How to make real change happen

In this article, Professor Donna Hall explains how a comprehensive, inter-departmental approach is needed to move beyond outdated systems, fostering a culture of questioning and collaboration in public services.

Never has there been a more challenging but equally hopeful time to be a public servant. There’s no time to languish in the tepid bath of managed decline for civil servants, council or NHS leaders. We could remain prone in the lukewarm bathwater of New Public Management and end up like the proverbial shrivelled boiled frog. We don’t notice our jobs have been the careful management of a defunct system (created in the 1980’s and now forty years later, well past its sell-by date) until it’s too late.

We are at the start of a resurgence of politicians and officers talking about public service reform. This is good news for me as there’s been little or no real reform-focused debate at the national level for the last fourteen years, apart from the devolved nations.

Missions are the new thing. Anyone who isn’t delivering a mission is going nowhere. There’s a resurrection of Total Place thinking from 2009 and the announcement of a new £100 million fund to initiate four test and learn sites.

I’m writing this opinion piece a few days before the publication of the new Devolution White Paper and hopefully there will be more reference to public service reform as a precondition of devolution. It’s pointless devolving the existing broken system of New Public Management to a place. It will just localise the dysfunction rather than genuinely reform it.

I suspect there’s a bit of a Whitehall tussle going on between those who want to make the existing system work better and more efficiently (the deliverologists) and those who realise that attempts to do this over the last forty years have all proved to be futile. We need a comprehensive approach to public service reform, setting out a whole system strategy for relational, place-based, community-powered public services. This needs to be backed by the Treasury and applied consistently across all departments.

Individual projects from separate government departments, even though they may be aligned to missions, will not succeed in the absence of an all-embracing, inter-departmental approach to relational public services.

Pat McFadden wants us to be disruptors. I think this is exactly what’s needed. However, most of the genuine disruptors I’ve had the pleasure to work with over the last forty years have been purposefully drowned in the tepid bath of managed decline. They’ve railed against the system and its obsession with “tight ship” governance and managerialism, and they’vesuffered the consequences.

We need to create the conditions for disruptors to flourish and to pull the plug out of the tepid bath (sorry I think this metaphor is wearing a bit thin now..)

So much of reform is about culture change—creating a culture where it’s okay to question, test, learn, and disrupt without prematurely ending your local government or NHS career. Leaders who create this culture where frontline teams have the permission to disrupt are, in my experience, few and far between.

One of the best leaders I’ve worked with who does this routinely is Andy Burnham, Mayor of Greater Manchester. As chief executive at Wigan Council, where we created the Wigan deal with citizens, Andy appointed me as the lead chief executive for public service reform soon after his first mayoral election.

Greater Manchester has been the poster child for reform for many years with the first Greater Manchester Strategy having two essential, mutually reinforcing pillars of ‘growth‘ and ‘reform’. This recognition that the two are deeply entwined and neither will work without the other was a genius idea of Sir Howard Bernstein, deeply missed.

With this incredible platform, Andy built a Public Service Reform Board, which he still chairs, bringing together voluntary and community organisations, NHS and council leaders, the Department of Work and Pensions, housing associations, Greater Manchester Police and Fire and Rescue. In this room everyone, regardless of their status, their organisation or their appetite for disruption could say whatever they wanted. They were freed from their organisational shackles and every conversation, every decision started with the person and their family and community – not the service or the organisation.

The innovative Greater Manchester Live Well approach was born in this room. Job centres are being repurposed into Live Well centres with a whole person multiagency support package delivered by incredible community and voluntary sector partners such as Unlimited Potential. Making the connection between good mental and physical health and getting into employment has been a key priority through Work Well which started in Greater Manchester ten years ago as a partnership with primary care providers, councils and the Department of Work and Pensions. This is such a great move for Greater Manchester and exactly what needs to underpin real devolution.

I suppose you could argue integrated health and care is an example of a kind of devolution to place. I’ve seen many of the forty-two Integrated Care Systems up close since their inception two and a half years ago. Many of us were also actively involved in the impressive NHS England workshops to design the guidance for the new ICSs during the pandemic. Those were genuinely hopeful times. But something has been lost in translation since the heady days of the co-production of the guidance.

Integrated Care Systems focussed to a large extent on governance rather than culture in the early days. Some ICBs are still talking about the need for another board or committee to oversee an area of increasing system risk when this is actually the last thing that they need. They need to encourage the disruptive reformers (the Rebel Alliance as I call them) within the system to test and learn with courage and conviction.

ICSs were set up to change the system fundamentally and yet many are primarily focussed internally on governance arrangements making financial savings (as instructed a few months after their creation) in the absence of a whole system reform strategy. Sadly, I feel they have become just another (hugely expensive) layer between local places and NHSE.Many council chief executives and leaders have effectively walked away from the partnership table with one well-respected county council chief executive describing her role in the ICB as being “like a house guest at an NHS party”.

Councils have enough issues of their own in managing the escalating cost pressures of children’s and adult social care without spending three hours in an ICB meeting where the discussion revolves around NHSE key performance indicators and budget pressures (despite the fact NHS budgets have increased exponentially whilst council budgets have been halved).

NHSE’s grip on local systems has strangled them at birth before their toes were even dipped in the tepid bath. At a time when frontline teams need to be liberated to redesign support in a neighbourhood; to start with a person, their family, theircommunity and join up the dots between fragmented silo services the grip of compliance to a national framework has never been stronger.

So what does make real change happen?

A few ideas:

• A comprehensive approach to reform across all government departments with a clear and consistent recognition that new public management is an expensive busted flush.
• Shift the relationship between citizen and state from parent-child to equal partners. Citizens aren’t just passive recipients of remotely commissioned silo services.
• Make the link between system dysfunctionality and the fact the public sector has no money. It’s the handoffs between the silo services that swallow up all the resources (in Wigan 80% of our resources were spent on repeated assessment and referral around a fractured system).
• Embed relational approaches into all aspects of service redesign
• A place based devolved approach by default.
• Liberate integrated neighbourhood frontline teams to work outside of organisational KPIs and help people in innovate ways.
• Give ICBs permission to innovate, to disrupt, making them accountable to local people rather than NHSE.
• Encourage courageous local leadership rather than “tight ship going nowhere” leadership at the political and managerial levels.
• Celebrate and recognise the disruptors, nurture the rebel alliance.
• Make all public services in a place accountable to local communities, unleash the power of the local community and voluntary sector by investing in it and trusting it to deliver.
• Reimagine the public sector as a career route of choice for bright young people with passion rather than something they regret after a couple of years and leave because they are unable to make change happen.