19
Public Services Committee
Corrected oral evidence: Designing a public services workforce fit for the future
Wednesday 16 March 2022
4 pm
Members present: Baroness Armstrong of Hill Top (The Chair); Lord Bichard; Lord Bourne of Aberystwyth; Lord Davies of Gower; Lord Filkin; Lord Hogan‑Howe; Baroness Pinnock; Baroness Pitkeathley; Lord Porter of Spalding.
Evidence Session No. 5 Heard in Public Questions 41 - 50
Witnesses
I: Dr Ana Canhoto, Reader in Marketing, Brunel University; Dr Aveek Bhattacharya, Chief Economist, Social Market Foundation; Professor Catherine Mangan, Professor of Public Management and Leadership, Institute of Local Government Studies, University of Birmingham.
Dr Ana Canhoto, Dr Aveek Bhattacharya and Professor Catherine Mangan.
Q41 Chair: Can I welcome you to the second part of this session of the Public Services Select Committee in the House of Lords? We are looking at what the future workforce for the public sector needs to look like. We are particularly thinking about how we will ensure the modernisation, the reform and the look of the public sector when we know we cannot throw money at it and we cannot simply recruit more. This is a huge challenge for the public sector but there are expectations out there about what the public sector will give.
This afternoon, in this session, we are particularly thinking about how the public sector can use digital transformation effectively and we have three people to help us go through this. We have Dr Ana Canhoto, a reader in marketing at Brunel University, Dr Aveek Bhattacharya, chief economist with the Social Market Foundation, and Professor Catherine Mangan, professor of public management and leadership at the Institute of Local Government Studies at the University of Birmingham.
Several of your colleagues have been to us on other parts of the inquiry and on other inquiries, Catherine. I see that you are also involved with New Local. I was involved a long time ago, when New Local Government Network was set up, so I have more institutional memory than anybody ought to have of these things. Welcome to all three of you. Once we have had the first question asked, when you first come in, can you introduce yourselves and say a tiny bit about yourselves, so that people watching outside really know who is who?
Q42 Lord Bichard: Following up your point, Chair, I think I am one of the oldest surviving fellows of what was the Institute of Local Government Studies at Birmingham, so it is good to have you here. Thank you to all three of you for coming along and helping us this afternoon. I wanted to ask you whether you have encountered any good examples of where digital transformation has helped develop different ways of working in the public sector, perhaps by enabling staff to cope with increasing demand or even reducing demand through prevention. Have you encountered any specific examples that would help us of that kind of thing happening in reality?
Dr Aveek Bhattacharya: I am chief economist at the Social Market Foundation, a non‑partisan think tank based in Westminster, and my interest in this topic comes from a paper I produced earlier this year trying to understand what public service reform means in the 2020s, addressing very much the sort of questions that this inquiry is looking into. How do we do more with less? How do we deal with growing demand and improve efficiency rather than just pouring money into the problem?
To address your question, it is quite a tricky thing because there is great awareness of the potential of digital transformation. We can all talk through the different channels, the different things that we ought to be seeing, and we can see that from outside the public sector in the different ways in which digital services and techniques have improved things in the economy. But it still feels like we are quite early in the journey of getting very hard, robust evidence of this working in practice and leading to efficiency gains.
I can give a few examples of things I have come across that are at least promising and different ways in which digital transformation could lead to higher quality and efficiency. One obvious thing is the automation of routine tasks and freeing people up from admin time. We can hope there is less time filling out paperwork. Estonia being the poster child of digital transformation is a bit of a cliché at this point, but the school management tool used there is called eKool. The only data I found on this was from the provider itself, so I am inclined to take it with a little grain of salt without external validation, but it claims to have reduced the amount of time teachers, on average, spend on admin by 45 minutes a day. Given the length of an average school day, this feels like a pretty big gain.
Another example of digital transformation that was quite promising, from my understanding of it, is the shift towards digital civil justice. There are critiques of the Courts & Tribunals Service reform programme, and we will return to this down the line in terms of the risks of excluding the digitally excluded, but 80% of divorce claims are now online, up from a relatively low base a few years ago. Small money cases and civil proceedings are increasingly online and the average time taken to settle those has gone from 14 weeks to five weeks. That is promising and shows that we can do it here. We do not just need to look to Estonia.
The third example that struck me—again, I would be interested to see greater validation—is the incredible potential of data analytics informing practice, so that we are targeting resources and practices at the people who most need support, at the time they need it most.
A promising intervention here is Nottingham Trent University, where they have what they call learning analytics. They leverage their institutional datasets. They look at whether students are using the library, whether they are attending lectures. They look at their door swipes. They look at whether they are logging on to the virtual learning environment. Then they can identify students that are at risk of dropping out or at risk of underperforming before those issues present themselves through the normal channels. In the previous section, we talked about prevention. This is another way in which this could be done. Again, it is early days but that is promising as well.
