On 19th May Bluestar hosted ‘Beyond Therapy’, the first ever festival of activism for child sexual abuse in Bristol dedicated to re-imagining our society’s response to child sexual abuse through research, creativity and connection. Emma Harewood hosted a panel with experts from The Lighthouse, Bristol SARC, NHS England commissioner and Claire Bethel of RedQuadrant, to talk about ‘Shaping the system around children and families – encouraging professionals to work in partnership to create whole system change.’
What does it mean to work in a true partnership?
The Lighthouse team explained it takes more than just co-location, although that certainly enables sharing of knowledge and expertise across agencies. Creating an understanding of each other roles, culture and priorities means you can influence others to keep the child central. They described working with police to slow down the process at the start of investigation so the child feels in control. As well as providing expert consultation to support social workers and teachers in the community, allowing the service to reach a wider group of children and embed good practice. And understanding the restorative value of the doctor’s examination.
Partnerships take time to create, and the team advised others to invest enough time in developing agreed ways of working before they open the door to children. They encouraged commissioners and policy makers to ensure there are enough sessions provided to create safe spaces for children to share and for supporting parents with the skills to be there for their child.
What are the benefits for children and young people when we work in a partnership?
The young people said they really valued all services being under one roof and the holistic service. Their persuasive voices gave support to recommission the full service offer after the pilot and convinced the judiciary to allow pre-record cross examinations in the Lighthouse.
We heard how the children felt welcome and ‘almost loved’ at the Lighthouse, only having to tell their story once in a safe place. They had choice and control over who they talked to and when. For the first time, the professionals had been organised around them, rather than the child fitting in with the professional’s ways of working. Young people in Bristol, Jersey and London have all said that being able to access something as simple as a sexual health follow-up in the safe place they first met the doctor after sexual abuse, is better than travelling to an adult focused GUM clinic where they felt judged. The Bridge in Bristol are looking for young people’s voices to amplify the need for this partnership service in their local SARC right now. Other young people in the AYPH study, remind us how important holistic support is to help re-establish friendships, school and family life.
Why is it so hard to achieve partnership working?
Ultimately the financial resources needed to create joined up partnership services are considerable and seen by some as gold standard. As well as the time it takes to really invest in the relationships and understanding needed to create true partnership. Add into the mix the logistical nightmare of all partners, commissioners and policy makers aligning their shared vision and commitment at the same time as contracts end! And finally, the need for sacrifices to be made in organisational culture and ‘the way we do things round here’ to find a middle way.
Creating new partnership and whole system change need passionate, relentless and creative leaders – but the difference the change can make to children, families and adult survivors is priceless. The external Lighthouse evaluation and final annual report have shown that investing in holistic, long-term support in a multi-agency partnership improves the experience and outcomes for children and families. With less victim withdrawals and more cases making it as far as the CPS, the Lighthouse partnership is starting to turn the tide towards a more child friendly experience of the justice system against the backdrop of a shocking all-time low in the conviction rates in the UK for child sexual abuse.
How do we ensure a better #future for citizens, communities – and ourselves?
How can we encourage #innovation in an over-pressurised and partly broken system?
Adult social care #commissioning is a fantastic space to explore these issues, as we’ve been doing for the last few weeks on an interesting project, and for years before that!
Commissioning in adult social care means shaping a complex system to get better outcomes for people with learning disabilities, physical disabilities or physical or mental health issues.
It can be as narrow (but challenging) as ‘procuring organisations to provide homecare’, and as wide and messy as ‘shaping a community where everyone can thrive’.
As a commissioner, you have varying levels of power, authority, capability, respect, and understanding in your organisation.
…you have to constantly respond to crises (most of them caused by ‘austerity’): a provider of care collapsing; problems recruiting and retaining workforce because they’re paid less than Amazon; 30% of carers off sick with COVID; an urgent need for particular specialist mental health services (say).
…and you have to work in a place, with all its complexities:
– do the chief executives of the council and the hospital trust get along, or can they not be trusted to be in the same room together?
– do our providers trust us, or are they still hurting because we clumsily tried to reduce their fees three years ago?
– do the community organisations agree with our ideas about ‘coproduction’, or do they see it as foisting the costs of care on to them?
What we’re doing is trying to produce a tool to help people doing this messy, complex job to assess their context, and:
1- put together a commissioning development plan to get more ability to influence the system of health and care in their place (or, even, the system of wellbeing)
2- decide which of twelve ‘commissioning approaches’ fits their place and their needs best
We’ve been running this as a #workoutloud process – so if you fancy diving in and contributing, you’re welcome! There’s an open Mural board and an open meeting on Wednesday 20 April at 2:30pm (links below).
