Five practical challenges to implementing new service models in local government
It’s well known that the adult social care space is complex, filled with risk, underfunded and as Neil Crowther said, it is probably also “underimagined”. Understandably, government funding is increasingly looking at the potential of digital solutions as one way of improving the wellbeing and lives of those who depend on councils for care.
Technology, including artificial intelligence (AI), assistive technologies (ATs) and internet of things (IoT) all have the potential to increase workforce productivity, make processes more efficient, detect changes in medical conditions or behaviours and ultimately support the most vulnerable in our society live well and independently for as long as possible. However, technology alone is unlikely to reap the results we all crave. The real power lies in the people and the system structures that allow them to deliver the care they were trained to provide in the first place. The problem is that experimentation on those areas in local government is often risky and made harder by the complicated governance structures which are in place, quite rightly, to protect the residents they serve.
LOTI’s mission in part is to provide a safe space to experiment and that’s why earlier this year, we launched the New Service Models in Adult Social Care Innovation Funds – a practical way to test projects that go beyond the usual digital brief. As part of this we offered £100K each to two projects. One of these projects is looking at developing a data platform for frontline care workers and the other is piloting a home care cooperative approach in Clapton, Hackney.
In this article, I share some early reflections on the practicalities and challenges we’ve encountered with our two projects so far when testing New Service Models in real life.
1. Public procurement rules delay projects
I’m neither the first nor the last person to say that public procurement rules, whilst of course necessary for ensuring fairness etc., do impede projects from starting promptly. I had to start with this because contract delays put unnecessary pressure on suppliers, particularly innovators, who typically run small teams, and have a need for consistent cashflow.
2. A more collaborative partnership approach yields better results than that of a commissioner / supplier one
We’ve been reflecting on this as a team at LOTI, because over the years we’ve commissioned and grant funded lots of different projects, working with the private, and third sectors as well as freelancers. One thing that we’ve observed is that great project outcomes are rarely achieved as a result of a transactional grant or contract agreement. Rather, they’re achieved as a result of great relationships and true partnership working, where there’s a common understanding of where we’d like to get to and our individual role in getting there. Having this, enables us to ideate, be creative about what we build and test, iterate and resolve issues in a way that benefits the work and furthers our understanding of what’s beneficial for the project.
Another point to highlight here is that of contribution / sponsorship / ownership. We tend to fund and conduct projects where collaboration adds value and lessons learned benefit the whole of the LOTI community. It’s for this reason that we insist on at least two LOTI boroughs sponsoring projects. We’ve seen this play out really well in practice where boroughs and suppliers get stuck in, shaping and developing ideas together. As a result, project outputs are of high quality and genuinely help officers. However, sometimes, we notice a more passive role from boroughs which makes it harder for suppliers and the LOTI team to determine what might be useful to officers in practice. We understand this is never for lack of interest, rather the pressure boroughs are under to deliver and constantly firefight making it difficult to dedicate resource or backfill roles.
3. A different type of organisational ownership could unlock better results overall, but truly incorporating such a structure is arduous
The home care in Clapton project is being led by Equal Care Co-op, offering us the opportunity to test a different type of organisational ownership model – a cooperative model – which then in theory has the potential to unlock more benefits for both those needing and providing care. In brief, the idea is that, people needing care can benefit from a combined offer of formal and informal care that suits their needs, having a say in what’s provided to them and by whom. Care givers can be paid better wages, are offered the opportunity to get fully trained and have the autonomy to deliver the quality care they were trained for. The reality though is that councils are limited by procurement rules making it harder, though not impossible, for these types of organisations to enter procurement frameworks. The other constraint is the cost of care with many councils facing huge pressures and barriers to increasing the cost of care more generally.
4. Data sharing within organisations and with external partners is hard but possible
The multi-agency data platform project involves extensive sharing of some personal and sensitive data without which frontline workers would struggle to fully understand the individual’s context and circumstances. We’re lucky to be working with Chelsea and Westminster Hospital as well as other partners to be able to obtain data from primary and secondary care, mental health, housing services to name a few. Without the commitment from these partners and council services to work on the details of the data privacy impact assessments and data sharing agreements across all partners, supported by LOTI’s Information Governance guru, Victoria Blyth, the process would be near impossible as other projects have experienced first hand.
A separate but related point that any local government data expert will also call out is the lack of data quality and standards across the sector. What we often see is that records are often incomplete or unique identifiers are inconsistently used or missing. These have a knock-on effect on the quality and reliability of the information presented to frontline workers who are making decisions about care packages.
5. Quick wins are unlikely to effect substantial change
I mentioned at the start that tech alone won’t solve the decade long issues in local government. Similarly, quick wins may demonstrate short term benefits but they cannot guarantee long-term sustainability or viability of an individual product or service. I’m making this point because our two projects and our broader thinking about the potential effectiveness of radical approaches aka new service models, are unlikely to yield these quick results. They require good faith, patience, an open mind and imagination. Without this we’re shooting ourselves in the foot before we even start.
We’ll be sharing more insights over the coming year, so please look out for further updates in the LOTI newsletter.