The next government faces a significant challenge in reducing public sector backlogs and improving outcomes for people, while struggling with continued restricted finances. A pragmatic solution to these challenges is a greater focus on integrating people, place and care – to achieve better value from the delivery of public services.
What does this mean? In summary, a focus on integrating three areas of local organisations and moving away from siloed operations. The three areas are:
- PEOPLE – focusing on those that are most in need of better outcomes, and most likely to be using various public services.
- PLACE – giving the organisations, working in the same local place, the tools and support to develop common approaches to those people.
- CARE – taking practical steps to align and coordinate operations in the care that’s delivered.
We know – it’s a huge issue, and there’s not necessarily a simple solution.
But we do think there is a real opportunity to align and future proof our local organisations around service provision, and to really deliver these services in a more integrated way that provides better outcomes for the people who truly need them.
We’ve taken a closer look at some of the challenges the public sector is facing, addressing how each of the people, place and care focus areas are critical to support the public sector goals, while keeping affected communities at the heart.
PEOPLE
Let’s start with the people-centric focus
This isn’t about just focussing on anyone. This is about really looking at the most vulnerable people in society who use these services during their time of need.
The challenge of rising and persistent public sector backlogs can be seen across numerous different services.
- In housing, the wait lists for social housing have risen significantly over the last decade, with 1.29m families on the waitlist at the end of 2023.1
- In health, the waiting list for hospital treatment was over 7.8m last September.2
- For children’s care, the average time for a care and supervision application to progress through family courts was up to 44 weeks at the end of 2023 – far below the target of 26 weeks.3
- In justice, the average criminal case takes almost a year to be heard.4
- In education, two thirds of secondary schools were oversubscribed in 2023. 5
With public borrowing already high, plus the acceptance that there will be no debt-funded investment into public services, where will the solution come from?
Rather than focussing on each individual service in silo, there needs to be an increased focus on the people who are most impacted across all of these services and working to manage the inter-dependencies across these more effectively.
Examples of this could include looking more closely at:
- Children in social housing getting to school when they have been placed in temporary accommodation that isn’t nearby.
- Victims of domestic abuse or sexual violence in need of immediate mental and physical health services and potentially housing, as well as support and advocacy throughout a justice process that needs their involvement.
- Better alignment of court scheduling with children’s social care teams, ensuring cases can be heard when they are ready but then resolved quickly.
By focusing on a people-centric approach in use cases such as these, the problem statements become far clearer and solutions become much more targeted.
PLACE
The focus on place
Services that impact these use cases are largely delivered locally, and therefore these local organisations need to be given the freedom to work together around these problem statements. Practically, this means even more devolution is needed to combined authorities, with the creation of more elected mayoralties, where budgets can be better devolved and integrated.
However, devolution of budgets and responsibilities alone will not solve this – unless local organisations invest in building relationships locally to support this integration. For example, this could mean greater use of Board-to-Board sessions between local partners, where Boards or management teams come together to better understand their common agendas. Another consideration is involving the expansion of joint governance boards around collective issues for local partners – local family justice boards are an example of a very effective place-based governance forum.
The majority of funding out of central government is allocated to at best service-based outcomes (i.e. increased provision of advocacy support to victims in the justice sector) but more commonly, inputs (i.e. funding a certain number of specific roles, in a certain place).
This incentivises siloed service provision and a disjointed experience for the people who need these services the most. To overcome this and move towards a place centric provision, local commissioners need to align strategically and co-commission the outcomes they require. This increases local spending power and provides more coherent place-based service provision.
CARE
Finally, the focus on care
As local organisations come together around the needs of the people in their place, they will need to go beyond strategic alignment, into practical operational alignment that delivers the right care or service for the biggest impact.
Referring to the use cases and problem statements above, the question becomes – what is the joint operational response to deliver the best care or service outcome for the individual or family in question? This will require a common language and practical steps to join-up operational decision-making in these cases. Multidisciplinary teams (MDT) have proven successful in health and social care settings for joining up key decisions between the organisations involved. Adopting the MDT model for other issues could prove effective.
It’s not a new concept
This integration is already happening where there is firstly sufficient scale to see the operational benefit of joining up delivery models and secondly the focus to see the impact on service users. But there is definitely a lot more that needs to be done – we’re seeing existing local organisations coming together around these problems, but it’s tended to focus more at a strategic and planning level, rather than at an operational level.
The people, place and care focus builds on both the integrated care agenda and the devolution agenda. Pockets of best practice can be seen up and down the country, for example:
- Integrating services around victims of sexual violence in London
- Local authorities working with CAFCASS, HMCTS and the Department for Education to tackle family court delays.
- Embedding integrated care systems to join-up health and social care planning and delivery.
What’s next?
It’s an interesting time for the public sector. The new government has an opportunity to tackle some of these really difficult social challenges by enabling local services to be delivered in a different way, centred around the people in society who need it most. The pressures of public sector cost-savings and backlogs are not going away, but there’s huge potential for local organisations to drive real impact for their people by adopting an integrated people, place and care approach.
We are passionate about working shoulder-to-shoulder with the public sector to transform outcomes for citizens.