Professor Catherine Mangan: Just as a shout‑out for some of the more traditional universities, we also use learning analytics, particularly for our students from deprived backgrounds, to identify those who are on the cusp of a 2.2 and a 2.1, or a 2.1 and a first, and then intervene. I agree that that is a really good use of data.
More widely, we have seen a lot of local councils investing in avatars and bots. I do not know whether people are familiar with the Alexa model. She is a chatbot who deals, in several councils, with very basic, simple queries that come in through the website, which frees up the customer service people to then respond to much more challenging, complex queries. That is enabling people to spend the time where it needs to be spent.
We have also seen the developments of—I am not sure I should call it this—Uber‑style employment models in fields such as housing maintenance and in some aspects of care. Where perhaps a report of a broken front door or a leaking pipe comes in, whichever plumber is in the area is free to take the job and will respond. Rather than having a call sheet and waiting days, it is a much more flexible model and much more responsive to what customers need.
It begs the question, though. You talked about improving services. We just need to ask the question about improving for whom, because this might be creating efficiencies for the organisations, but in terms of the experience of both the public servants delivering and managing this service, and the residents on the end of it, there is a question: “Well, how good an experience is this?”
We all know how frustrating it is to not quite get the answer you want from a chatbot and seemingly not be able to talk to a human being. We know that, in some of these cases, a lot of public servants feel that they have lost that relational aspect of their job, and that is what they came into the job in the first place to do.
This is a particular issue with GPs, where they have moved to telephone consultations. Although it is much more efficient and they can probably get through the patient list, they feel that they have lost that relational aspect. It has become very transactional. They are losing a big chunk of the reason they came into public service in the first place. When we are looking at improvements and efficiencies, we need to look at it from both sides of the equation and look at what we are losing by digitalising services.
Lord Bichard: Presumably what we want to do is to use digital to take away some of the boring, mechanical, bureaucratic processes that we all love, working in the public sector, and allow people to spend more time on the thing that brought them into the public service, which is outcomes, clients and users. Why are we not better at doing that? Why do we seem to have encountered the problems that you are describing? Are we not managing this process very well? Are we just using technology to make the process more efficient and not redesigning the job?
Professor Catherine Mangan: Talking to leaders in the public sector, we do not really have the skillset across the public sector to necessarily be digitising the right aspects. Because some things that we think may be transactional, for example somebody ringing up to pay their council tax, involve people and families, and their complex lives, quite often it is not really about paying council tax. It is about, perhaps, not having an appropriate home, not being able to pay, benefits being wrong and that sort of thing.
Quite a lot of the time we engineer in a lot of failure demand in our digitisation of services. A lot of places have just gone hell for leather—“Let’s digitise everything”—without necessarily understanding the whole system. I absolutely agree: we should digitise the very transactional things that are easy to do, but I am not sure we always understand that some transactional things are not simple, technical problems. They are actually quite complex problems without a single answer. In some aspects, we have probably digitised the wrong thing and then not necessarily been able to row back.
Dr Ana Canhoto: Good afternoon. I am a reader in marketing at Brunel, and I teach and do research on the use of technology in service delivery. If I may, I would like to make three points, one regarding the automation of those boring parts of our job.
It is true that, in a way, some of these things are repetitive, and we could free up time and energy to deal with others, but, in areas where jobs have been highly automated, we are finding that those boring bits are a bit like breaks. They are lulls that allow us to recover in order to then do more of the cognitively demanding tasks. Staff who have had all those bits removed end up with a much more stressful job because they are always dealing with the difficult cases, so we also need to be careful on that point.
The other area is why we have not automated more things. There are many reasons, but one is that the public service workforce deals with very complex problems. A private firm can choose which segment to focus on and can decide not to serve certain segments, even a bank, but a public service organisation cannot. A council will have lots of different people with, say, lots of different needs and ages. The problems are much more complex and therefore it is much more difficult to automate than for an online commerce company, so we need to recognise that.
On the first question, about good examples, the people who spoke before me talked about productivity and using technology for analytics. I would like to focus on good examples of the user experience, for people who have to deal with public services.
Here, the challenges that people face are sometimes because services are very fragmented. They find it very difficult to understand where they need to go and whom they need to talk with. One good example here in the UK is that the Government Digital Service has created the GOV.UK portal, where all the services are centralised, which makes it much easier for people to find information. It also means that, because we become familiar with the platform, it breeds trust and breeds adoption, so that is good.
