Tag Archives: service redesign

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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Today’s report by the Audit Commission and the LGA on the future of the local government workforce re-states some stark statistics.

“Government funding for local government will fall by 26 per cent, or £5.5 billion, over the period covered by the Spending Review (2011/12 to 2014/15), and councils must find most of the savings in the first two years. Because staff account for nearly half of all spending by councils, workforce costs have to come down.”

In England, the report adds, local government has already lost at least 145,000 jobs.

The study suggests fairly bullish attitudes to transformation, as you would expect, and outlines some concrete examples of future outsourcing. But the report also says that councils intend to “extend competition to cooperatives, social enterprises and mutuals” (Work in Progress, par 69). This is interesting, but does competition exist between cooperatives and mutuals? is there really a competitive market? Are there any examples of this already?

Of course, it is part of councils’ role to make markets to meet their needs, but how far down this road are we and is this a credible strategy for major cost saving in the short to medium term? If it is, where is this happening? And if it is not, are some councils still unwilling to talk about traditional outsourcing.

Incidentally, the Guardian has an interesting piece on the outsourcing of Islington’s education service by Mark Taylor director of schools, Cambridge Education. This is written by the outsourcer, any other perspectives?

A little over a year ago, I was called to a meeting with two senior civil servants, from two different government departments, to be briefed on the government’s public service reform white paper, Open Public Services. The aim of the paper was to present a new angle on the government’s strategic agenda. Yes, there was austerity, yes there would be cuts, but the white paper would present the positive case for reform, joining up the change agendas in health, police, schools and local government. It was explained that, at the next election, the government wanted to be able to say more than it had cut the deficit. It also wanted to be able to articulate its underlying strategy and achievements in public service reform.


However, the white paper, as then drafted, never saw the light of day. It was caught up in inter-governmental disagreement, partly between Conservatives and Liberal Democrats, partly between departmental interests, and partly between those who believed in harder or softer policy. In the end the paper was re-written several times and, although accompanied by a strongly worded article by the Prime Minister in the Telegraph, it was eventually launched to a bit of a shrug of the shoulders from public service chief executives. Everyone could see its pro-market  rhetoric, but what impact would the words on the page actually have in the real world of services designed or commissioned? It was written as if market forces didn’t already exist in great swathes of public services and yet had little to say about how more would be done in this direction.  Furthermore, perhaps because it was read as a post-hoc attempt to make sense of existing (and much harder-edged) policy commitments in health, police, schools and local government, it had nothing like the bite of those departmental drivers.

Interestingly, therefore, Ben Brogan at the Telegraph has an update today saying that “Downing Street is starting all over again on public service reform.”

I agree with Fraser Nelson who says this is “depressing,” but it is not surprising. The white paper was always a bit of a badge, stuck on to create the impression of change, but running the risk of over-promising what the government had no idea how to deliver.

In New York for a few days and crossed the Atlantic with Delta Airlines for the first time and was really surprised by how poor the quality of service was. I had no idea that there could be such variation between transatlantic carriers. The service prior to boarding was good and we left on time, but once aboard I was surprised at how old the aircraft was. The bathroom furntiure was held together by bits of twisted wire and there was no at-seat entertainment. In principle there ought to have been a film on small screens that we could all tune in to watch, but there was a problem with the system so they weren’t working. In any case, this was a long way from personalised entertainment systems that other carriers seem to have as standard where you can choose a film to watch, rather than everyone on board having to watch the same channel, with no ability to pause, rewind, change your mind etc..

The crew were also extremely old-school (and this had nothing to do with their age) and I heard many passengers from the US and France commenting on how unfriendly they were.

Which all got me thinking about markets … My experience will certainly mean that I will not fly Delta again in a hurry. But why did I choose them in the first place, and how could I have made a more informed decision? The public sector does a lot to promote transparent performance, customer information in order to inform taxpayers, citizens and customers. Part of the rationale is that this replaces the market mechanism where informed consumers make free spending decisions. But in my case, at least, I made a rather large spending decision based entirely on price with no wider context about what to expect in terms of quality. Again in my case, Opodo was selling airline tickets as if they were a commodity, as if one were the same as the other, whereas in fact, in my experience, Delta is not equal to other carriers. Over time, I can see that the market will regulate itself by reducing repeat business but aren’t consumer aggregators missing a trick by not including customer feedback in their sales transactions, especially when this might mean people trading up so as to avoid the really poor performers, even if they are the cheapest?

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.

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