Or you can give us a quick comment here:
What is one thing you’d like to offer to adult social care commissioners to help them decide their approach?
The Public Service Transformation Academy has been commissioned by the LGA (the Care and Health Improvement Programme, jointly run with DHSC and ADASS) to produce a tool for adult social care commissioners to go through strategic options appraisal – i.e. to assess their place and decide the best approach to commissioning.
Yesterday I was lucky enough to chair Transforming Commissioning: Levelling Up and Community Investment, a Third Sector Commissioning conference from Westminster Insights. It was one of those events where (all credit to the organisers), each of the speakers had a hugely high proportion of powerful, crisp messages in their very short slots, and the audience were engaged and well-informed.
Here are my rough notes from the wrapup at the end of the day, attempting to summarise some of those very rich messages.
Credit to the speakers is at the end; you can consider that the good ideas in here come from them, and bad interpretations are all mine.
Ad break: as well as the brilliant work we do at the Public Service Transformation Academy to build capacity for commissioning and transformation, we’re currently working on behalf of the LGA on a project to provide structured support to adult social care commissioners to develop their strategic approach.
If you’d like to share your experience or ideas to inform a free, open, local-government-wide tool and learning community, we are interested in hearing from all parties.
There are several different ways that you could get involved. We are looking for interviewees, case studies and focus group attendees.
We are also planning to create an open learning community. This will meet for the first time on the afternoon of Wednesday 9 February and will meet fortnightly on four more occasions.
First, and above all, commissioning that privileged the competitive incentive above all others probably is dead, or certainly deserves to die – we should be seeing competition as one of the very powerful (and risky) tools in the toolkit.
The reality is that twelve years of austerity has left us with a great deal of damage. We heard that civil society – at least organised civil society – is weakest where it’s most needed.
The old saw of fragmented funding comes up every time the voluntary, community and social enterprise sector gathers – and comes up every time local government gathers.
And yesterday I heard about Public Health England not yet having a 2022-23 budget with which to carry out it’s critical NHS workforce planning role. And about NHS capital funding; announced on December 24, and absolutely needs to be spent before 1 April.
There’s a risk this becomes the background noise, the water we swim in. But we need to take this seriously.
The HUGE cost and friction of current funding mechanisms isn’t just ‘something the recipients like to moan about’. It’s an actual economically demonstrable disincentive to value.
If you wanted to design a system to stymie all the good things we are seeking from ‘levelling up’, you would design it this way.
This is of a piece with the absolute fragmentation of coordination across the sector – or perhaps I want to say the fragmentation of coherence – the ‘institutional clutter’, the ‘pinball referrals’, the lack of joining-up which creates a negative multiplier on spend, impact, and citizen experience.
Nevertheless, there’s still a deep strength even in the most deprived, most under-invested communities.
Amongst many philosophical reflections and aphorisms, Will Balakrishnan of the Mayor’s Office for Police and Crime in London challenged us: “Ask yourself – are you the prisoner of your experience?”
I think that’s particularly relevant in the context of fragmentation, and of lack of civil society organisations where they’re most needed.
Another theme – and the antidote to fragmentation – is relationships.
This is all about relationships – relationships between levels of government, levels and peers of the community and voluntary sector, and between citizens and ‘providers’ (and between citizens themselves – especially when you consider a starting point of ‘we are all citizens’.
It’s easy to get carried away and think ‘relationships’ is all about sweetness and light and connections.
Relationships are NOT just a love-in – I mean, have you ever been in a relationship?
Good relationships are robust, challenging, they provoke growth.
Will reduced all of commissioning to three questions:
1. What is life like now for people?
2. How is it changing?
3. How might it change if we do things differently?
And added two provocations:
Imagine there are no services
How do we make space for conversation?
This relational underpinning to commissioning and to voluntary and community sector investment and whatever ‘levelling up’ means is critical.
We heard two really great comparable challenges:
This should be about paying forward, not in arrears, from Kathy Evans of Children England
And an exhortation to focus on measurable outcomes as a way of bringing the fragmentation together, from Andreaa Anastasiu of the Government Outcomes Lab
This will feed in to the balance of story and data later, but I want to make the point that this relates to relationships too. A transactional relationship can never focus on the bigger picture.