Where it fails is that, even though it is all in the same place, it is still quite fragmented. If I want to do my taxes, I need to use a certain number. If I was ordering some Covid tests, I would need to use other numbers. It could be much more simplified by having just one point of identity, one point of entry.
Here, good examples are usually in the Nordic countries. Finland, Denmark and Sweden all have much smoother interaction. Citizens need to enter only one ID number and then they can have access to all the services there. There are some good things being done in the UK at the central level, but not so much at the local government level, which is much more fragmented. There could be improvements of the user experience. That would be my suggestion.
Lord Bichard: I think you are right. Many of us who use GOV.UK would agree with you, but why are we finding that so difficult? Is it because we are not actually very good at co‑creation, co‑production and co‑design, so we do not actually listen to what the user is telling us they would like? Is it because public service professions, maybe, are not enthusiastic as we would like them to be? Why do you think we have this problem, because GOV.UK has been around for a long time now?
Dr Ana Canhoto: There could be two problems. First, we think in terms of products rather than needs. When a new parent, for instance, has a baby, they will need to register the child. They will need to apply for child support. They will need to apply for parental leave. They have lots of problems to deal with.
Instead of thinking of the user, we are thinking of the product. I think, “I’m the person who does the child registration. I think only in terms of that”. We are thinking of functions rather than needs. That would be one. It is a completely different way of looking at service that most private firms have and public services do not.
Secondly, it is cultural, because public service workforces have an ethos of fairness and equality, treating everybody the same, whereas private firms have a principle of differentiation: “I treat people differently”. Again, culturally, in terms of staff and how you approach things, that could be a barrier. If I am going to develop personalised, very effective services, I need to see customers as individuals and treat them differently, according to their needs rather than according to principles of treating everyone the same, if that makes sense.
Professor Catherine Mangan: Apologies, I realise that I did not introduce myself. I am from the Institute of Local Government Studies. I agree completely that we do not design around the whole person. Certainly in the public sector, that is because different bits of the public sector deal with different aspects of people’s lives.
The fundamental challenge of this is our inability to data share. That is what really gets in the way of being able to design platforms that support people’s whole lives, because you only ever see one aspect of a person. Even in a council, one bit of it might know your housing needs and what you are paying for council tax, but it will not know whether your children are at school, whether you are about to have a baby and that sort of thing.
If you compare that with the profile that Amazon or Tesco has about an individual, we are so far behind that. Because of our inability to share data, it is just really difficult for any digitisation to be able to look at somebody in the round and tailor what we might want to offer them to that. That is a huge challenge for the public sector. We have been trying to tackle this for decades and really not got anywhere. Even the integrated care systems are still finding it hard to share data between social care and the NHS. We absolutely have to tackle that if we are going to seriously digitise our public services.
Lord Bichard: This committee has been very active in that area and we will continue to be, because I completely agree with you. The only disagreement I have is that I do not like having private‑public sector discussions or comparisons. An awful lot of the private sector provides even worse digital services than the public sector does. Some of them are outrageous and that is not because they do not have the investment to make. I just want to avoid us getting to a position where we think public is bad and private is good, because that is not the reality.
Q43 Lord Porter of Spalding: Despite not wanting to speak about anything to do with digitalisation, on that last point about the barriers to data sharing, Catherine, is that because it is the law, is it because professional silos will not allow their bit of the silo to be broken down, or is it because the public do not trust the state when it comes to data and are very reluctant to let anybody share it?
Professor Catherine Mangan: I think it is a combination of all three. We looked at integrated care trusts in the past and, when we explained to the users how their data was going to be used, because we had to ask for permission, they were often very happy if they understood exactly how the data was going to be used and it was used in only a very limited way.
What citizens are concerned about is how that data will then be used. It goes back to Lord Bichard’s point that we know our data is not always used particularly responsibly by private sector organisations, so I think there is a nervousness about that. There are regulations on what can be shared but a lot of that has been chipped away at, so that has reduced.
I think there still is a real reticence on behalf of local government to tackle some of these issues, as you probably know better than I do, because it opens a Pandora’s box and we know we are in it for the long haul if we start to talk about data sharing.
Quite often, we see parts of organisations developing workarounds, so, instead of sharing the data, somebody will email a summary of somebody’s situation. We are creating a lot of work to get around what would be much simpler if we just shared data. I do not think there is a simple answer and a simple solution to that, but it is a combination of all the things you suggested, Gary.
Q44 Lord Filkin: Thank you to the panel for coming. Sticking with the big subject of the potential for digitalisation and the application of technology to improve outcomes and to, in a sense, empower and enable workforces to get better results, let me ask two questions, if I could. The first is a problem area. What can workforces do to ensure that we do not exacerbate inequalities in the process?
