Editor's Comment

Big designs

Transforming public services through co-operative redesign, ending duplication, integrated working and a little flexibility when it comes to bureaucratic rules: tough, but not impossible.

Social care is one of the areas of the public sector with the most pressing need for new ways of working, and in some places integrated care is becoming a reality. In others, it still seems a long way off.

It’s a major topic in this edition, as you can see in our special report from pages 42 to 50. Doing it properly requires uncomfortable decisions that don’t come naturally – prioritising the patient or care user can mean deprioritising the interests of one’s own organisation. Effective joined-up care with resources appropriately distributed can mean more types of some jobs are needed – but less of others.

The government has given the move to integrated care added impetus by cutting cash from some budgets and pooling it as the ‘Better Care Fund’, which depends on local authorities, health and wellbeing boards, clinical commissioning groups and health and care provider organisations coming up with radical new ways of delivering services.

As you can see in our report from a major roundtable discussion on the fund on pages 44-46, the jury remains out: is this a short-term political fix to try to gloss over the fact that there is less money in the system? Or a genuine opportunity for transformational change in the interests of patients and care users? That depends on the quality of the bids and the scale of ambition shown by local areas – we’ll get a better sense of that as the year progresses.

Transformation is also the name of the game – literally – for the Public Service Transformation Network, as explained on pages 32-33. This new group of experienced ‘revolutionaries’ (as the minister Brandon Lewis called them), drawn from across central and local government, and elsewhere in the public sector, are helping carry on the work of the four ‘whole place’ community budget pilots across more localities. According to the PSTN’s calculations, 33 upper-tier authorities accounting for 22% of England’s population are now receiving help and support in transforming services in their area. But the approaches taken sound less like the original ‘pooled budgets’ vision of the pilots, and more like intensive partnership working, evidence-based reconfigurations of services, and back office mergers. It will be interesting to see if any areas plan anything truly radical – and to see how the government would react.

Adam Hewitt

Editor