Governance – another word for relationships – also emerged as a really critical issue – and like other forms of assets it needs to be built up (in advance) – and can be measured by trust.
Learning and adaptation came through as really critical – a sector with people literally leaving because they are worried about the ‘precarity’ of their own jobs, with 30% of the effort and cost going into bidding, managing, measuring and reporting (my own illustrative figure) – who has time to learn?
There was a strong push to better connect the grassroots with the national policy agenda, which is always ‘playing catch-up with what’s on the ground’.
Part of this is that MPs and Councillors have to spend some time connecting to community and the voluntary, community, and social enterprise sector. But civil servants don’t. Give them opportunities for secondments, visits, deeper, embodied understanding.
They are bright, well-intentioned people and they are listening.There was particular praise for the government’s response to the procurement green paper responses – ‘hey, it looks like they actually listened!’
The question was put to VCSE attendees: “What do you know about the system that no-one else knows?”
How can you use your insight at the grass roots level (at the level of the reality of people’s lives!) to break through – to confront people with human, electoral, economic realities – that changes perspectives, mindsets, and policies.
The really good news, as we heard from Matt Whittaker of Pro Bono Economics, reinforced by real data from many others, is that the economic and social pictures are aligned and clear:
Moving money to the local pays back better
For every £1 into social infrastructure, c63p is re-spent locally (using the Calderdale case study from Sian Rogers at Calderdale Council and Rachel Bentley of the Centre for Local Economic Strategies)
And you get £3.20 back in the following decade – it regenerates places
So civil society spend not only has a massive impact on civil society where it’s most needed, it also gives a massive economic boost.
And we had a reminder – how easily we give up on this – early intervention and prevention offer us enormous value!!
Not to mention that, just perhaps, we should be thinking about key services – especially services for children – not as a luxury but as a huge investment. If ‘schools should be cathedrals’, is it really right that we might recoil in horror at the idea of accidentally over-investing in children? God forbid we might ‘gold-plate’ anyone’s pre-school experience…
Furthermore, investment in civil society can shift core services (as Calderdale showed).
And you get an extra multiplier on these effects if you work with organisations led by and for minoritised communities.
The bottom line is: attempts at transforming economic context succeed when there is the right community and social context.
Matt Whitaker pointed out to use that the WELBY measure – ‘wellbeing adjusted year of life’ – is now in Treasury mainstream Green Book guidance – so let’s use !
(And the Treasury has the Magenta Book for complex evaluation)
So certain parts of government still ‘need persuading’ about the benefits of devolving spend and the ‘efficiency’ of the community and voluntary sector – but even their own evidence is pretty clear – so let’s use it.
So changing mindsets from thinking about individual activities (fragmented) to thinking about outcomes – and gathering data and evidence – is critical. We need to articulate the cause by better articulating the value – to get to a place where “you can’t be a serious politician and talk about building a better UK without talking about civil society”.
One really big takeaway for commissioners from all this is – despite all the pressures – to really play an active market stewardship role – understand your provider market role, and really thinking about the relationships you are involved in and shaping.
This, inevitably, means investment. And that includes – especially with covid – making sure core funding includes funding for sector resilience and wellbeing.
It also means seeing the bigger system of which we are a small part, understanding that ‘giving away power’ is just a myth – that if we see ourselves as a small influential part of a bigger thing, we can go much further.
There was an inspiring belief in the power of local authorities.
Despite facing the greatest struggle of resource and capacity ever – lots of positive things can happen locally, particularly in partnerships between the sectors locally.
The rallying cry here was to build the infrastructure to take things out of the hands of central government. To build that core economy, abundant economy, based on relationships and people connected with each other, not on the scarcity of goods and things.
At the same conference last year, I gave a talk on ‘commissioning is dead – long live commissioning’ (a favourite topic since at least 2012). The ‘commissioning cycle’ which puts procurement at the heat of commissioning deserves to die.
As we are slowly moving out of the equivalent of a wartime footing with the pandemic, the hope for the future is in continuity of funding, building local governance capacity and relationships, and building community power in which the public sector plays a constructive role.