Secondly, given that this is a very major question for us in our report, can you offer some strategic insights as to how public sector employers should go about working with their workforces and their digital transformation potential? Clearly, digitalisation will have very a significant effect on roles, procedures, numbers and skills, and one wants to find ways that harness the workforce and maximise the potential for beneficial digitalisation.
The first question is about how we avoid worsening inequalities and, I hope, improve them; and the second is about strategic insights into the process of working with workforces that will necessarily change their roles and operations.
Professor Catherine Mangan: This has a real potential to exacerbate inequalities and we have seen that in some of the digitalisation that has already happened. We have to recognise that, for some of our residents, we will always need to offer a face‑to‑face alternative. One in 10 people in the UK still do not have access to the internet and do not have a smartphone, so we need to make sure that we do not create barriers to accessing our public services.
The other thing we need to be mindful of is the way in which we develop and create algorithms. We need to do that in an ethical way, so that we are not coding in bias and coding in the ability to prevent people getting services. We just have to be very clear about what the ethics are when we are developing these systems.
To give an example from my own current background, we have proctoring for exams, so people can do exams online but we know that the person is who they say they are. That software does not recognise non‑white faces properly. It will come up saying, “I don’t think this is the same person”, because it has not been coded or developed properly. We have to be really, really careful that we do not roll out things that will exacerbate the potential for people to not access it. Shall I stop there or do you want me to address the second question as well?
Lord Filkin: Let us go round the three of you first on the first question, not to get in too much of a muddle, shall we?
Dr Ana Canhoto: Catherine talked about the impact of data. There could also be an impact in terms of processes, for instance, because digital technology could be a source of stress depending on the problem that the citizens are trying to solve.
If I am trying to do something really simple such as paying my council tax, I just log in, I pay and it is done. If I live in council accommodation, for instance, and I have complex problems where I need to deal with two or three parties in a row, the digital technology could exacerbate stress because I never have closure when I deal with one. I am not sure whether information has transitioned one to the other. I need to repeat everything.
It is sometimes more the most vulnerable members of society who have to deal with those very complex problems of health, accommodation, education and so on. This could also be creating discrimination in that way, in helping solve the problems of people who already have fewer problems to deal with.
In terms of the infrastructure that you mentioned there, I agree. A lot of people use the internet only through mobile phones and so on. It is also important to think about the gaps in terms of the workforce, because it is one thing to work in London where you have 5G everywhere, but I live in Oxfordshire. It is difficult in some areas to get even 3G connection.
If I am a nurse or a social worker, out and about, my phone does not work. I cannot enter data as I am going, so I provide a lower-quality service or have to spend more time afterwards entering the data when I finally get into the office. It could disadvantage the staff themselves, not just the users.
Lord Filkin: Aveek Bhattacharya, do you have any comments to make on the inequality, mindful that the Government have a major digital inclusion strategy, which is a big topic in itself?
Dr Aveek Bhattacharya: This might be a bit unpopular, but it is worth considering the possibility that technological progress involves exacerbating inequality. If we look at various forms of technological progress that we have made as societies or as a species, such as air travel, smartphones or any of the big leaps that have been made, generally the well‑off benefit first and then it trickles down.
If there is an efficiency/equity trade‑off, it is not obvious to me in every case that we want to ensure equity, or that we necessarily want to privilege making sure that the hindmost catch up rather than progressing. The extent to which we should be concerned about this will vary from service to service.
If, for example, computer‑savvy, digital‑savvy people can get through their GP appointments more quickly and have a better experience because they can use chatbots or online appointments, whereas other people have to wait a bit longer because they depend on face to face, that seems to be less concerning than, for example, if we have a two‑speed education system, as we have seen through the pandemic, where some people are benefiting from online tutorials. This is just because of the nature of education as more of a positional good, where, if some people are doing better than others, that relativity is much more important.
I think it is worth considering that there might just be a genuine trade‑off. As we said earlier, the culture in public service is to privilege equity, understandably so, but that might not be the best decision in every case.
Q45 Lord Filkin: That is a very interesting challenge, which we will reflect on. Let us come to the second question, if we can. We do not have a lot of time, but it was essentially an invitation to offer any high‑level insights about how public sector leaders, particularly, can address the opportunities of digitisation, recognising that it will have significant implications for the workforce itself, in terms of roles, skills and procedures, et cetera.
Professor Catherine Mangan: There are two aspects to this that I wanted to raise. To use a horrible phrase, we need more Generation Z in the public service workforce because they bring digital fluency with them, whereas a large part of the public service workforce currently has had to learn it. They are not what we would term digital natives, so it is hard to envisage what things might look like, whereas Generation Z have great ideas. They have been brought up with this, so they already can see what could be done.
