Ian Jones Volunteer Cornwall and partners – Written Submission (FFF0001)

Summary

It is widely agreed that we have to increase collaboration to improve the delivery of public services and develop new local place-based outcome focused communities of practice. However, our collective experience remains embedded in a legacy of transactional relationships, hierarchical structures, competitive approaches, and minimal trust that separates the public body and its services from the person and community. We have to move away from the very rigid ‘New Public Management model that has dominated for the past thirty years that damages these relationships. This submission reflects on some of the changes needed to make the shift we all desire.

Building the foundations for cultural change

Strong relationships and shared responsibility should be the basic foundation for public bodies, the VCSE, communities and individuals to join together to improve services. This requires a fundamental new approach moving from “top-down” priority setting, paternalism and rational segregation, treating people as passive recipients to one of coproduction to address the interlinking complexity of people’s lives. It requires a different approach to commissioning and procurement at a local level and a devolution of responsibility and budgets from public sector to community. Personalisation is paramount, building on the interactions between all stakeholders as equal partners within the system. This is a shared endeavour between the providers of services, the ‘recipient’ and the community. The focus has to be on how we create agile teams and support to shape around emergent practice to learn, continual improve, maximise what works and minimise what does not. Finally, we also have to established new measures of success and risk. The public sector acting alone, can take too many risks away from individuals, families, and communities, then overprescribe narrow, short-term solutions damaging the long-term ownership of the outcomes for people.

Recruitment, retention and training:

  1. Understanding the workforce. We need to shift the public service workforce away from the silos we currently have with its hierarchies of specialisation, to one where people work and shape at a local level understanding the multiple needs of its citizens; recognising the inter-dependencies needed to wrap services around people and community.  Training has to adapt to these new ways of working and should allow people to move systems easily depending on need and interest. The workforce is more than just those people employed by public bodies, VCSE and volunteers are part of it.
  2. Adding value to work. It is increasingly acknowledged that practitioners want more out of a job than just a narrow working day. They want to see meaning, purpose and also have the ability to do new things. This can be achieved by tying in professional practices with being part of a wider team, where new skills and experience is encouraged, culture of learning embedded, and recognition of the joint endeavour celebrated.
  3. Recognising problem solving as a skill. We have developed an educational and learning structures based on a reductionist and mechanistic approaches to problem solving. New ways of thinking recognise that the complexity we face demands innovative and flexible ways of operating. We have to link the required practice with those who can join up services for people and communities. This has to be a bottom-up approach where specialisms are drawn down when required and everything is wrapped around the person and community. Professional qualifications are important, but we cannot be governed by isolated specialist interventions.
  4. Developing portfolio careers. We have to promote working for the public sector as a portfolio career which will allow people to continually learn and engage at a local level to deliver outcomes. We have to enable public sector, VCSE and local people to work together and create new pathways into the workforce.
  5. Creating shared asset-based approaches. It is not a case that failing to attract high-quality professionals to the public sector is the fundamental issue impacting on access to services to address inequalities. The major issues are to do with how we treat people and take a deficit-based approach when engaging them. Sometimes ‘high-quality’ professionals can hinder not help if they patronise those they are meant to be assisting and empowering.
  6. Understanding reach. Public bodies providing services have to work with partners beyond their boundaries, especially with VCSE which generally has better reach into what the public sector consider ‘underrepresented groups’.

Transforming workforce effectiveness:

  1. Digital as an enabler. Digital is not a panacea; it can both include and marginalise equally. The endless focus on integration and co-terminosity of digital can take us away from the key issue - how the workforce shares data to make the interaction with the individual as good as it can be.  The greater focus is on supporting capacity in communities to keep social connections in place.
  2. Digital technologies can be used most effectively for distributed learning and has the ability to develop cross sectoral multi-disciplinary teams. Outcome focused place-based teams and learning together to better understand roles, responsibilities and sharing practice is vital.
  3. Maximising resource. To maximise scarce resources public sector has to crucially work with the VCSE and members of the community in a totally different way. Prevention is paramount and the VCSE which takes a strong personalisation approach to what they do are in a much better position to do this. Costly public sector professionals have to be utilised only when their specialist expertise is required. The ICS and PCNs are being formed which will allow for this embedding to be built upon and where these new communities of practice can be developed. Population health management will assist in this. The ICS can build it strategically into long-term plans and the PCNs operationally on a day-to-day basis.
  4.      Reform and reshape ground-up. Over the past few years, we have seen increased pressure within our public sector partners, as well as specialist independent provision such as care homes and domiciliary care particularly. This growing crisis certainly calls for workforce reform, but the danger is we do this in the usual top town, commissioning led, punitive approach that leaves a legacy of poor relationships. We have to develop bottom-up relationships, teams working across sectors and disciplines so we can better utilise the capacity we have within communities. It has to go beyond public sector bodies we have to develop new practice and take the Buurtozrg approach to self-management to the next level.

