Innovation in children's services

Featured article - 11 October 2017
By Richard Selwyn, Former assistant director commissioning at Suffolk County Council

Head-shot of the author, Richard Selwyn, Former assistant director commissioning at Suffolk County Council

A dystopian future, hover cars, neon advertising and colonies on Mars. That was the vision set by the original (and best) Blade Runner film - but look closely and the lead character still uses a pay-phone on the street corner to speak to his replicant girlfriend.

Innovations are difficult to predict - particularly when the public sector is running dry on the current service model - and the next will be a paradigm shift across a lot of different technologies and cultures. Let me explain.

Funding has been squeezed, so we now find ourselves reluctantly in the business of rationing, telling people we can’t help them, and fighting to sustain overwhelmed frontline services. If we keep cutting without innovation, then we all know where this ends up. And the impact there will be on families and communities.

But don’t despair, there are green shoots that show a different way to deliver. I’ve termed it a Moonshot for the public sector, because we can do great things if we work together to improve services. There are three coordinates to the moonshot:

1. Understand and anticipate

New data sources and big data analytics are creating a step change in our understanding of population needs and outcomes. Better understanding increases the accuracy of predicted need, making it economic to target individuals and offer help much earlier.

2. A compassionate system

Staff working in public services are compassionate, but our systems are not. We often push people away until their lives get worse, have long waiting times to manage demand, and offer services that don’t fit their need. There is now an economically viable alternative to reach out and support citizens earlier – a compassionate public sector system.

3. Integrate to control demand

The more we understand the local public system the more we see it is indivisible. Integration is critical to control where demand is met, to build trust between providers and manage how the statutory, community, universal and digital resources are all used to support citizens. Inevitably funding will move from expensive statutory services to real early help, increasing the volume of demand but reducing overall costs.

You’ll see that there’s a system of different innovations described here. Each has an impact, but it’s only when they are taken together that the three coordinates show us how to create a more cost-effective as well as better public sector. It’s no good having hover cars, if we’re driving them to a pay-phone.

I’m particularly interested in the progress we’re seeing in digital transformation, and the conditions to use this is practice. Digital transformation is dogged by challenges: people who know what the tech can do, are rarely those who understand frontline practice; there is a cultural shift in accepting that tech can deliver some outcomes as well as a case-holding professional; and we need up-front investment in infrastructure and data to make this work.

But some local areas are in fact investing and the cultures are changing. For example, new databases that capture all the information live from case management systems. Universities working on algorithms to predict future need, and reallocate frontline staff (beginning to reach-out to support families). And culture changes with school nurses using Chat, new online translation based on artificial intelligence, apps for young people to support each others’ mental health.

I’m really interested in the following potential changes because they help us to think about next practice in some key parts of government. Of course, we run the challenge of how to innovate when politics means we cannot be seen to fail. I suspect the answer lies in small shifts and controlled environments to test the following:

Assess the needs of all children

In England we only collect data on those hitting a threshold of need, so we only have good data on those who need help, rather than good data which can predict who might need help in the future. In Scotland, they’ve fixed this by having surveys for all school children, so the new algorithms can start to understand local need, predict who needs help, and offer that help now. Ultimately this information will also augment professional-decision making.

Create a community based market for real early help

If we can predict future need, then what cheaper support can we offer? Perhaps a local charity can help a family? Or a school teacher could build relationships? Or we could send an email to hook up a new mum with a local baby group? If we scaled up this sort of model, would it significantly reduce demand into our safety-net services?

Test new technology

Often we decide to admit or keep a patient in hospital to be on the safe side. There is a revolution in health monitoring and artificial decision making which will mean more people can be supported at home. In the long-term this will be a democratisation of health intelligence, for now there is potential for a better experience and outcomes for patients, and cheaper services.

Bonfire of the sovereignties

There is a human behaviour (ingrained in government structures and legislation) which fights to keep public services apart. Will combined authorities allow us to test a truly integrated public service model - combining the support from health, care, the police, the Department for Work and Pensions, and community services? I think this is an inevitable position if we apply systems thinking to service design, but that pesky human behaviour does have a habit of getting in the way.

Digital innovation will be a big enabler for the future of the public sector - helping us to make the paradigm shift to an integrated, proactive and compassionate service model. The challenges are in building the infrastructure, edging towards the culture change, and selling a vision of next practice whilst taking safe incremental steps. We’re a little way off replicant care workers and an integrated Martian public service, but if we come together, we can take a moonshot for better services and face these challenges head-on.

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