However, the painful effort needed to get even this far also illustrates that encouraging, even forcing, agencies to join up in operational delivery is not enough. The most senior levels of policy making need to address the more fundamental issues of how delivery is incentivised and prioritised before they focus on the structure of delivery through Total Place.
The imbalance between managing demand and managing delivery
The current focus is all too often on provision of service rather than understanding the need. Take the real life example of a family moving to a new area with their disabled son. The father quickly contacts the care services seeking a portable bath hoist and with commendable haste the family has separate care, education and transport needs assessment so that within 12 weeks the combined local authority and health partners have commenced delivery of a comprehensive package of care costing many thousands. In week 13 the father again contacted the local council and, while appreciative of all the unexpected attention and support he still didn't have his bath hoist.
Total Place requires total commissioning
What joining up services in the locality requires above all is a joined up view of the customer and their needs. It is about identifying, analysing and managing demand, prioritising the demand that needs to be satisfied and then selecting the most efficient and cost effective means of delivery.
This means achieving a fundamental separation between demand and delivery management, and this is the concept that underpins the thinking behind strategic or total commissioning. It is about far more than better buying. Public services need to accept that the customer is increasingly demanding, intelligent - and, with the aid of technology; can and should be empowered to make their own choices and even help themselves. To exercise that freedom of choice, the public needs access to good information about what is available and how and where to find the solution and funds to secure it.
Changing the culture from total delivery to a more informed relationship
This requires a huge cultural and behavioural shift away from a paternalistic determination of what an individual is entitled to and has traditionally been given, to a public service culture that concentrates first and foremost on what is needed.
How can this be achieved? The centrally driven Customer Insight initiative presents an opportunity for local authorities to achieve this through the increasingly vast amount of customer data being made available through customer profiling and demand mapping approaches. Its intelligent use can have real benefits.
For example, one local authority area was experiencing continual increases in the levels of teen pregnancy, in spite of several years of collaboratively targeting health, education and social agency effort at the pre-teen market.
An analysis of all the teenagers involved in teen births and pregnancy scares in the recent past was undertaken in an attempt to identify any indicators of cause.
Within a matter of weeks of the data being analysed it became clear that nearly all incidences of teen pregnancy came from just four primary schools in the area. Immediately the focus of preventative planning started to shift from the secondary schools and numerous primary school locations to targeting just these four schools and the families whose profiles most closely matched past trends in teenage pregnancy.
The result is a more informed and targeted delivery of services in the areas where it is most likely to have an affect - and it is working. More importantly, it is achieving joined up results at reduced effort.
If the public sector is to get the right outcome from Total Place it must first have a searching debate about the outcome it intends to achieve and be prepared to collectively shift the balance away from a culture of total provision, moving to a more engaged, intuitive and interactive relationship with the customer.
If the policy and funding incentives are themselves focused on collaborative outcomes rather than obsessed with the boundaries of who delivers what and how, there is greater scope to shift the local debate to one about what is needed, where.
Once there is clarity in the total scope of demand, it is easier to collaboratively prioritise the need and collectively invite public, private and third sectors suppliers to step up to the challenge of demonstrating who is best placed to deliver it.
This is the essence of strategic commissioning. Without it, in these the most challenging of times, public services are denying service users the maximum opportunity to experience a total solution.
Karen Cherrett, local government expert, PA Consulting Group
To read the article in Guardian Public, click here.