HEALTH

Why our future is small, nimble and digital

Professor Donna Hall urges councils to be more radical in their thinking by reimagining their future where prevention and seamless services are wrapped around citizens and communities rather than around the separate organisations who host them.

Twelve years of deep and relentless cuts to local government have created a Swiss cheese effect. There are gaping holes, sometimes barely held together chasms in many services.

Capacity has been stripped back also as councils have responded to three seismic events – the Covid pandemic, supporting refugees from Ukraine and the cost of living crisis.

At the start of austerity, many councils took 10% of the budget from each service, including corporate strategy, policy, data and analytics, strategic finance, strategic organisational development and communications, transformation teams etc; sometimes these services were hit harder than other frontline services.

As a result, the strategic capacity for thought leadership, establishing the evidence base for action and the delivery of public service reform has been decimated in many councils. People were redeployed into ‘thinking' roles who didn't have the skillset or the backing of leaders.

In Wigan we took the decision to protect these services as we saw them as essential for the delivery of the deal, a new social contract with citizens.

While the NHS is constantly front and centre of media coverage of intense winter pressure and elective recovery, local government remains in the shadows of the news unless there is a catastrophic overspend or daft investments.

Both the NHS and local government need to radically reimagine their future – one where prevention and seamless services are wrapped around citizens and communities rather than around the separate organisations who host them.

Starting with a blank sheet redesign approach is particularly hard in the NHS because, unlike local government, foundation trusts are topped up financially at the end of the year whatever they spend.

There is no incentive to radically transform or remodel the siloed medicalised workforce and to combine it with local government social care staff, for example.

There are many examples out there of councils who, despite the current conditions, are trying new things, essentially brilliant projects. But it is rare to find councils that have stepped back, taken a helicopter view of everything and considered:

  • What is our core purpose?
  • What is our 10-year strategic framework to achieve this?
  • How can we work with citizens on the journey?
  • How do we embed community power in everything?
  • How do we embed relational working across the whole council and partnerships with the NHS?
  • How can we listen harder to our staff and take on board their ideas?
  • How can we listen harder to residents and do the same?
  • What shall we start doing?
  • What shall we stop doing?
  • What is our clear and simple statement of purpose?

The future council will be smaller, nimbler, more enabling than providing, almost entirely digital, seamlessly integrated with the NHS, employing empathetic deep listeners who focus on prevention, local community assets and strengthening the social not just the physical scaffolding of places.

It will step back where it isn't needed and focus on creating job and other opportunities for people who need more support. Social value and carbon reduction will be as important as economic value.

When redesigning services they will always start with the person, their family, their community rather than simply the unit of presenting need.

Silo ‘interventions' which are expensive, based on eligibility criteria, disorganised and punitive will stop and we will rethink our plan around the person and the place with a flexible place based workforce working to place values which include ‘courage'.

Some might think this is all a bit too risky but the biggest risk we face is not being radical enough.

Professor Donna Hall CBE is chair of New Local, and former chief executive of Wigan Council

@wearenewlocal

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