We know it is very challenging to attract and then retain younger people into the public service, so we need to look at the way that we design those roles so that they do appeal to young people, with much more variety and flexibility, and flatter hierarchies so that they feel they can contribute. We know they are always frustrated by hierarchy. Attracting younger people who can help with this is critical.
I do think that our public service leaders need a specific set of skills to make this a reality. They need to be agile leaders. They need to be multitalented, with the ability to manage digital processes, contracting, blending creativity and commercial acumen, but keeping that critical public service ethos.
Because we will be working in a much more virtual world, we need leaders who can be a stable hub around which a virtual and possibly changing team can work. They will have to work on trust and engagement, with a focus on outcomes rather than processes. They will need to be really good change managers who can champion agility, open‑mindedness, creativity and flexibility, recognising the potential of people who are perhaps slightly different from them, and designing roles where people feel they can make a difference and have autonomy. They will need to understand the system and the user journey, so working with citizens, examining that user journey and engaging them along the way, and, as we picked up earlier, breaking down those barriers to information sharing.
Finally, we need leaders who are authentic and very alert to the risks of inequality. I hear what other speakers have been saying about potentially needing to live with that, but we should at least be aware that that is what we are doing, and aware of the potential for inequality, discrimination and unequal access that stems from digitalising services. It is important that they recognise that there are ethical choices to be made when we are writing and coding algorithms. Those are the two key points that I would want to make in answer to that question.
Dr Ana Canhoto: I would add one point about the importance of being champions of digitalisation. It has been shown time and time again that, when the leader is enthusiastic about technology and champions technology, the process of digitalisation is much smoother and the things you go on to achieve are also much higher.
I agree about agility, also because digitalisation means that we could have data coming in at all times. If we do something, I immediately get feedback on how many people are looking at the website, how many people are downloading, how many people are watching this. It is also about being comfortable with changing decisions quickly. You do not make a decision and then move on. You keep fine‑tuning it. It is a completely different style of making decisions and managing in this new era.
Dr Aveek Bhattacharya: This comes back to what we have said before. Following on from Ana’s point, there is a new set of skills. For example, with big data, data analytics is a different skill. That might be a different role you need to recruit someone into.
Linked to that, with a lot of this data stuff, can people interpret it? Can people integrate it into their day to day? That might be taking people who have done things a certain way and making sure that the information they are being fed is in a way that is understandable to them. Are they traffic lights, dashboards or very simple messages, and, conversely, do people know what to do when they get those flags?
Another thing that strikes me goes back to the conversation we were having earlier about people’s roles being different and GPs saying, “I didn’t really get into this to have conversations with people on the phone”. In some cases, certainly, there will be valid pushback and maybe you are missing something. In other cases, it may be that the role is just going to be different moving forward or needs to be reoriented.
In the public services, professional identity in many cases is such a strong motivator and a core part of who people are that, when the roles shift, that needs communication. That needs to be a shared process rather than being told, “You used to do it this way. Now you’re doing it that way. You thought your job was this. It turns out that it’s something else”. That is just going to breed resentment and frustration, and undermine the project.
Lord Filkin: Thank you all. That was extremely helpful because, in a sense, if digitalisation is part of the solution, how a skilled workforce and skilled leaders address it is as relevant as how front-line workers address it. We will have to reflect on that and, I am sure, make some strong points about that, and you have given us a lot of ammunition to do so.
Q46 Lord Bourne of Aberystwyth: Thanks very much indeed to the panel for some fascinating insights. Continuing on the digitisation theme, but looking at it from the other end of the telescope, we sometimes beat ourselves up a bit too much on the failures. Considering where we were two years ago, there have been some significant successes. I just wonder whether we could perhaps focus on some of those. That might be useful for us in looking at our report and in inspiring other people, and you have touched on how important it is to do that.
Again, given the very swift shift we have seen from the physical GP consultation to the online and similarly with tuition, it is understandable that people have been a bit unsettled. Can you give some examples of how we can sell that and specifically of where it has been successful? We have talked about the success of the Nordic countries, but we have had our successes too. If you look at the vaccination programme, a lot of that has been aided by digitisation, as with lateral flow test ordering. There are some things that lend themselves to that.
I am also very conscious about the one in 10 who do not have access to digital. That is significant and some of the people who need public services the most are those who are perhaps under threat from that, if threat is the right word. It probably is from their perspective. What can we do about that?
Boiling it down, what do we do about the one in 10 who do not have access? How do we overcome that and how do we focus on some really strong examples of how effective it can be in selling it to the Great British public—all of us?
