Let us consider a ‘whole system’ intervention from the UK Government. Total Place was an attempt to improve the quality and efficiency of local public services in England. It was by no means the first or only attempt to do this, lower than hoped for outcomes from public investment is a perennial problem.Total Place did however manage to engage with the problem in a new way. Working in initially thirteen pilot areas that were cities or rural counties it was soon being actively pursued in over 80 such areas representing more than half of England's local councils. The approach taken and the manner in which this generated such a rapid and viral spread of its ideas may be informative in the US context.
England has one of the most centralised systems of government in the developed world. In Europe only Malta is said to be more centralised in its bureaucracy and only New Zealand spends a higher proportion of its public funds centrally. This situation has arisen over a long period, certainly over 150 years and some historical perspectives draw analogy with the local feudalism of the Saxons slowly succumbing to the centralised control of the Norman yoke.
Certainly by the time of the mid 19th Century, the Westminster parliament was taking an increasing interest in local affairs where previously its concern had been the empire. Legislation arose that took control for matters such as public health and finance away from local councils as concern arose nationally around their effectiveness. Interestingly, there is no real data to support a presumption that central control works better, but it fitted with the notion of increasing efficiency through scale which was following Britain's rise as the first industrial economic power.
The degree of emphasis may have changed over the decades but the notion that people cannot be trusted to run their own shires and cities became embedded in government thinking and there are certainly examples that could be found of corrupt or incompetent local leadership that could be wheeled out to support this view when necessary. In fact, the growth of industrial wealth in its early stages was largely unsupported by national involvement and in cities like Birmingham under Joseph Chamberlain it was the local corporation that invested in and developed the local infrastructure that supported growth and improved living standards.
By the time of the Blair government, this belief in centralisation and scale had become an unchallengeable paradigm which found its apogee in the establishment of 'new public management'. This was a considered and determined attempt to make public services more efficient through applying the sort of large consultancy approaches that were deemed to work in business. By instituting a set of targets, improvement agencies and inspection regimes the belief was that central government could ensure much better outcomes for local people. Undoubtedly, against the measures chosen there was much needed improvement.
However, the improvement has been shown not to be as lasting as had been imagined and came at a time of sustained investment in public services. As a result, it was unclear as to what extent the improvement was due to the approach and to what extent due to the greater investment. At the same time, 'improvement'had become a burgeoning industry packed with experts, consultants and proprietary approaches, most of which could point to some benefit they could demonstrably have delivered. In parallel, local public servants became increasingly adept at 'gaming' the system to produce improved inspection ratings with little demonstrable improvement on the ground.
There was another issue with England's centralised form of control. As politicians progressed through the party system they began by representing places. For local councillors these are wards, quite small areas of geography and for Members of Parliament they are constituencies which, although somewhat larger in size, are still quite local. To progress as an MP means leaving places behind and starting to master policies.
To reach the top of Disraeli's 'greasy pole' means mastering the brief in the great department's of state, Health, Education or the Foreign Office. The only time Lord Heseltine could remember the Thatcher cabinet discussing a place was after the riots in Liverpool. The Public Accounts Committee which scrutinises government's work almost invariably calls departments of state before it individually and Secretaries of State with their civil service permanent secretaries are responsible before parliament for their departmental policy area, not for any place.
The result of this is to fragment the delivery of services to local people through a myriad of agencies, quangos and departments who further complicate the process through contracting a variety of further organisations to work on their behalf. The focus in such a system of operation becomes the objective or purpose of the delivery body, not the need of the recipient. The National Audit Office could offer a sensible view on whether money being spent on a particular issue such as childhood obesity was being in any way misappropriated but had no way of identifying whether the collective output of the vast array of inputs, funded separately and with little coordination offered a cost effective return for the huge sums involved.
