Local authorities are pinning their hopes on service transformation to secure their future, but is it an impossible task? The MJ and PA Consulting hosted a round table discussion with leading local authority chief executives to consider options for service redesign while below a case study highlights a project at Hampshire CC. Michael Burton reports on the discussion highlights

C hange and transformation are part of every chief executive's lexicon; the question is whether they are only words or represent real activity. The group of high-powered chief executives recently meeting at The MJ/PA Consulting discussion had no illusions that their sector is under huge pressure and cannot stand still but they were distinctly less certain about whether their own responses implied transformation.

One participant bluntly summed up his view of transformation saying: ‘We've given up the "transformation" word. No one welcomes being told they're being transformed. Avoid it at all costs.' Another added: ‘We've not taken a transformational approach' while a third commented: ‘There's a danger of doing transformation which has no relationship with the outside world and is fighting the last war.' A further comment was ‘it's not about finding a new model but about using the same people who are already overloaded.'

However, this does not mean lack of any desire for change. As one chief executive summed up: ‘We're still remarkably positive despite struggling with it for many years though we're experts in local government at planning the future while looking through the rear view mirror. I've had five conversations with my leader when he's used the word "futureologist." The challenge is how to deal with the short term while looking into the future, indeed how to find the time to think about the future.'

The pressures of dealing with the short-term were clearly articulated by participants. One said: ‘The only story is last minute fixes. It creates an environment where transformation becomes difficult.' Another added: ‘My end game is just survival and it's going to get worse' while one chief executive said ‘We're desperately paddling. Most of what we've done has been coping with demand rather than being in a place where we feel comfortable.' As another participant joked: ‘There's a bit of a survival theme here!'

Inevitably the subject turned to social services. One chief executive said: ‘Our focus is on building resilience. We're working on co-design and co-production. Children's is a bigger pressure than adults. We're getting older young people. As a corporate parent I'm delighted when they do well and go to university but dread the cost. Also the cost of long term disabilities is a concern as children with disabilities become adults with disabilities.' Another chief agreed, saying: ‘On children services we have lower numbers but higher costs.'

Referring to the strain between reducing costs and maintaining services one participant added: ‘We're outcome based and trying not to put financial issues and the achievement of outcomes in conflict but the more we tackle demand then the more we save.' One chief pointed out that so long as children's services was a local authority problem the government would always avoid any responsibility, explaining: ‘The trouble is children's social care isn't the Government's problem. When it's their problem ministers will find the money.'

But one participant pointed out that the cause of the rises in health and social care costs, the baby boomers now approaching old age, are also the very generation which has grown used to high quality customer services. He added: ‘In the long term baby boomers won't tolerate what we have to offer – that will create the imperative for change.'

Clearly technology is one of the key drivers for service improvement and cost-saving. There was a mixed picture of progress from participants around the table even though all recognised that technology is about quality of life, not hardware, one summing up their view with: ‘Assistive technology is about making people live independently longer, it's not about a bit of kit.'

On the positive side many of the chief executives' authorities were reasonably well advanced. One said: ‘We're working on telecare and we're making sure assistive care technology is built into this. There's a big push on digital, driving out costs and also bringing together fully integrated commissioning with the clinical commissioning group.' Another added: ‘The new wave of technology gives us more flexibility in adult care than the previous generation of technology though we're not making as much use of the technology as we could.' Staffing and culture were cited as barriers, one adding: ‘We have a line in our capital programme on assistive technology. The real challenge is our staff. Care staff are desperate to give service in the traditional way. We still have an equipment store with the NHS which may have worked 20 years ago. We're still worrying about our old technology let alone the new stuff.'

Lack of finance, especially for adult care, was part of the landscape though one chief executive pointed out that ‘the amount of money you spend doesn't equate to an outcome. It's about allocation of resources and whether it's being spent in the right place.' The weakness of the government was also mentioned, one saying: ‘There's a vacuum at the top. The question is whether that's a problem because it means there's no direction or an opportunity. As an optimist I say we should step in and fill that policy vacuum.' There were also comments about their own politicians' influence on transformation. One chief executive observed that ‘members are less risk averse than I can remember. Sometimes it's me who has to remind them about being careful.' Another participant, expecting new councillors after next May's elections, said ‘the main challenge is to get new members to understand the legislative framework otherwise it makes transformation difficult.'

David Rees, head of local government services at PA Consulting, summed up the discussion with: ‘The trick to doing more than just surviving is to be clear about the strategic ambition and then to work through a series of bite-size actions that move the organisation in the desired direction. The future is one where local government stimulates resilience and independence to reduce demand and technology can play a significant part in that. Larger scale and more creative use of assistive technology and the insight it generates must be part of that future picture.'

Assistive technology

Like all providers of adult care, Hampshire CC faces the combination of significant cost pressures and rising demand. Of the county's total population, around 15,000 vulnerable adults have been assessed as having eligible care needs. The majority of this group are receiving services at home.

One of the responses to these challenges, which Hampshire CC has adopted, is to radically rethink the role care technology (assistive technology) plays in both mainstream social care provision and within the wider care system.

The PA Consulting-led Argenti partnership takes complete responsibility for the council's care technology service, from driving referrals, through to assessments, installations, equipment provision and monitoring.

At the end of year four of this five year contract, over 8,600 people were receiving telecare as part of their mainstream care package. Most impressively, it has delivered an evidenced net saving of £7.1m to the council.

Now 98% of service users would recommend Argenti telecare to others; 94% say their care technology has increased their feelings of independence, safety and security. Nine out of ten social workers report that the Argenti solutions are ‘good' or ‘very good' at achieving care outcomes. Argenti now also provides the same managed service for Barnet LBC.

TheMJ/PA Consulting round table attendees:

Chris Naylor Chief executive, Barking/Dagenham LBC

John Hooton Chief executive, Barnet LBC

Carolyn Downs Chief executive, Brent LBC

Paul Najsarek Chjef executive, Ealing LBC

Fran Beasley Chief executive, Hillingdon LBC

Lesley Seary Chief executive, Islington LBC

Ged Curran Chief executive, Merton LBC

Will Tuckley Chief executive, Tower Hamlets LBC

Charlie Adan Chief executive, Kingston RLBC

John O'Brien Chief executive, London Councils

Heather Jameson The MJ (chair)

Michael Burton The MJ (rapporteur)

David Rees PA Consulting

Steve Carefull PA Consulting