Creating a new NHS England: Health Education England, NHS Digital and NHS England have merged. Learn more.
Redefining the role of the public in public services
On #OurDay, the chief executive of Wigan Council and Wigan Clinical Commissioning Group sheds light on a game-changing social experiment that has fundamentally changed the relationship between public servant and citizen.
Back in 2010, Wigan, one of the largest metropolitan areas, was highlighted by the Institute for Fiscal Studies and Financial Times as the third worst-cut council in the UK. Like many others, this means that over half of our operating revenue budget has gone. Similarly, this year the clinical commissioning group (CCG) has a £30 million deficit and there is huge pressure on GPs, frontline staff and our hospital and community services as winter approaches.
However, rather than take the traditional approach of using reserves, increasing council tax, or cutting and reducing services, we have chosen a different, more radical model.
We have created a community-based demand-management social experiment we call “The Wigan Deal”. We have changed the relationship between public servant and person; between citizen and state.
It’s not a project or pilot. It applies just as much to the chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust as it does to the leader of the council, the chief police officer and the GP chair of our CCG, and all our staff working across the borough.
We have been relentlessly doing this for the last eight years. And guess what: it really works! Here are some of our key lessons:
- Give all staff – NHS and council, Department for Work and Pensions, police, housing and volunteers – the permission and support to innovate. Some of our organisational rules don’t make sense to patients, residents or workers. We are assessing and referring and passing people who most need our help around a fractured and often incoherent system.
- Despite funding cuts, invest more in the community. Unlocking the talent, expertise and creativity of local voluntary and community organisations is critical to connecting people to a supportive, grassroots team. A £10 million investment in 500 projects over the last five years has stripped out demand from the public for expensive, clunky statutory NHS and council services.
- Encourage all staff to develop different relationships with people. Foster an asset-based mindset, seeing every person as a uniquely talented individual and finding out what matters to them rather than simply what the matter with them is. Reconnecting with people as people rather than a unit of need reminds people why they became public servants in the first place and reconnects them to their own fundamental values of wanting to help people.
- Re-shape all public and voluntary services around local neighbourhoods. All the international evidence suggests that, ideally, population footprints of between 30,000 to 50,000 residents form the best basis for integrated place-based working. Establish these teams and give them all the tools they need to support people more effectively in a more human-to-human way. Stopping referring to each other; meeting every day in a ‘huddle’ to share system data, intelligence and information about a person or a family; and developing a key-worker approach and coordinated action plan to avoid passing people around the system, is so empowering for frontline staff.
- Deploy ethnography (the study of people and cultures) extensively across all systems. Quiet observation and ‘blank mind’ questioning of a person builds a different type of dialogue and a different type of relationship, seeing what motivates a person to get better, whatever the presenting issue. We only employ ethnographers, whether they are a bin loader, a social worker or a brain surgeon.
- Only employ and retain staff if they genuinely share this mindset and value base. People will try to stop it, describe it as dangerous or too risky. Our core values of being accountable, positive and courageous are reinforced every day, embedded in person specifications, appraisals and one-to-ones with line managers.
- Build a high-energy cohesive cross-organisational team that shares the same vison and values.
- Stop funding the things that don’t work.
- There’s no time for pilots – just do it everywhere and do it now!
- Keep it simple so that everyone gets it.
- 80 per cent of cost in public service is on processing people – shift this to an investment mindset so that 80 per cent of public service time is investing in families, individuals and communities to be happy, healthy and independent.
But what has been the impact?
Wigan people are among the happiest in the UK. Council tax has been frozen for the last five years, while outcomes for people have improved. Looked-after children numbers are reducing year on year. Adult social care made a surplus last year – one of the few not to be in an overspending crisis. We have one of the lowest levels of delayed transfers of care and the only “Outstanding” CQC reablement service. And both the hospital and council are rated by staff as the best organisations to work for in their sectors.
It’s a great time to be a public servant. Never has there been such a need for stuff like this!
“Only employ and retain staff if they genuinely share this mindset and value base.”
It would be most interesting to know how you assess this aspect.
Testing in Bloom’s Affective domain (1956) is notoriously difficult.
Wigan has a BeWigan set of system values based on being positive, accountable and courageous, and this has now expanded to cover NHS colleagues as part of the Healthier Wigan Partnership.
Interviews are asset-based and focus on identifying positive examples of attitude and behaviours. “Some professionals are uncomfortable working in a human-to-human way and need the comfort and distance of a clipboard,” Donna explains. “If this is the case, we will help staff move to another organisation without this value set we share around the Deal and our partnership with residents.
“We measure it through an honest and open dialogue between line manager and staff and regular “my time” and “team time” 360-degree conversations in the workplace which start with the question ‘how are you?'”