By 2008 with the impending financial crisis looming and increasingly clear, a means of cutting through the organisational spaghetti of government in England was clearly needed. Total Place was designed to do just that and had at its heart some simple guiding principles that it was hoped would start to help people work more effectively with the complexity of a social system at the scale of a nation state. The over-riding requirement, driven home repeatedly by Lord Bichard on public platforms and to the most senior politicians and civil servants was to start with the customer. Total Place began with getting to understand the nature of the lives of the people we looked to serve, not the relationships between the organisations which served them. People had to move from being data to human beings, a shift from demography to ethnography.
The other focus was on the money. This was not a detailed financial analysis. Many civil servants and consultants seemed determined to prove the audit trail. It felt as if they believed that if only they could draw the map of all public expenditure (and later all private and 3rd sector expenditure on social problems) then they could crunch the data and produce a fix. Given that they were products of new public management this wasn't unexpected and the need for such people to prove themselves as experts repeatedly threw up challenges to Total Place. Instead the focus on money was to remain at high level, to illustrate the discrepancies in the system and to draw political and public attention to the importance of resolving this at a time of financial crisis.
The work began by choosing a number of pilot areas to focus on a particular topic that they thought was highly pertinent to their area. These included such issues as drug and alcohol abuse, housing, care of the elderly or early intervention in families with complex behavioural issues. Again the established view was that this sort of scattergun approach could never lead to a breakthrough. The demand was for focus on a single topic. This would have been a certain way to hand the agenda back to the experts who had failed to resolve the problem and had indeed been part of its creation. Again it was to take much resistance for this view not to take hold. Part of the mantra in creating Total Place was that 'people own what they create'. To chose and dictate a topic centrally that local agencies would investigate was no route to a more localised and efficient form of organising.
The method of choosing the places where the work was to take place was driven by politics and pragmatism. It was necessary to have a careful blend of political control in each place and to include a mix of types of local authority, cities, counties and London Boroughs. They were also being chosen against a tight timescale. The then chief secretary to HM Treasury wanted to announce the places in the Prime Minister's cabinet meeting on a Tuesday. We were therefore given 48 hours to nominate the candidates. This again ran contrary to the principle of people owning what they create. If places were to genuinely choose to be involved then it required numerous agencies on the ground to opt in and to fully understand what they were opting in to.
Clearly this was impossible given the constraint so despite refusing to comply with the timescale to the alarm of civil servants, we were able to call on our network of local government leaders over a weekend and find the requisite number of place within the timescale. Inevitably this meant that some places that could have made a significant contribution did not become formal pilots and the question 'why them?' was raised on more than one occasion. In the end it came down to the haphazard nature of political decision making as much as any guiding brain. In any event, being on the margins of such a process rather than a formal pilot is often a more creative space and there were certainly those who would prove that over the period.
Another part of the mantra was to 'start anywhere, follow it everywhere'. By starting with individual lives the topic chosen became inevitably only part of the story. When you sit and talk with people struggling with long term substance abuse the inevitable interplay of employment, education, housing, crime, parenting, health and mental health (to name but a few) all start to come into the conversation. The belief that it didn't matter where you started soon began to hold up as each of the projects began to bring forward the complexity of individual lives and human interaction in an industrialised society. Total Place needed somewhere to draw this together and to begin to address the issues that were being raised. The forum for this became the clumsily named 'high level officials group' chaired by Lord Bichard. This was composed initially of a handful of the very senior civil servants and local chief executives. By the time the project was in full swing over 40 people would be attending. Bichard was very clear that this group needed to do things, not simply talk about them. Another mantra of the programme was that 'real change takes place in real work' and that 'the people who do the work do the change'.
The members of the high level officials group were linked in a variety of ways. Several of them had worked for Bichard when he was a permanent secretary. Many of them had worked in local government prior to gaining senior roles in the civil service and many of those had attended the Leeds Castle leadership programme which we had run. This meant that there were strong pre-existing networks and a common language and understanding for tackling the problems this group faced. It also meant they were seen as outsiders within Whitehall, able to operate a little more freely, but also struggling to influence as much as perhaps they might. Bichard also ensured that each central government member sponsored a local project. This involved spending time in the field with those doing the work to experience and understand the nature of the challenges first hand. This gave each project a route into the heart of central government, a champion who could introduce them to the policy makers they needed to influence and who could unlock the doors in the corridors of power. It also made for a much more informed conversation around the meeting table, a conversation driven by the experience individuals brought of people's lives, not an analysis of carefully crafted spreadsheets, tables and presentations.
