healthcare update - issue 10
Total Place such a good idea?
Total Place is the government’s new initiative focusing on a
“whole area” approach to public services with the ambitious aim of
delivering a better service at less cost.
According to one study carried out by PricewaterhouseCoopers on
behalf of London Councils, some £11 billion of the £73.6 billion
spent on services in the capital in 2009 could have been saved
without impacting on service delivery.
Many of you will already have seen the articles which have
featured in the HSJ highlighting some early Total Place
initiatives, the first focusing on Croydon’s PCT and the London
Borough of Croydon’s efforts to improve child health and the second
on offender management in Luton and Central Bedfordshire.
There is no doubt that Total Place is an attractive concept,
particularly in the context of the pressures on the public purse
but how difficult will it be to deliver in practice?
Thirteen areas have volunteered to act as pilots for Total
Place. These pilots are focusing on the three keys strands which
have been identified as critical in ensuring that Total Place can
deliver public services better, at a lower cost, by doing things
differently - Counting, Cultural Change and Customer Insight.
Counting will comprise of two stages. An initial high-level
counting of total public spending in each pilot area to provoke
debate among local partners about how public money comes together
and then a deep dive look in detail at the public spending specific
to the theme of the pilot in question.
Cultural Change underpins the success of Total Place with the
need to develop a different set of behaviours and culture more
focused on outcomes for citizens across public services as opposed
to the performance of individual silos.
Customer Insight has the potential to drive Cultural Change.
True insight requires a proper understanding of the customer's
needs, wants, expectations, behaviours and experiences and the
active application of this understanding in the design and delivery
of services that better meet the customer's needs.
Each of the pilots were due to report back to central government
in early February and it will be interesting to see what has been
learnt and what conclusions are drawn.
What is clear, is that Total Place has the capacity to radically
change the way public services are delivered but much of that
change will be controversial as can been seen by the suggestion by
London Councils and the Local Government Association for councils
to take some responsibility for commissioning non-acute NHS care
budgets.
Not surprisingly, this idea has not been well received by
Primary Care Trusts with David Stout, director of Primary Care
Trust Network at the NHS Confederation, commenting “all complex
problems have a simple solution that doesn’t work. This is one of
those solutions.”
Mr Stout believes that what patients want to know is that the
planning and delivery of health services is led by local clinicians
not local politicians.
While the concept behind Total Place is an attractive one, the
structure needed to deliver the utopian vision of better services,
at a lower cost, are very far from clear, even if it does not mean
bringing organisations currently delivering public sector services
together under one roof as proposed by the Local Government
Association, and is instead delivered either by formal partnership
working or a looser affiliation of public sector organisations,
there will undoubtedly be real challenges:
- How is funding to be contributed by the partners (particularly
in the context of the pressure on the public purse)?
- Who is accountable for delivery of the service?
- Who makes final decisions if there is disagreement?
- If the project fails, what next?
What is clear is that the Total Place agenda will survive
whatever the result of the election, as shadow local government
spokesman Bob Neil has publicly endorsed Total Place saying,
“we will keep that approach on board as its localist.”
It is clearly critical for all public sector organisations to be
actively involved in reviewing the conclusions reached by the
pilots and engaging with what that may mean to them.
In the next edition of this newsletter we will review the
conclusions of the pilot groups and comment on the potential
implications.
talk to us
Dominic Swift
0161 242 1303
Partner and Head of Public sector and Property
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The content of this update is provided for the purposes of general
interest and information. It contains only brief summaries of
aspects of the subject matter and does not provide comprehensive
statements of the law. It does not constitute legal advice and does
not provide a substitute for it.