We have had some marked successes, but it is just part of our national character that we go on about the failures and forget that we have been pretty effective at delivering a rather effective welfare state system. We always insist on beating ourselves up about it and going on about the failures. Sorry, who will go first?
Chair: Just to say, we are about to have a vote and the bells will go, so I will suspend the sitting while the bells are ringing but we can vote where we are.
Lord Bourne of Aberystwyth: It is a triumph of digitalisation.
Chair: Just to warn you, that may happen in the middle of you answering this question.
Dr Ana Canhoto: Indeed, there have been successes, such as the GOV.UK website, which I mentioned when I started, and definitely the vaccination. These successes tend to be at the central government level or in the London area. Where you move to more the local government area, it is patchier in terms of the resources and accessibility of the services provided, but also the access.
Sitting suspended for a Division in the House.
Dr Ana Canhoto: I was referring to the issue of digital exclusion and digital poverty. Most people have access to some sort of mobile internet. Most people can access the internet through mobile phones, even at the lowest levels. When we design digital interfaces, we need to design them for mobile phones more than desktops because those people who are more excluded, with more disadvantages, will be using mobile phones, usually, to access it.
Having said that, they will probably not use the latest version, so we need to have that in consideration. This was one of the issues with the Covid contact tracing app, for instance, which did not work on some older smartphones. Even iPhones would not work if they were two or three generations earlier, so it is important to design interfaces for mobile phones, having in consideration that they will be not the latest version or the latest operating system.
That is on the technical side, but there is also the content. Going back, because it is mobile phones, maybe sometimes people would prefer to receive a text message as a reminder of something to do rather than having to log in or receive an email.
Moving on, beyond the technology, there is also the issue of accessibility. Sometimes the language on these services is very official and very complicated, and that becomes a bit overwhelming or threatening. That is also an aspect of digital accessibility. It is not just having the device but also writing in plain English, in non‑threatening language and things like that. For instance, there is some research in Finland, a country that is very advanced in the digital transformation, that there is a gap between migrant and non‑migrant communities of about 10 percentage points. Research showed that it was mostly about feeling intimidated when going to those websites and not trusting them, so sometimes issues of intimidation and trust are bigger, actually, than the technological barriers to access the services.
Professor Catherine Mangan: I completely agree with all of that. We need local government to get much better at segmenting our market, if you want to call it that. There is the 80:20 rule. Probably about 80% of a typical population in a local authority area will be very happy to engage with online services, but then there is a big section, for all the reasons the previous speaker alluded to, who find it very challenging to engage with officialdom, authority and bureaucracy, and get very anxious about that even if they are able to access it. They are very anxious about engaging with a system for whatever reason. We know that, in lots of areas, particular communities did not take up the vaccine and the only thing that worked there was public health consultants going around and door knocking.
We need to be very careful about segmenting and then put the resources in the right place. Where it is easy for people to engage, we know that section of the population will be happy to do that online. We put that over there. That is fine, but we then put proper resource into engaging those sections of the community who do not want to or cannot for whatever reason. We have to be proactive there and not presume that they will come to us.
That is why that worked really well in those areas where they sent the public health consultants out. In fact, they sent some of the democratic services officers door knocking as well, just so that they could have a friendly face of the council helping them to respond. We just have to get much better about understanding residents and understanding how they want to engage with us.
Lord Bourne of Aberystwyth: That is very true. Thank you very much.
Dr Aveek Bhattacharya: The point about trumpeting and recognising successes is really well taken. As you said, we have had this incredibly sudden shift towards a lot of things being online in healthcare and education foisted on us. It is clear that, to the extent that things did not visibly fall down, an incredible amount of adaptation occurred very quickly.
In some ways, a big risk here is that people lose heart. The narrative we tell ourselves, for example talking about learning loss in schools, was that we have had two years of disruption, things have gone terribly and we just need to get back to normal. That would be a tremendous shame, given that there has been this push towards trying out new things, even if that has been unchosen.
One of the tasks for the next year or two, given that the data presumably exists—I would be keen to do it myself if I had the time and resources—is to look at educational and health outcomes, at which institutions have been able to weather the last few years relatively well and at what can be learned from them. Presumably with the data we have we can identify who managed the digital transformation relatively well and what we can learn from those case studies. That would be a worthwhile exercise, because we should see this as an iterative process, one that was probably accelerated far more quickly than we would have wanted, but that was a first go, essentially.
Q47 Baroness Pitkeathley: Going back to the question of the people who are reluctant to use digital means and how important it was to have people going around knocking on the doors, for example, at the time of the pandemic, do we assume that there will always be a cohort of people like that and therefore we will always have to build in some human contact for them, or can we assume that, as more Generation Zs come through, that cohort will get smaller and smaller and eventually disappear?
