy. The levels are: service (level 1), customer (level 2) and community (level 3). All local authorities are likely to be performing at a range of levels across their services. At Level 3 the authority is concentrating on designing out the need for the service in the first place. With good design approaches a local authority is more likely to be able to operate at Level 3 where community enablement leads to less reliance on the local authority. • to find out more visit: https://iese.org.uk/iese-transformationframework/
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Shaping services through human-centred design Dr Jules Maitland is the founder and managing director of humancentred design agency All In. The agency is based in Canada but works with not-for-profit and government organisations worldwide to help address social problems through the human-centred design of public services and social change. Pictured: Dr Jules Maitland.
Q: What is human-centred design? A: “The principles of human-centred design ask us to keep the people most impacted by the problem that we are trying to solve front and centre throughout the design process. In the context of public services it asks us to think very carefully about the problem, asking us not to jump to solutions, but instead really explore the problem and ground it in the reality of the service users and service providers. This nuanced insight into the context in which the problem is occurring can lead to a better and deeper understanding of what the actual problems are on the ground, and lead to the design of solutions that are better equipped to address them. ”
Q: Where does the user’s perspective come into human-centred design? A: “The way an organisation views the problem is often very different to the way the issue is experienced in the community. Sometimes we find ourselves masking the symptom where there are much deeper root causes. If you don’t spend that time exploring what the issues are with a community and you only bring them into test the solution, you might have a great solution, but it might be fixing the wrong problem. People experiencing these complex problems day in, day out, bring perspectives, insights and capabilities to the table that, no matter how well intentioned a team is, they are otherwise never going to see.”
Q: Do you think local authorities are using human-centred design? A: “It is certainly an emerging practice in local government, and with all practices there are the early adopters and others who don't yet know how it can help them yet. When I attended the iESE Transform Awards it was very clear that there are authorities who are already taking a very human-centred approach to service (re)design. They may not necessarily be aware of the language of design and design principles per se, but for them this is their natural way of working.”
Q: What might be stopping some authorities from using human-centred design? A: “There is a legitimate vulnerability in working closely with service users, around inviting people to explore these complex social problems because the public sector may feel it should already have the answers, and the perceived risk around setting
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expectations while engaging in meaningful dialogue. It can be overwhelming to start thinking about adopting human-centred design principles if you don’t yet recognise your organisation in them. It doesn’t have to be all or nothing. It is okay to start small. Look for opportunities in your existing projects to check your assumptions or ideas with members of the public. In my experience they are so thankful when they are asked, and they have valid and insightful ideas. For me, that is where the culture change is, changing the conversation and relationship between the public sector and the public.”
Case study: River Stone Recovery Centre River Stone Recovery Centre in New Brunswick is a substance use disorder treatment space set up in July 2020 with funding from Health Canada. In September 2020 the same team set up The Phoenix Learning Centre as an emergency dropin centre for people experiencing homelessness and housing insecurity affected by the impact of Covid on essential community services. The Phoenix Centre has since closed after planning consents prohibited its continued operation, but a new site is being sought. All In helped with the design of both centres from a service user and service provider perspective. “The primary focus of the brief was to help make sure the voice and needs of both the program participants and the team were included in the design of the centres. We designed a range of activities to explore the experience of substance use disorder treatment with clients and team members, identify strengths and limitations of current approaches, then generate and test ideas for alternative approaches,” Dr Maitland explained. “We created prototypes to test the overall concept with existing program participants, the services that should be provided, the times of day that they should be provided, and the room in which injectable opiate replacement therapy would be offered. We also facilitated the cocreation of a code of respect between staff members and program participants to establish mutual expectations and boundaries." Dr Sara Davidson, Medical Director at River Stone, said: “All In helped us draw the staff together and come up with shared vision which
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empowered people to feel engaged. Involving the participants provided a good reality check about what we were trying to create. The collaborative approach helped build into the system the bigger concepts around providing a space that would be most helpful to the people we serve. It was nice to have an agency come along and validate a lot of the things we were trying to do and help us design things appropriately and in a supported way,” she added. Dr Maitland explained some of the impacts the design work was able to have: “At a macro level, taking this approach created a collective sense of ownership between team members and program participants. Individuals could see their experiences and needs reflected in the design of the new space and service, and the space and service was more robust because of that. At a micro level, through broader explorations of concepts such as safety and belonging, we were able to identify and minimise power dynamics. We designed elements of the centres to reduce unnecessary barriers between the team and program participants and make resources freely available to program participants." "Participants being able to see the weather forecast so that they could prepare mentally and physically to spend the next few hours outside in extreme heat or extreme cold without having to ask a member of staff. Being able to get a drink or a snack when they needed it, without having to ask permission. They may not seem big impacts to those of us who are lucky enough to never have been in that position, but they are central to designing public services with dignity," Dr Maitland adds. Dr Davidson believes that if an organisation is considering using human centred-design it is important to be ready to take a good look at the challenges it is having and have the willingness to let go of preconceived ideas. “Anyone who wants to truly be able to transform their workplace needs to suspend disbelief, assumption and be open to making change. They need to really want to make authentic changes to something, not just keep working within the same parameters but be ready to do a deep dive,” she concluded. • Find out more about All In here: www.allinagency.ca See a Social Research & Development field guide about River Stone Recovery Centre and the design process here: River Stone Recovery Centre - Resources (recoverynb.ca)
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