Demonstrating Radical Efficiency
'Radical Efficiency' holds out the promise of different and better public services, provided at a lower cost by:
- increasing the efficiency of service delivery models
building on family and community assets to reach more families in greater need using fewer resources; and
- improving the effectiveness of services
engaging deeply with families to learn about their lives and using these insights to design support that can really make a difference.
Transforming Early Years, which was a practical demonstration of the principles of Radical Efficiency, set out to deliver on this promise. Over a period of 18 months, teams of early years service providers worked intensively to redesign aspects of their early years offer, at the same time as reducing costs, with an ambitious target of 30% savings in their first year of operation.
Spotlight on early years
New evidence about the importance and success of early intervention in improving whole of life outcomes coincided with deep cuts in public sector spending, and a growing concern about the cost of failure to deal with the complex problems faced by some of the hardest to help families in our communities to create a 'perfect storm' for Early Years Services, in which they were challenged simultaneously - and significantly - to improve their outcomes and reduce their budgets. More for less just wasn't going to be good enough. Services needed to be different, better, and lower cost too.
Six locality based teams took part in the project. They were: Barking and Dagenham, Corby, Heaton in Bradford, Knowsley in Liverpool, Reading, and West Basildon in Essex.
Teams were eclectic and drawn from across the range of professionals working in and around children's centres. They included directors of children's services and children's centre managers, and health and social care professionals and educators, working alongside social enterprises, charities, community activists and parents' groups.
This short report summarises the findings of the Transforming Early Years project which ran from January 2010 to July 2011.
What we learned about...
...designing 'different'
"We provide a good service for those who choose to use it but we are not well known to those who don't. I used to think that we should do more – but now I know we should do different." (Locality team leader)
Although teams came from all around the country they discovered that they shared many common challenges:
- Existing services did not sufficiently engage 'hard to reach' families and those most in need
- Families who most needed support were often isolated and sometimes segregated
- There was a lack of effective outreach and poor communication by professionals with families
- Services were found to be uncoordinated, inflexible, bureaucratic and expensive
- There was limited involvement of parents in existing service design or delivery
- There was insufficient focus and spend on early intervention
- Stereotyping of families from other community members & professionals was widespread
- Families felt little control over their lives and how they interact with service professionals
So it's perhaps unsurprising that the new services designed on the basis of these insights were quite similar too. Although they varied in detail and in delivery methods, all the new services featured:
- a shift from professionals diagnosing and responding to families' needs to families taking control over the design and delivery of services themselves;
- a change in focus from working with whoever turns up to the Children's Centre to reaching out into the community to make sure families in most need were at least aware of what's on offer; and
- an intention to prevent problems arising, rather than dealing with the consequences.
New roles for parents
In all cases the preferred model for working with the community was through the design of a range of volunteer roles for parents. This presents a particular challenge in the communities surrounding Children's Centres, which are located in the 30% most deprived communities in England.
In England in 2010, the 'typical' volunteer was a woman aged 39-45, qualified to degree level and living in one of the most prosperous 10% of neighbourhoods. Around 57% of all volunteers fit this profile. The amount of voluntary activity in the wealthiest 10% of areas was well over twice that in the most deprived areas
Early indications of the success of the various approaches to recruiting volunteers to new community based roles were good, but teams will need to continue to be creative and ambitious if volunteering is to live up to their expectations and help them to deliver on their plans.
New roles for professionals
The implications for working with users like this for the role of professionals working in the Children's Centre started to become clear very early in the design process. Straightforwardly, some colleagues could lose or have to significantly reorientate their jobs. Teams realised they needed to be sensitive and smart around managing this. They talked about the need to 'win hearts and minds'; and about:
"...making partnership with users the best choice for everyone. Not by coercing users to be engaged or coercing staff to engage users, but by generating insights on both sides so that people understand it is being the best way to go about things.” (Programme Leader)
Finding Service providers need extended time and varied opportunities to explore the challenge their new service is trying to tackle before they define possible solutions. This process of exploration and questioning can be difficult and feel strange for service providers, who are geared for intervention and problem solving. But it also builds their confidence over time and helps drive providers to generate focused, relevant and appropriate new service ideas.
Finding Working with the community as a route to transforming services is a compelling idea. Service providers hoping to recruit and deploy volunteers need to make their expectations about how volunteers will contribute to the new service explicit, and evaluate these in the specific context of the community that the new service seeks to engage. Service designs and implementation plans need to attend to changing trends in volunteering.
Finding Participation in design and decision making processes helps to mitigate any anxieties staff may have about changes to their role or career prospects arising from the new service. Participation by members of the community makes the design better and builds an appetite and expectation in the community for the new offer.
...designing 'better'
By involving families in new and different ways in their redesigned services, Transforming Early Years teams explicitly set out to achieve improvements to family and community life likely to impact positively on children's lives. The teams planned for...