Dr Ana Canhoto: We may always have a residual group but it is very important not to assume that this group will be just older people or economically disadvantaged people. Some people may exclude themselves or may be excluded by issues of trust, as I mentioned. We also have, for instance, segments of the population where they cannot use online services because they are running away from domestic violence.
There is a segment of the population who may be excluded not because they want to but because they have to, and we should not oversimplify and think it is just age or education. It may be that those are very vulnerable and really need our help.
Baroness Pitkeathley: That would include people with learning difficulties.
Dr Ana Canhoto: It could be, exactly.
Professor Catherine Mangan: It is a great question, and possibly sometimes we assume that that will actually be the case, but I am not convinced. Where we have relational services that are based on developing trust, long‑term relationships and reciprocity in a relationship between a public servant and a resident, there will always be a need for some form of face‑to‑face interaction.
That might be for only 10%, but we should not assume that we can create a 21st century public servant bot for the future and run our public services like that. There will always be the need for actual relationships, but you are right that that will diminish over time as more and more people get used to being able to interact online.
Dr Ana Canhoto: Here, third‑party organisations become extremely important. Those that represent groups such as victims of domestic violence or individuals with learning disabilities become crucial in reaching those groups.
Dr Aveek Bhattacharya: I would echo that, in that the conservative, prudent assumption would be to assume that, for the foreseeable future, there will be at least a group of people. Technological habits are generationally quite sticky. We were talking about Generation Z. As a millennial, I am a bit hurt that I have been overlooked as a digital native, but there is some truth to that. Our technological habits can be quite sticky and it is not just about literal access to it. It is not just literally about being physically able to do it. It is about having confidence, comfort and trust in the system, and those things are very, very hard to achieve.
Q48 Lord Hogan-Howe: Just to put a challenge in, are most services now not designed to be used by telephone, whether it is a GP or anything? They do not expect you to walk in and make an appointment, so why is it different for a clever phone on which you use data? We assume that people have telephones, and most of them have. So why are we being more sensitive about this? I am not saying we should not be. I just think it is worth putting the challenge in because everybody will eventually have a clever smartphone.
Dr Ana Canhoto: Could you repeat the question?
Lord Hogan-Howe: Yes. I think most people have a telephone at home; 99.99% of people at home have a landline. They are expected to contact their GP and their schools by telephone.
Dr Ana Canhoto: I do not have a landline.
Baroness Pinnock: People do not have landlines any more.
Lord Hogan-Howe: Well, yes, but my broad point is that they use a telephone to access most of our public services and our commercial services, frankly. Therefore, why is it so different to use the same device in a smart way?
Baroness Pinnock: I see what you mean.
Lord Hogan-Howe: All our services are designed to be contacted. They do not expect you to walk in through the front door and have a queue for cleansing services. I am not saying that no one does but, anyway, probably I should just leave it there because otherwise I will get cut down.
Baroness Pinnock: I am sorry.
Lord Hogan-Howe: No, do not worry about it.
Chair: It is that it is more complex to use things.
Lord Porter of Spalding: I did not lose a day being pinged. Nobody pinged me to tell me I was near anybody else who had Covid.
Lord Davies of Gower: You make a good point, though, because, if I may say so, there are certain suppliers like Sky that it is impossible to get on the telephone. There is a barrier there, almost, and you have to spend ages and ages going through some sort of menu to get to them, so I get your point.
Baroness Pinnock: On the point about the people who will have difficulty in accessing services, it is people without any mobile reception. Where I live, up near the Pennines, there is no mobile reception, and that will the case for lots of other parts of the country. I will just mention that. We need to think of those people, because often they are also remote from the services. The other point about using smartphones, which is absolutely valid as that is what people have, is that public services still send them forms to fill in on smartphones and you cannot—not easily.
Chair: Well, you cannot sign them. That is the problem.
Baroness Pinnock: It is. So there is some rethinking to be done. Sorry, that is one of my bugbears.
Q49 Lord Davies of Gower: One of the important aspects of this inquiry has been the integration of public services. How could digital transformation support the integration of public services, and how could such integration benefit the workforces?
Dr Ana Canhoto: Do you mean integration in terms of divisions?
Lord Davies of Gower: Yes.
Dr Ana Canhoto: To start with, digitalisation could for instance make it easier to share data, which then could help those services understand and get them a more complete view of citizens. It could help in that way with the issue of sharing data that Catherine mentioned earlier. The challenge, then, is that again it requires changing the perspective with which you approach citizens, not through a product but through the needs that they might have. That would be my main takeaway. Sharing data and information enables the development of that broader understanding of citizens and their problems.
Lord Davies of Gower: Do you have any examples to give us?
