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Transforming public services through place-based accountability

Source: PSE Oct/Nov 16

Jessica Studdert, deputy director of the New Local Government Network, discusses the need for a place-based approach to accountability to better align service activity and catalyse transformation. Public service innovators understand that future reform must shift from a collection of individual services tackling single issues to a collective system-wide response designed around people’s needs. 

At present, our public service accountability architecture works against change rather than enabling it. We need a radical new model which aligns service accountability over a sensible geography to democratically elected leaders. Such a place-based approach to accountability would better align service activity and public resource around the needs of people and places to catalyse transformation. 

The traditional model of Whitehall-led accountability over public services, with a clear line of sight to Parliament, has largely been in place since the middle of the last century. Separate public services operate locally but are accountable centrally – for example, hospitals and job centres. People’s health and employment are approached within a clear ‘remit’, beyond which ‘crosscutting’ challenges – for example, poor health being a barrier to employment – are harder to address. Silo accountability can be valuable: it makes it easy to identify who is doing what and how much it costs. 

Tackling the root causes 

In an era when public resource was rising, the ineffectiveness of separate services incapable of treating related problems together could be masked by increasing investment, or introducing a new ring-fenced funding pot tied to a particular crosscutting problem. In a time of constrained finance this is no longer possible. Even if it was, it is no longer sufficient for the evolving demographic challenges which require preventative approaches. People are living longer, and there is increasing prevalence of lifestyle-related conditions which have wider social and economic impacts. Complex challenges like inter-generational worklessness require more sophisticated responses. Demand will keep rising unless services make the shift from managing the symptoms to tackling the root causes of problems. 

Siloed working is also ill-suited to take advantage of the opportunities of the digital age, where private sector innovation is creating increasingly user-led service responses designed around individual preferences. This is leading to increasing expectations of individual efficacy and control, which provides a challenge to the status quo for public services designed to ‘do to’ rather than ‘work with’ people. 

Where transformation is happening, it is driven by the need to respond more intelligently to demand pressures on stretched resources. Separate public services are increasingly shifting from partnership to collaboration to integration. Yet this is largely being driven on the ground within a traditional silo accountability framework that has, so far, largely resisted change. 

Health and social care integration had been driven through the Better Care Fund, which is now rubbing up against the urgency of the NHS England-driven sustainability and transformation plan (STP) process. This latter approach to whole-population planning is driven over a larger ‘footprint’ and is bringing together different parts of the health and care system to plan for population-level needs, albeit without any legal underpinning. 

This emerging landscape is not aligned to the parallel process of devolution, which has to date been driven by growth priorities. Most devolution deals have involved a degree of public service reform. For example, the successor to the under-performing, nationally-managed Work Programme has featured, yet the model has been ‘co-commissioning’ with the DWP still in the driving seat. Even in Greater Manchester, the pioneer of health devolution with the opportunity to align the budget around place priorities, powers have been delegated rather than devolved, and Whitehall accountability remains over health services.   

Departmental institutions and remits at the centre remain intact, despite devolution creating new accountability across places. The Public Accounts Committee betrayed the status quo default of the centre when it recently warned about “increasingly complex delivery methods” undermining traditional accountability, of which devolution is one. This was because reforms were making it harder to follow the public pound, but rather than present an alternative vision for how a new approach to accountability could better adapt to the reform imperative, it sought to reinforce the primacy of departmental territorialism. 


How would place-based accountability work? 

So what would place-based accountability look like in practice? It would need to be driven by function rather than prescribed form, but democratically elected mayors and council leaders would provide visible and transparent leadership. Their role in forging local systems change would be to collaborate with local public services, and agree place-wide outcomes to which all services would work towards. 

Some areas are pioneering new models of working already. For example, St Helens is pursuing local service system change led by all parts of the local system – the local authority, health, police and fire, housing association, schools and further education. This approach has democratically elected stewardship, but all partners are agreeing deeper collaboration that works beyond organisational boundaries to place priorities. The ultimate end game would be to design a locally-led and owned system that better serves local need and reduces costly demand over time. 

As new forms of place-led accountability emerge, budgets should be pooled at a greater scale between service partners so that duplication and perverse incentives to work to silos can be driven out of local systems. The idea of local public accounts committees has built momentum recently – they would interface with new devolved architecture and be charged with “following the public pound” across places. This could serve to build the local evidence base for devolved pooled budgets from the centre at a greater scale. They would shine a light on the unaffordability of silo working, whereby costs can be shunted between services if efficiencies are pursued through individual organisations rather than across a local system (think hospitals paying the price for inadequate social care provision). 

There would be implications for Whitehall structures too, as traditional departmental “control” would need to be relinquished in favour of a model that holds whole places to account for high level people and place-based outcomes, rather than separate service performance. A more intelligent interface between the centre and places would change from one of ‘tiers’ to ‘spheres’ of accountability. 

The new Theresa May administration is yet to stamp its mark on devolution. To date it has been seen at the centre as a policy initiative rather than a route to creating place-based accountability that better aligns resources, services and institutions around the needs of people and places. To move in this direction would be radical, but would forge a system-wide approach that would be fit for purpose for the demands of the 21st century.

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