- more adults volunteering and taking up new roles in the community
- increased take up of learning opportunities
- an increase in peer-peer support between families
- more families with multiple problems spending time in children's centres
- improved communications between providers and families
- increased awareness and take up of the services available
- a more visible and explicit role for men in childcare and family life
- an increase in intergenerational connections within the community
- increased take up of preventative health care
...with the expectation that reaching and engaging more of the adults in families with complex problems and who had not previously taken up the offer of support would lead to:
- better qualified adults and lower unemployment
- reduced household debt
- increased social capital and less crime and anti social behaviour
- stronger family relationships and less family breakdown
- improved maternal mental health
- improved diet and nutrition
- an increase in breast feeding and immunisation
And that supporting families to do better in these areas would improve outcomes for children too, and in particular help towards:
- improvements in educational attainment at the foundation stage
- reduced child poverty
- improved housing conditions
- cleaner and safer communities to grow up in
- fewer looked after children
- improved health and wellbeing of children
- fewer obese children
But, compelling as they are, these connections are only part of the story. To be sure of 'better' the new services also needed to create opportunities for families to engage in activities proven to have an impact on children's lives – what the teams called 'evidence based interventions'.
Teams were focused on who they would work with – identifying the families most in need and thinking about new roles for parents and others in the community - and how – bridging the gap between the professional services and the families that need their help. Their next step will be to focus on what their peer supporters and the professionals working with them will do; what activities and provision they need to offer.
Finding Evidence points to services which help parents develop key parenting skills and behaviours and which have a direct link to improved outcomes for children including, but not limited to, breastfeeding and home learning. These two are highlighted because they are examples of support that need not be delivered by professionals, but could instead be provided by parents trained as peer supporters. These services can also successfully be delivered in the family home.
Finding Service providers are able to articulate connections between improvements for parents and families and improvements in outcomes for children in broad terms. They need support to develop detailed implementation plans which translate their logic and ideas into evidence based activities in their new services that are likely to make a difference to children's lives.
Finding Parents who are peer supporters gain at least as much benefit as parents receiving peer support. Creating a range of roles and opportunities and widening access to the broadest possible group of parents from the community in delivering the new services are likely to increase both reach and impact.
...designing 'lower cost'
Radical Efficiency points to an approach to public service design which does not start with the aim of reducing costs, but in the end almost inevitably achieves it. Building on the strengths and assets of communities and families mobilises community resources to meet community challenges, and shifts the emphasis from professional diagnosis and intervention to capacity building and sustainability.
Four of the six locality teams reached a sufficiently advanced stage in the design process to enable them to produce a business case for their new service, including predicting costs with reasonable confidence. Immediate cashable savings of 13% (Knowsley), 21% (Basildon) and 38% (Bradford) were projected in the first year. Reading predicted their first year spending to increase by 29%, but then to reduce by 27% in year two. Basildon projected savings in their year two operating costs of 39%.
Savings were demonstrated through a combination of:
- reducing provision that was heavily dependent on expensive professionals and other paid staff, and increasing involvement of volunteers in managing support for families in their community; and
- improving the reach of the new service compared to the old, so that the costs incurred by the new service pay for support for a larger number of families. This had the effect of reducing the unit cost, or cost per family, of the new service.
More scope to reduce costs
Impressive though these savings are, other opportunities to reduce costs in the short to medium term remain largely unexplored in the Transforming Early Years business cases. In particular moving out of expensive buildings and into other community spaces, including family homes, has the potential significantly to reduce costs in the medium term in rates, security, heating, lighting, maintenance etc. Similarly optimising the use of technology such as mobile phones, social networking and so on has been used to good effect in other examples of Radical Efficiency.
Also absent from the business plans were any proposals for decommissioning of existing services. Given the poor notices received by services in the teams' own reviews at the start of the Transforming Early Years project (see pages 3-4 of this summary), this is clearly an important next step.
It will be challenging - it's very difficult to stop providing services in the public sector, even when they are failing. But in the current financial environment, investing in new approaches as supplements or improvements to existing services simply won't be possible.
Long term economic benefits
The opportunity to save money on a much bigger scale rests in the economic cost of the social problems that early years services aim to prevent. The redesigned services address outcomes for children, families and communities which, if they can be improved, can be given an economic value, i.e.:
- reduced child poverty;
- increased attainment at the foundation stage;
- fewer looked-after children; and
- fewer obese children.
For example, fewer looked-after children will mean savings to the social care system right away. The cost of residential care in a children's home per week per child is estimated to be £2428.
But preventing children from being taken into care should also mean better outcomes later, many of which will translate into economic value. For example the total cost to the economy of young people not in employment education or training (NEET) amounts to around £22bn or £104,300 per young person per year.
Finding Short term cashable savings and longer term economic benefit will accrue if the new services are successful in:
* reducing the number of professional and other paid staff and increasing the number of unpaid volunteers delivering the service; and
* improving outcomes for children by :
1. helping their parents to improve their parenting skills by engaging them in activities in the new service proven to make a difference to important indicators such as school readiness and positive parenting; and
2. improving their parents' self esteem, mental health, employment prospects and therefore earnings potential by creating a range of community based roles for them to take up and training and accreditation to support them to do well.
