Seven principles of public service reform

Developed as part of a recent review of services for people living with cancer (commissioned by Macmillan) I found that formulating the principles created a framework that then supported the wider research, commentary and policy recommendations. Only one of the seven principles directly mentions cancer, in reference to the issue of cancer poverty, though even it has a much wider application.

The danger in condensing complex ideas into axioms is that they become weak and simplistic. The aim, of course, is that the reduction concentrates the thought, amplifying the essential point while retaining enough nuance to acknowledge a deeper argument.

Comments most welcome ….

I. Let’s do the right things, and let’s do them low cost
The new paradigm is not ‘more for less,’ it’s ‘let’s do things differently (and less expensively!).’ We don’t want less of the same old, we want something we’ve not yet had (but that we can afford!).

II. Inform and empower: promote freedom of choice and autonomy
People with good information make better choices. We must be there when needed, but people want to remain free from us as much as possible and to interact with us on their own terms, when they must.

III. It’s the money, stupid!
Even when cancer does not lead to death, it often leads to poverty. This is often avoidable, and more could be done to avoid it more often.

IV. We must not just learn from the past, we must also learn for the future
We cannot redesign for the people we have already served, we must redesign for the future users of services. We must be adaptive to future generational change including the demands and expectations of the baby boomers, generations X and Y.

V. Increase participation, co-design and build community capacity
People want to help others and people want to help themselves. By building on the social capital in communities, we can increase the capacity for humanity in the care system.

VI. Services must not be defined by existing professions.
New arrangements will promote collaboration, cooperation and coproduction; aligning objectives and budgets and service delivery – towards a seamless service.

VII. Leadership is important
Change is needed and change won’t happen without us taking action. Let’s mobilise our resources to make a difference.

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Cancer in the community

I’m in Coventry this week doing a piece of work with the City Council and partners for Macmillan Cancer Support. The essential driver for the work is that the cancer profile in the UK is changing. Due to our lifestyles and our growing life expectancy more people get cancer, but due to investment in prevention and to advances in medical care, more people survive cancer. In other words, as Macmillan chief executive Ciaran Devane puts it, “the number of people dying from cancer is falling but the number of people diagnosed with illness is rising.”

Macmillan estimates that the number of people living with or beyond cancer stands at two million and is rising by more 3% a year.

The challenge for the country – and for charities like macmillan and for statutory and government agencies – is how to support the growing number of people for whom cancer wasn’t a death sentence, but whose lives have been deeply affected by the disease.  (See for example the National Cancer Survivorship Initiative)

My work for Macmillan, with Coventry, is to take a look at existing community services for people affected by cancer and to make some recommendations for improvement. I have a five day programme during which I will be speaking to services users, frontline professionals, GPs, consultants, service managers as well as elected members, directors and the chief executive. After 2 days I have been impressed by people’s willingness to engage and encouraged at their openness to new ideas.

It goes without saying that this is not a project can hope recommend huge amounts of new spending, so the emphasis is on innovation and service redesign. Not the old cliché about doing more with less, but doing things differently. Doing the right things and doing them better.