WHITEHALL

Back to square one

John Atkinson argues that the next government would have to return to Total Place principles from the start of the next Parliament, if it wants to see pooled budget benefits by 2020

It was no great surprise that despite the huge energy and interest created by Total Place, it was a casualty of an incoming government's desire for a fresh start.

Although we managed to get Community Budgets written into chancellor George Osborne's first Spending Review, without strong HM Treasury leadership, departments of state never really bought into them, leaving the four places to struggle on, once the much-heralded central government support had gone.

It was also no surprise that the Department for Communities and Local Government (DCLG) was unable to further the agenda on its own.

The department carries little weight in Whitehall and was certainly not about to persuade Andrew Lansley, Iain Duncan Smith or Michael Gove that their long-rehearsed policy implementation should be led locally and that they should relinquish control from the centre.

The mantra of ‘localism, localism, localism' soon came to mean being told when to empty the bins and which flag to fly.

Yet Total Place was undoubtedly ‘on the money'. When I trawled through each of the reports, a simple calculation showed there was £20bn of savings to be found if you
took the findings from each place pro-rata per head of population.

Now, there is just about everything wrong with this calculation.

It couldn't possibly stand up to close scrutiny, not least because pilots didn't publish all the data in the fear that councils would be hammered with spending cuts by an incoming government.

The £5-10bn of savings that Ernst & Young found in the much-reduced scope of the community budget pilots suggests my figure was not fantasy.

So perhaps it is unsurprising that suddenly ‘Total Place' is a phrase that has started to once more crop up repeatedly, not least in association with Ed Miliband's Hugo Young memorial speech.

The idea that you can improve people's lives while reducing the cost of services was always going to be seductive. Away from the Whitehall glare, people around the country are getting on with trying to make the best impact they can for people's lives with diminishing resources.

In one place, a focus on high users of local health services chose to help people pursue whatever would make most difference in their lives. That meant being able to cook their own meals, or get to the shops alone or maybe see friends.

The result was not just a reduction in the cost of non-elective admissions; the cost of care went down as well.

This busts the myth that savings in one must be a cost in the other. If people are living better, healthier lives, they need less of both health and social care. It also did something else; both staff and resident satisfaction levels rose markedly.

Everyone felt the approach was better. You can reduce costs and improve outcomes if you start with the person, not the service.

The underpinning approaches and philosophy from Total Place are also alive in the work on ‘systems leadership' and the leadership support to the health and care integration pioneers.

That means over 50 places around the country have support in their work that draws on all the learning and experience from Total Place.

When I talk about the value of such support, people resurgence of belief in Westminster around Total Place.  It has taken a new government more than half its term to realise that a series of disconnected, strongly centralised interventions are not going to work.

The succession of junior ministers working under secretary of state for communities and local government Eric Pickles' patronage lack the wit or influence to make any headway in this complex political field.

The longer-term nature of this work means little personal, political capital for the secretary of state himself. Best leave him to fix the floods.

For an incoming Labour government the risk is that history would repeat itself. Those who drove the initiative last time – John Denham and Liam Byrne – are no longer at the centre of things.

The institutional memory is retained only in the likes of Andy Sawford and perhaps, Steve Reed. There is no sign whatsoever that a Treasury led by an opportunist such as Ed Balls would add the necessary spine to the approach that the DCLG simply cannot deliver alone.

So if the next government, whatever party forms it, really wants to take advantage of the huge benefit a Total Place approach can still deliver, now is the time to start thinking about what it takes to make it work, not halfway through the next term when the next ‘plan A' is failing.

Total Place works as an approach, not because it defines a better future, but because it sets about making one.

In a world where parliament and the Local Government Association still focus on policy statements rather than pragmatics, it remains refreshing and challengingly different.

John Atkinson was the architect of Total Place and now works as an independent adviser on leadership and change. He is programme director for the systems leadership programme that provides leadership support to the health integration pioneers.
 

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