We often ask why public services fail to deliver the value that we want them to.
The short answer is: because they’re not designed to deliver that value (Thanks Paul!).
That might seem surprising considering the service design work and effort that goes into ensuring the services we deliver meet the needs of our users, but often this effort is made without addressing a more fundamental public service design problem. We seem to want to break up public services to make it more convenient for us to measure their outputs and outcomes rather than group them together in ways that maximise the value that they deliver to those who need them.
Public services are compartmentalised along many lines that bear no relation to the needs they are supposed to meet or the value they are meant to deliver. Those lines are often driven more by the requirements of those who plan and fund our services, than by the service users’ needs that they aim to meet.
For example, health, social care, welfare benefits and supported housing come under different government departments, are funded by different commissioners, have different regulations and measure success in different ways. These services are often delivered to the same people at the same time in their lives to help meet a need triggered by the same life events, e.g. sickness or ageing, yet because they are separately managed, they often fail to complement one another, or even conflict with each other.
At one point, I came across a sheltered housing estate among whose residents there were as many as eight failed discharges from its local hospital per month, simply due to a lack of communication between those delivering services in the hospital and at the housing estate. I’ve also seen examples of social care workers doing the best job they were able to but actually making their service users more unwell because of a complete lack of medical input into care plans or timely feedback to clinicians.
Public services being organised along lines that suit the services and those who fund them, rather than ones that suit service users who need value from them also raises a deeper question about where the demand for labour in public services comes from. If public services aren’t designed backwards from the value that people need from them, then they will have been designed forwards from the aims and objectives of those in charge of them.
The huge amount of effort that goes into ensuring public services meet users’ needs and expectations is almost always carried out within the boundary of a single service, such as a housing association, hospital or a social care provider. While this work is extremely worthwhile, and necessary, it simply won’t address the fundamental design flaw, that services delivered to the same people to meet the same needs are broken up along functional lines that are arbitrary from service users’ perspective.
I often think that some of the terms we use even pass some of the blame for this design flaw onto our service users. When we use terms like “hard to reach client groups” and “complex needs”, I think there is a danger that, without realising it, we are expressing the limitations of our own services considered in isolation, in a way that focuses on the characteristics of our service users rather than on the services they need.
In the private sector, successful companies understand the need to work with complementers to ensure the seamless delivery of value to customers. A good example of this is how car manufacturers work with finance, insurance and fuel suppliers and government regulators to remove any barriers their customers may have in getting value from the vehicles they sell. However, this value network approach seems to be the exception rather than the rule in the planning and delivery of public services.
There are some excellent examples of joined up working in the delivery of public services, such as NHS High Weald Lewes Havens Clinical Commissioning Group, recently highlighted by The King’s Fund, but until we address this fundamental design flaw of fragmentation at a higher level, my concern is that our efforts to improve public services will be working against their design, rather than to fulfil it.
I established The Improvement Agency to help address the kinds of problems caused by this fundamental design flaw, as part of the “integration agenda”. Let’s hope that as this agenda develops, integration in its own right will no longer be necessary as the underlying design problem of fragmentation is resolved through system-wide changes to public service design.