Dr Ana Canhoto: I gave the example earlier of the new parents. As soon as there is a child, you know that this person will need these services. You can almost cascade it—“Okay, next you do this; next you do that”—instead of relying on the new parent to realise and to go to different services. You know that the person will need that. You can share the information.
Professor Catherine Mangan: Yes, it should be able to help us to integrate, but only if we get over some of the data-sharing issues, and we design the systems around the users and their journey. People remember the Torbay care trust from a couple of decades back. Everything that it did was designed around a fictional care user called Mrs Smith, which helped all the public servants from the different parts of the system to understand what a user journey would look like. Everything was created from scratch around that particular person.
We would have to go right back to the beginning and design it from scratch, rather than trying to shoehorn our existing systems together, because we know they do not talk to each other. As Aveek mentioned, if professionals do not have skin in the game, if they do not have a stake in how it is being designed, they will not engage with it. A lot of this will have to go back to basics and design those integrated systems from scratch.
Lord Davies of Gower: Aveek, I saw you nodding there in agreement. Would you like to add?
Dr Aveek Bhattacharya: Yes, I have just a couple of thoughts. I am afraid I do not have a specific example, but there are a couple of ways in which it could help. I could imagine an ideal of a single front door or a triage system, where you are dealing with a service user who could potentially be engaging with or need help from multiple services, and that could be delivered digitally, through a chatbot or something where you can very easily interact with people.
Even when doing that on a face‑to‑face basis, often one of the difficulties with integration is knowing where to refer people to. In a project I have been doing on legal aid and civil justice, it often is not clear which service you are signposting to people or who can help. A lot of that can be digitised and updated very quickly, so that, if this person needs help with debt or with family law, you know where to send them.
A big part of the difficulty of integration is that it is adding to people’s workloads and adding to the stuff you need to know. If you are a GP, legal stuff is not your core mission or your core knowledge base, so digitisation of resources there can help. We could, to some extent, do this almost algorithmically: “Here are the things you need to check beyond doing the obvious medical checks”, for example, if you are the front door of the welfare state.
All those things, in principle, seem to be ways that it could help with integration7. Having said that, the one note of caution on integration is that, in my understanding, integration is very much relationship‑driven. In practice, if we have two organisations, or even two units of the same local authority or institution, that are dealing with the same user base, for them to work together often depends on personal relationships between the service deliverers. Insofar as all this stuff is being done digitally, it might undermine integration if the people do not get together in a room, do not build the necessary relationships or do not understand each other well enough.
Lord Davies of Gower: That is a helpful answer to end on.
Chair: That is a very interesting point to finish on.
Q50 Lord Hogan-Howe: I have one quick question, because it has run through what we have talked about today, which is about data and privacy. People are genuinely concerned that individuals may not want to have their data shared, but what is the actual evidence? For example, in the NHS’s push to get the digitalisation of Covid records online, when people have been faced with the dilemma, “Do I sign up to share my data or not?”, broadly speaking, what is the evidence about whether they agree to it? Is it always 3% who refuse or is it a third? Does anybody have any ideas?
Dr Ana Canhoto: It is quite complex because it depends on the type of data, so people are very reluctant to share data about, for instance, health, financial circumstances or religion. So it depends but, yes, you are right. We call this the privacy paradox. People are very reluctant in principle but then, in practice, they end up sharing more data than they said they would, so sometimes it is about how we present it.
Lord Hogan-Howe: It may be an unfair question, but I would be intrigued to know what the take‑up rate was for the apps that many of us have used on the vaccine side, and whether anybody knows, or perhaps we could discover, what the take‑up rate has been for the NHS record sharing.
Dr Ana Canhoto: I do not know the take‑up rates by heart, but I could find that out. I know it also depends, for instance, on whether it is customary. When people ask for your data every time you access the news, you become used to sharing it. When it is the first time, you are more reluctant. There are issues of habit and the cost of rejecting the data—whether it is very easy to say, “No, no cookies”. All those things will have an impact. It is quite complex, but maybe my colleagues have other points.
Baroness Pitkeathley: It is one thing to think that you are sharing data for the national good, as it was around Covid times. It is quite another to share your own sexual history, for example.
Dr Ana Canhoto: Even then, it depends on how it is used. We saw this with the collaboration between the NHS and Google DeepMind. People shared the data but, when they realised it was being used by this big conglomerate, they were very unhappy with the idea, so it is also about what is done with your data. That is important.
Chair: Can I say thank you to all of you? As I said to the first panel, if there is anything you think of later that we should take into account, or anything you think we have not been hearing, we would be really grateful if you would send us a note in whatever form is easiest for you to do. Thank you very much indeed and we look forward to working with you again.