Transforming existing workforce structures:

  1.       Shape integration around outcomes. Integration of the ‘services’ is paramount, and we cannot just focus on integration of public sector bodies as it gets bogged down in bureaucracy and governance issues. We have to really focus on the outcomes that we are trying to achieve with people not just the provision. We have to do this within place in order to make integration happen or else it gets lost in hierarchical and structural discussions. We have to develop this new place-based practice with the focus on the needs and aspirations of people and work with them to achieve it.
  2.       Understand the role of the VCSE in reform. Working with the VCSE is fundamental to any reform of public services. For too long government has separated the services from people so that we have lost the connection of what we are meant to be doing. We have to develop outcomes bottom up and shape teams around this. In Cornwall a number of larger VCSE bodies are rolling out social capital hubs within communities in order to join up personalised provision working with communities so that we can then collaborate with our specialist public sector professionals. With commissioning we are also looking at an outcome focused VCSE provider collaborative to ensure we can reduce competition with communities in order to focus on outcomes and impact. The larger VCSE partners will then be able to mobilise the thousands of grass roots groups and tens of thousands of volunteers as we did in during the pandemic and engage people and communities as if the services were theirs.
  3. Reform commissioning and procurement practices. These practices are outdated, utilising adversarial and competitive processes that stop people from working together. Narrow KPI’s and commissioning silos create service gaps and work against teams “knitting” together support to wrap around an individual or community. The current outcome for public sector is focused on the methodology of the procurement process and not the impact that is required. There is much conversation about outcome-based commissioning, but it is stopped by the old-fashioned rigidities we have built into the system. We need to better understand how to link success measures and outcomes with community participation as people are disillusioned and want to get involved in doing things themselves. Within the public domain of the future, we need to understand the relationship between representation and participation.
  4. Leaders need different skills. The required Leadership for the necessary new approach to achieve maximum outcomes needs to understand complex systems and the difference aspects of what needs to be managed and how services can be delivered with people. Primarily leadership has to be distributed downwards and allow for the emergence of new ideas to build on innovative practice that works. It also requires an understanding of when to call in the necessary professional to undertake distinct pieces of work and yet not allow the dominance of the professional to govern from the top down. We have to draw down the expertise from the bottom up when required. The Cynefin Framework is useful in this respect when trying to understand different ways to manage this. 

 

  1. It is crucial that we work from the bottom up to allow the new communities of place-based practice understand local needs then work upwards. So, from PCN, into Integrated Care Areas (three in Cornwall) then ICS, then regional and finally national. This is somewhat anathema to the current centralised culture and control that we currently have, this existing approach is no longer working and fit for purpose and has to change.

New mechanisms are emerging through the ICS’ and PCNs, we must build on them. The first question should be, ‘what is the best level’ then generate activity and support from the bottom up, particularly frontline expertise. Government has to utilise the skills of local partners to help shape those that are coordinated at national level.

Creating user-centred public services

  1. Managing and measuring what matters together. We have to work from the bottom up, from the coal face and allow cross-sectoral and multidisciplinary teams to shape service delivery. We have to establish the right measures that are built from the bottom up and based on maximising outcomes for people and place - not for hierarchical institutional reporting. innovation. To concentrated on emergent best practice and continual improvement we need a new type of manager (public sector and VCSE) that works across organisations and with communities, these managers have to be supported to deliver these new communities of practice. We currently have institutional and professional barriers which stop this from happening and layers of management and measurement that prevent innovation.

 

  1. Embracing the challenge. It is clear from our work in Cornwall that people want to become involved in identifying, developing, shaping, and delivering services to meet the need of their communities particularly to support the most vulnerable members. The VCSE is ideally placed to do this work as part of a new systemic approach. We have to move away from consultation and passive coproduction to one of joint development and delivery; what we do is what matters not what we talk about. Our current institutional and professional barriers stop this from taking place and we have layers of management and measurement that prevent this need innovation from continually happening. We have also got bogged down with the term ‘choice’ this is an old-fashioned consumerist term and is difficult make real with restricted resources. What we see is that people want to feel in control and engaged more than having the perceptions of multiple choices. Here it is personalisation that matters not choice.

In Cornwall, the VCSE are actively building the place-based structures with the ISC PCN starting to invest in the necessary cultural shifts. The approach has been endorsed but it is not easy, and our commissioning and procurement practices run counter to place based integration. To scale this up, we need to invest in training and development, encouraging teams to challenge the norms and behaviours and be supported to embed new ways of working. We have demonstrated through the pandemic the power of the voluntary sector and community in meeting need. The danger is that we lose this learning with public sector bodies deciding what structures are relevant – if we do what we have always done, we will ‘get what we have always got’. We see the social capital hub work we are doing linked into PCNs as the ideal vehicle to move forward embracing emerging practice and developing a new asset-based culture of delivery.

 

February 2022