Earlier this year, Breaking Barriers Innovations (BBI) and Agilisys collaborated on a roundtable titled ‘Pathways, Places and Priorities’. This discussion centred on how healthcare organisations, local authorities and the wider public sector can work together to best help citizens through an intelligent, holistic approach that features early intervention and the adoption of latest technology solutions.
In part one of our series on this topic, GovTech Leaders spoke to Nic Werran, Managing Director of DragonGate and Partnerships Director at Breaking Barriers Innovations, to find out how citizens should be more involved in their health and care, how organisations can work better together to help highlight those most at risk and why success needs a joined-up approach.
Can you tell us how BBI’s approach to locally-driven, joined-up delivery of public services has developed?
“My company, DragonGate, was pushing for change from the bottom up, while at the same time, Lord Patel was trying to influence top-down change. Together, we came to a similar conclusion, that everyone in the sector is almost unanimously in favour of place-based change but the way our public institutions are set up make it very difficult to achieve this goal. So, we started working on a one-off project three years ago in Bradford – something you’ve written about before on GovTech Leaders – and BBI was developed.
“Our work in Bradford demonstrated that there were clear benefits to be achieved by transforming health and social care away from being a very reactive model based upon disease-based control into a predictive, proactive model which would build itself around the patient’s journey.
“The positive reaction to report on the Bradford project led to further requests from different parts of the public sector, who were looking to apply the same principles to different issues, whether that’s the justice system or health and social care. What we’re looking to do is provide very practical evidence for those working within the public sector to say not only is place a nice thing to do, but it’s actually an extremely important thing to do and it will potentially save you money in the long run because you’ll be focusing on reducing demand not managing it.
“Last year, West Lancashire CCG were the first NHS body to say, ‘we want you to look at housing as a topic’, because it’s the number one way they can keep people out of hospital in the first place. So, we built up a partnership of organisations to look at that, including Agilisys as digital transformation partner. From that, we’ve developed HOMES report, that contains a “Playbook” for delivering place-based partnerships.”
Do you see this joined-up approach being driven by CCGs and the healthcare system or do you see it being driven by local authorities?
“At the moment, I think there are two big sub-sectors, local government and the NHS, both looking at place-based change, but both are still fairly orientated within their own segments.
“If you look at STPs, they acknowledge the important role of local authorities and wider sector such as housing and both feature in the five-year plan and the long-term view but, if you gave an honest assessment, the weight of it does predominate around the NHS at the moment, with less detail around local authorities housing. That means there’s a lot more work to do in bringing everyone to the table.
“Local government finds the NHS as confusing as most lay people and I think the NHS still doesn’t understand the way local authorities are truly set up. The public sector has a general consensus around accountability, transparency, value for money for the taxpayer but there are bigger differences between different parts of the public sector than I’d say between the private sector and the public sector.”
Do you therefore think it takes an organisation such as yours to provide the link?
“What we’re trying to do is make the case for place, and the way to do that is to look at what organisations have to do over a significant period of time, ten to fifteen years. We have to ask how they use their money at the moment and then, if they were to do it in a different way, does it allow for better service provision that’s more affordable as well? Of course, we also have to find out ways to do that.
“If the NHS actually spent more money on prevention than it does at the moment it will stop people going to the hospitals in the first place and it will save money, but it’s very, very difficult to do that when you’ve got a model which is centred around hospitals and disease control. And most of the things which we’re dealing with in the NHS system aren’t actually around disease control, it’s around some of the social determinants of health like employment, housing and education.”
Where are the cost savings available through a project like this?
“I think the long-term cost savings will be through the reduction of failure demands, so it will be the reduction of cases reaching a critical stage, which can be solved through inter-organisational working. There’s going to be a lot of money spent in any area amongst a very, very small number of families or individuals. The reason those individuals are constantly cropping up in the system isn’t necessarily anything more than organisations not talking to each other. There’s a massive saving to be made there.
“This is also about potential income for local Government. For example, the local authority may have an appetite for investing in social infrastructure, using their land and assets for the NHS, who don’t have that much capital at the moment. The NHS can have new types of working environment it needs to deliver the long-term plan and local authority would have a dependable income stream. With the NHS as tenants, it drives private sector investment as well.
“Then there’s the workforce to consider. NHS workers are being drawn across different systems at the moment. The actual training, the development, the long-term needs of the health and social care workforce, can be dealt with much, much better with a place-based approach, which also leads to savings.”
From your project experience so far, do you find that citizens welcome these sorts of approaches?
“Absolutely. When we do our work, we start off working with the public sector partners and saying, what is the one thing that would make the biggest change for your communities? And then we map that out. The second stage is testing a lot of that theory with residents or core groups. If you’re not building the future plan around the residents’ needs, then it’s going to fail in the short term.
“In Cornwall at the moment, where we’re looking at a project which is about rural isolation, the first problem is to identify what’s the thing to focus upon, the second thing is to test out the future plan with residents. With this project it’ll be a predominantly ageing community and we’re going to gather feedback on a few interventions which the local authorities and NHS have put together, which could make a difference to their lives.
“I think the other thing is if you’re not doing it with the workforce at the same time, and you’re just doing it at a very senior level, the future strategy will fall down. That has been a recurring issue with a lot of very well-intentioned place-based strategies in government over the last decade. Lots of strategising has been done at the top, based upon a lot of good information, but it’s been quite hypothetically brought together and they assume the workforce will just carry on with it when actually it just looks like a lot more work, potential risk and very little benefit.”
So, it’s as much about culture as it is technology or anything else?
“Absolutely, and that’s come out from a lot of our recent roundtables and reports. That cultural gap is probably the biggest area for government to look at, at the moment. The technology is all there, but the actual cultural bridge between where we are now, and what goes on in the future, which means bringing the workforce on the journey, is recurringly not being addressed.”
With this in mind, how can we take your work forward and really scale it up?
“From our work, what we’re saying is firstly, identify what the place based partnership looks like including the geography that can’t be done from Whitehall – that’s got to be through partnership work between local authorities, the NHS, the CCGs and making sure that the core organisations which you can’t do without, like the biggest hospital or the most influential CCG or the biggest local authority, are on board from stage one.
“I think the first thing to ensure in any partnership going forward is not to get everyone on board, but to get the organisations which you can’t absolutely do without on board in a very, very genuine sense and build from there.
“I think the second thing is to identify not a whole multitude of different initiatives, but to identify a single intervention for all organisations to coalesce around, which will unlock a whole host of wider benefits, and that should be attuned to place and it should be attuned to the demographics, the culture or the required interventions of the place. So, it could be around an ageing population, it could be around dementia, it could have a very high youth demographic that’s coming up in ten years, but it’s got to be focused around that single challenge that can’t be addressed using silo working.
“And then I think the next bit is, as mentioned earlier, bringing in the communities very, very early on, bringing in the workforce and then mapping out what the supporting architecture, such as technology, looks like. What we’re not saying is just do a lot of strategizing, then identify what IT to buy – it should all be happening in parallel.
“So, to conclude, don’t develop a strategy or a solution looking for a problem. Start off with getting partnerships on board, use data to identify what the single intervention and goal is and then work with the workforce, residents and industry to develop a plan of action that can be delivered without waiting for outside help.”