The work created some fascinating examples of how our good intentions, prejudices and ignorance could conspire to create situations that seemed counter-intuitive. One project looked at the process for new claimants seeking state benefits. They found over 50 different types of benefits that a new claimant might seek with guidance to staff from the department of work and pensions running to many thousands of pages. The actual time taken to process a new claim was over 12 hours of work but by working together in a triage system, the various agencies involved could reduce this to just more than 3 hours of work. The impact of this is highly significant. That 12 hours was spread over 35 days and cost annually, in this one small part of the country cost over £10million per annum. In getting it down to just 3 hours, it now would take just ten days saving £4million from the cost of processing. But it didn't end there.
By understanding the lives of people who are in need of claiming benefits something else emerged. People who move in and out of work on a fluid basis, they may be doing door work, catering or van driving, never stop signing on for benefits and don't declare their earnings. This is because the time taken to get your benefits when your employment is inevitably terminated (as it has been so often in your 'career') puts you and your family at risk. The landlord needs his rent, the children's school uniform needs replacing, there are utility bills to be paid. So benefits are claimed illegally and tax revenues are lost as a direct consequence of attempts to do the contrary, to stamp out fraud and make the system rigourous. It is the classic example of an unintended consequence, our best intent and intelligence perpetuating the exact opposite of the situation we set out to create.
It was important to try and make sense of this as we went along. The system we were slowly and inevitably exposing was more complex than any of us could alone comprehend. Cognition in such systems is a collective act so another part of the mantra was to 'connect the system to more of itself'. This took a variety of forms and attempts, some ran well some did not. The participants energy and enthusiasm determined which continued and which did not. You cannot make people commit to things they see no value in.
The most basic of the connections was at the very local level, as people who worked with particular families or individuals made new relationships or refocused existing ones. We also connected places who were running similar projects, finance officers, project officers, consultants and politicians together. And every so often we tried to bring together the whole damn lot. The high level officials group was another example of utilising this collective intelligence as was the meeting of government ministers. What was intended as a sign-on and sign-off meeting by three ministers became a monthly meeting in the Palace of Westminster where up to ten Ministers would come together. Hearing the stories of local people as opposed to administrative data was instrumental in gaining momentum. After hearing once such example, a minister remarked 'this is what walks through the door when I return to my constituency on a Friday. It is this that we need to do something about.' Sadly most of the ministers lacked the necessary seniority and as the Brown Government looked inwards towards the end of its time, the 'big beasts' of the Labour Party looked to their futures and not to the change that would have moved this agenda on.
In the end, the scale of the prize that could have accrued in savings through committing to this new approach to change was never fully realised. As Alistair Darling's final budget as Chancellor (and as it turned out of that Labour government) was prepared local leaders became more reticent with their data, fearful that any potential saving would be clawed immediately to the centre as austerity measures were imposed. The short-sightedness of this was alarming as it simply reinforced the old centralised bureaucracy. When savings inevitably came, local council budgets were ruthlessly and quickly slashed in the absence of the strong argument for greater self-determination that could have been made.
A rough calculation based on a pro-rata saving if all the change had been progressed amounts to around a quarter of Britain's structural deficit. Although such calculations could not be caveated heavily enough, none the less as an indication of the scale of waste locked up in inefficient attempts to manage complex social systems in a top down manner it is significant. The range of duplication overlap and gap created by such an approach is inevitable and without means of resolution from within the system that created it. Only by working with the social system that is England as a complex and living entity can it hope to be significantly improved and thus release the costs inherent in the current process whilst improving the lives of those we serve.