Speakers at the event were:
Andreea Anastasiu, Senior Policy and Engagement Officer, Government Outcomes Lab (University of Oxford)
Vidhya Alakeson OBE , CEO, Power to Change
Matt Whittaker, CEO, Pro Bono Economics
Will Balakrishnan, Director of Commissioning and Partnerships at Mayor’s Office for Policing And Crime (MOPAC)
Rachel Bentley, Associate Director, Centre for Local Economic Strategies (CLES)
Sian Rogers, Policy & Projects Manager, lead for Voluntary and Community Sector, Calderdale Council
Honest conversations, discussing the undiscussable of emotions and reasoning – nothing can develop unless there’s a shared effort to get at the truth
Clarity – no learning is possible, and productivity and psychological safety are unlikely, without clarity of roles, tasks, decision-making, and relationships
Learning – true learning isn’t possible without planning, prediction, and learning and reflective practices
These three create a learning system
4. Culture shaping, understanding that leaders and systems and emotional responses to them create conditions which generate psychological safety and productivity – or not.
A productive system.
Intent – measure customer / citizen / community outcomes – as they judge them.
A purposeful system.
Culture and achievement of intent are self-correcting measures – if you measure the actual outcomes of your practices; the experience of employees and customers, and learn what works, you can’t go wrong.
But you have to make them a practice – daily, built-in, acknowledging your weaknesses.
Why is a bridge and water such a good explanation of how people go wrong with business transformation?
I use this image to open a lot of my learning and teaching on service and business transformation. What do you see?
white water – froth and waste which we can remove one obstacle at a time, allowing us to see more at each step
the chance to bore out a concrete channel to carry the water smoothly… until the detritus builds up again
a flood of demand we need to build defences against
a rich, living ecosystem we should explore
upstream and downstream opportunities for improvement
a keystone arch – a miraculous way to make a bridge support its own weight. But try to copy someone else’s business excellence without understanding the scaffolding needed to make it work, and you’re just throwing stones in the air and hoping they stick.
The point is that when I say ‘here’s an image which is about business transformation’, everyone responds from their perspective, their understanding.
If you want to really satisfy your customers, read on.
Most organisations hear ‘listen to what the customer needs’ and say ‘yes! optimise for this!’
They hear ‘transactional efficiency saves money’, and go ‘yes! everything efficient!’
Truth: there are two types of customer service flavours:
1) transactional – customers can reliably specify and find the right service, and just want it over with – or not needed at all. Paying a bill, changing address. You want reliable, standardised, low-cost activity to drive volume, fast.
2) emotional/’customer intimacy’ – when you really need to listen to know what the customer needs. Understand. Experts, specialists to work with them for a joint solution, and every requirement is a new, unique little project.
You can do one, or t’other. But try to mix and match, you’ve got problems.
Treating emotional as transactional fails to meet the needs, costs you more, and upsets customers. Treating transactional as emotional… well, same.
Which parts of your service require customer intimacy? Which operational effectiveness? Are you sure?
Have you ever been given the wrong sort of service?
First, you establish enough shared context to move on – so you all know what is happening around you.
Then, you establish enough shared purpose or intent to move on.
Remember, you all need to be able to move to the next step together – any problems, back down you go!
Then, identify the critical ‘what if’ (risk) and ‘how to’ (outcome) questions which, if answered, will allow us to define the work to achieve the intent.
Generate ideas to answer those critical questions, select the best, and check benefits and concerns of the actions they suggest – do a mini ‘seven steps’ on each piece of work if necessary
Then assign tasks and get on with work… and learn what you’ve done wrong.
The golden rule is:
any time you get a surprise, e.g. you learn that we didn’t understand the context, that our purpose might be counterproductive, that we didn’t really understand the context, that we’re answering a question wrong… …you have to all go back down as many steps as needed to correct that problem.
It takes practice. And it works.
Where does your team go wrong on decision-making in complex times? Where do you get it right?
This was a client, but it might as well have been me! With things changing so fast, unpredictably, and it being hard to know what you can rely on, how can we make any kind of business decisions for 2021?
Sure, we’ve learned!
How much we don’t know – the degree of uncertainty we were actually always operating in
How much we can cope with. If the pandemic, lockdown, economic impacts etc have shown us, it’s that we can keep on keeping on
In businesses I work with, decision-making has survived and improved in these main ways:
realising how important the ‘thick data’ is – the actual stories of peoples’ lives, to go alongside the cold hard analytics
increasing the effort to get the right information to really make decisions to the right levels of management – compared to how waffly and, ultimately, meaningless those meetings were before
realising how many decisions need to be, and are, taken at the frontline – freeing people up to get on and do that, with only big strategic decisions out of their hands
What’s your big learning about decision-making from 2020? How are you feeling about big business decisions in 2021?