Responsibility and Public Services

Chapter 1

Design against demand (the contextual needs of the citizen)

The current system understands demand as a transaction, e.g. a phone call. It sets handling standards (answer within x seconds) and target measures (y% of calls to be answered) against that transaction and seeks to reduce the cost at all times. From the perspective of the citizen, services designed around these ‘transactions’ rarely supply what they need and are just a wasteful part of the process.

We carried out some research for Advice UK on how well the voluntary advice sector was working. Advice organisations, local and national, help people struggling with decisions around the granting of disability allowances. They manage cases and provide advocacy. Of all the cases going to tribunal, 93% were found in favour of the plaintiff. This is eyebrow-raising in itself but the real learning comes when you find out that the agencies involved (as they were then) rarely got their sums wrong. The decisions were technically accurate but the judges found that the context had been ignored. In other words, the person had been ignored. So, for example, a person with mental health problems was deemed by the Department for Work and Pensions (DWP) to have ‘recovered’ and the support was withdrawn. The reality, as noted in the tribunal decision, was that it was precisely that support that enabled the person to cope. When it was withdrawn the recovery was reversed. The point is that the transactions – the technical aspects – don’t take ‘context’ into account. For the citizen, context means, ‘Do you understand me and my life?’

People from every agency we work with talk about and believe that they deal in ‘person-centred’ services. So to conclude that we need to change the public sector from a transactional perspective to a person-centred perspective will simply get the eyes rolling. The problem for most people is trying to fathom why anyone would design a system that was not person-centred. But design it they did. It is equally difficult for practitioners – how could they admit to themselves that they are not person-centred?

A better focus might be one that tackles effectiveness and efficiency, the goal being to do exactly what matters at first point of contact – either the issue is resolved for the citizen, or the right processes are designed so that problems can be resolved as efficiently as possible for all concerned. This is the critical concept that initiates change. It is the place for leaders to begin to understand what the process could look like, and then (when you’ve tried it) what it does look like. The new way of thinking, doing only what matters, becomes much clearer both in principle and in practice. The paradoxical aspect is that when you seek to improve effectiveness in this way, the efficiency improves all on its own.

A Case Study
Stoke City Council

The leaders of the functional departments at Stoke City Council had been learning what worked for citizens and what did not. They had also involved other agencies, such as Fire & Rescue and the police services. They took the decision to set up a multi-agency team that would be capable, as they saw it, of best handling a range of issues.

The first problem was how to identify people who needed help. One view was that any of the contact points in the council would suffice because people would bring something somewhere and the real problems could be picked up after contact. The other view was to understand what happens in a given geographical area – unknowns included the relationship between a geographical area and its people as well as the relationships between the people themselves. Given that a goal is to build strength in the community itself, this seemed to the Stoke team to be the obvious way forward. They worked with the local politicians and chose a ward that was representative without being extreme. The next step was to find out what issues the people had and what mattered to people in that ward.

It is easy to over-plan this activity. The truth is that people will only talk to your agency about things that they believe you will act on. Therefore, the probability is that you will never know what the issues are until you engage with them anyway. Start somewhere and learn how to find people. The Stoke team soon found that visiting the housing department and connecting with housing officers was a very quick way to find people who needed help.

The next problem was how to get people’s trust. Why would people trust agencies that have seldom provided any effective help? But this became straightforward. The task was to understand demand (in context) from the citizen’s perspective, which involved asking a set of simple questions. They discovered that it was just these two questions that seemed to work:

•

What does a good life look like?

•

What works /does not work for you in your life at the moment?

The team found this a deceptively simple concept – it is so obvious. Yet in practice, they found careful listening, summarising and demonstrating that they had understood what they had been told, a difficult skill. People are not used to being listened to.

The conversations were recorded verbatim and then the key phrases extracted. It is too easy to fit what is said into preconceived notions of what matters so this is an important step.

For the team’s benefit, the recurring themes were then collated, and five stood out.

•

Help me get/keep a job.

•

Help me manage my finances/claim benefit.

•

Help me move to a more suitable property.

•

Help me live closer to friends and family.

•

Help me keep my home.

This is not a generic demand analysis and it is certainly not a blueprint for service design but it does indicate the skills that the team were likely to need to pull on. Although there will be similar needs expressed elsewhere (people are people) this must be treated as the picture for just this ward in Stoke.

The next thing of interest is to work out how representative the data is and what patterns it shows across the ward. Plotting the data from various agencies on a map, a significant overlap was found1. A relatively small number of properties/families were involved at this stage and all were in social housing developments. This was then a working map to which other families/properties could be added as they emerged.

Many people planning this type of research ask us how we know if we have identified all the demand. We don’t; but what Stoke found was that as citizens realise that you can be trusted and that what you do works for them, they talk to each other and word of mouth finds the others (“You helped me, can you help her?”, “You did this for my neighbour, can you do it for me?”)2.

The Stoke team now had a reasonable picture of demand by geography. They knew not to generalise – each ward would need its own analysis. They had an understanding of what mattered to people, what problems they needed to solve in context and the extent of these problems. The next step was to design against that demand. The risk at this point was for the team to fall back into designing solutions for each of these top five categories. This would miss the point. Solutions will emerge for each person as team members gain knowledge and engage the individuals in what will work for them. The design process is a learning process:

•

How do we learn what works?

•

What is the connection and interdependence between the apparent problems?

•

What does the outcome of solving a problem look like?

•

How do we build resilience in the person, family and network?

Design became simply a process of ‘pick a person who needs help, get the best resource to take responsibility for providing that help and see what we can learn’. This is still work in progress.

The first challenge was to decide how to begin with each person. The most important early outcome was to build trust and demonstrate a different relationship between citizen and services. Then help was provided based on something that mattered to the person.

Some examples

A woman suffered from agoraphobia. The team arranged for her to have a garden bench so that she could begin the process of feeling comfortable outside.

A family moved into a new property and found waste items had been left behind by the previous tenant. Multiple requests to remove them had not been actioned. Getting them removed proved to be enough to make them feel that the team genuinely wanted to help.

A woman suffered from alopecia and had become a recluse as a consequence. The team bought her a wig.

A tenant was on the verge of being evicted for failing to keep his property maintained. The team arranged for him to have a lawn mower, which he was very happy about, and this started the process of turning the relationship with the housing department around.

Another woman was struggling to feed her family. She didn’t have a cooker and was relying on bought meals. The team arranged for her to have a cooker.

These all seem trivial issues but they were very important to the citizens in question. They heralded the new approach and a new relationship – someone really did want to...