So the more parents taking part in the new service the greater the savings. Service providers need support to develop ambitious plans for operating their new service at scale, if they are to realise the full potential for reducing costs.
Finding Service providers need support to consider the full range of opportunities to reduce costs, such as scope to close buildings or exploit technology for instance, as well as shedding professional and paid staff.
Finding To appeal to commissioners, service providers need to develop a case and plans for decommissioning and disinvesting in old services that are failing, as part of a business case for introducing new services.
Early involvement of the full range of partners is key to generating deep ownership and engagement. Any delay in the active involvement of other partners along the way makes the task of effective implementation more difficult, emphasising the need to get the right mix of personnel in the core team.
Project teams in localities were assembled on the basis of interest and invitation at the beginning of the programme, and so team composition was the 'best guess' that could reasonably be made at the outset of the right combination of skills, experience and perspectives required. By the end of the project, teams were able to identify the mix needed successfully to deliver service redesign.
Finding Transforming a service using design approaches offers a unique professional and leadership development opportunity for the individuals taking part. It requires them to change their mind set and ways of working completely, to create the conditions in which radical new ideas and plans can emerge.
Finding Service providers need to be thoroughly prepared for the amount of time and energy that transforming their service will require. Expectations need to be high and made explicit.
Finding The range of skills and dispositions in the service design team is at least as important as the formal roles that people hold. Teams should include people who have emotional intelligence; empathy, energy and resilience; are willing to take risks; have passion and vision; and are well networked and knowledgeable, in particular about volunteering, other services and safeguarding.
Finding Including people in the service design team from other relevant services is essential to securing the active engagement needed to move from ideas generation to implementation.
Teams taking part in the Transforming Early Years project were supported through workshops, practical tools and 1:1 consultancy. The programme was designed to stimulate innovation in each locality by offering experiences and access to expertise that would support teams to develop:
- new perspectives on challenges – changing the lens or viewpoint brought to bear on the problems that their services sought to address; and
- new perspectives on solutions – looking to alternative providers, including users themselves, and rethinking the resources available to meet their needs.
Teams (i) gathered insights through ethnographic research, resource audits and horizon scanning in order to clarify the challenges they faced. They then (ii) identified new solutions through co-design workshops and (iii) tested them using rapid prototyping methods. Alongside this service design process, teams were asked to estimate the cost of their new service and to model the savings that could be achieved on implementation.
Finding Direct engagement with services users' perspective is a powerful and affecting process for service providers. Beyond normal engagement with clients, processes like ethnography for instance, bring providers into contact with different types of service users (or non-users) to enable them to ask new and different questions. In particular, senior officers long disassociated from their client base, can rediscover their passion and commitment to the quality of their service. User perspectives help teams to locate and hold onto the moral purpose in their service design process.
Finding Service providers, even quite senior officers, don't always know how much they are spending in their service and to what effect. This makes it very difficult for them to engage with discussions about cost savings and value for money.
Finding Estimating the likely costs, and potential savings, of new services must start early and be revised throughout the service redesign process. In particular, asking explicit questions about costs and value for money should be a tool to challenge and refine early service ideas alongside, for example, service blueprinting.
Finding When undertaking the complex and sometimes slow job of service redesign, teams can find it hard to explain what they doing and creating with others, including those to whom they are accountable. So processes for transforming public services need to include a strategy for communications. Effective communications are also key to engaging internal stakeholders and external service users, who may be critical to the success or failure of plans for implementation.
Finding Service providers are able to generate ideas with very little support and encouragement. They need much more support to turn their ideas into plans for implementation, which avoid neutralising the radical impact of the new service with conventional ways of working.
Acknowledgements
This report and the evidence that informs it have been compiled by researchers working in parallel to the IU and NESTA programme design and support team.
Our approach was governed by an enquiry framework which informed the design of methods and instruments for data collection and analysis and our sources were:
- Internal project documentation
- Locality team documentation i.e. business cases, locally produced reports, cost calculations
- Observation of programme level (i.e. all locality teams) and locality level workshops
- Observation of project team meetings
- Interviews with locality team leaders
- Interviews each with project team members (designers, leaders and consultants)
Our thanks go to Kirsten Hill from Livewire Learning who provided invaluable support in carrying out interviews and coding and analysing project documentation.
Also to Sarah Keen from New Philanthropy Capital for her brilliant encouragement and patience as well as her expert analysis of the cost implications of the new service designs.
We are grateful to the Transforming Early Years locality teams for opening up their ideas and practice to our scrutiny and for their contributions to moderating and refining early insights and their implications.
Finally thanks to the Transforming Early Years project team: Vicki Purewal (NESTA) and Sarah Gillinson, Claire McEneaney, Ruth Kennedy, David Jackson and Matthew Horne (Innovation Unit).
Caireen Goddard, Goddard Payne and Julie Temperley, Temperley Research
October 2011
Endnotes
