A better way forward: How community power can save money and reduce demand on public services
Public services are failing to deliver the outcomes people need. Mila Lukic, CEO and Co-Founder of Bridges Outcomes Partnerships spells out the problem with centralisation and why we need to think about service design and delivery in a very different way.
The traditional model of service delivery – based around centrally-organised, standardised solutions to discrete problems – doesn’t work when people are facing complex and interconnected challenges. Those experiencing homelessness, for example, often end up interacting with multiple Government departments at the same time – each of which treats them as if they face a single, discrete problem. This is not only inefficient and expensive for Government, it also often fails to achieve long term, positive change in people’s lives.
There is a better way forward. If we want to improve the lives of people facing complex, interconnected challenges we can’t rely on piecemeal, standardised solutions. We need a more targeted and holistic approach – an approach that looks at the ‘whole’ person, works to understand what they really need, and empowers them to help themselves. This is ultimately the best way to create sustainable change in their lives.
This means turning elements of the traditional model on their head, in order for all those involved in the ecosystem to channel three key principles:
- Collaborative Design: Instead of trying to design specific solutions to ‘fix’ narrow issues, work with local groups and expert partners to agree an overall shared vision, grounded in clear, quantifiable metrics that represent genuine improvements in people’s lives.
- Flexible Delivery: Rather than imposing standardised, clearly specified solutions, give delivery teams the freedom to tailor their solutions to local and individual circumstances – then collect and analyse impact data dynamically, so we can learn from what works and keep iterating to make programmes more effective.
- Clear Accountability: Instead of focusing evaluations on short-term KPIs linked to activities or inputs, agree clear metrics that correspond to tangible improvements in people’s lives and report transparently against them. At the same time, work to understand the broader systemic impact of each project and tease out the lessons learned to inform future projects.
These principles are already taking root across different service areas and locations, and the impact speaks for itself. In North East Lincolnshire, for example, the people-powered Thrive North East Lincolnshire (Thrive.NEL) service which provides non-medical support for adults with long term health conditions, has improved patient outcomes and reduced secondary care costs for the NHS by 34%.
Designed by the local Clinical Commissioning Group, the council, public health teams, local GPs, a coalition of local voluntary and community sector partners together with patients, the core principles of collaborative design, flexible delivery and clear accountability are embedded within the approach.
When Thrive.NEL first launched, GPs referred patients to Link Workers who created an action plan with them before offering a pre-determined set of social activities including gym memberships, nutritional support, and a gardening course. However, the Link Workers soon realised that people wanted more than what was on offer. The flexibility enabled by an outcomes-based approach meant the partnership could work with people accessing the service to rethink and redesign it.
Now Thrive.NEL has a range of new community groups – often created from scratch and led by service users – including a knitting group, a fishing group, a diabetes healthy eating group and a baking club. Making service users not only the co-designers of what is provided, but sometimes also the implementers of provision significantly increases their sense of agency – something that is often taken away through standard referral processes.
Thrive.NEL’s success – backed up by a comprehensive dataset combining outcomes from individuals with NHS usage data – has provided vital lessons for Humber and North Yorkshire Integrated Care System and the national Social Prescribing model.Andthe numbers speak for themselves.
At the end of March 2023, Thrive.NEL had supported 1,538 individuals, just over 50% of whom live in the 10% most deprived areas in England. Of those who accessed the service for 12 months, 93% improved their well-being, increasing to 99% after two years in the service.
Lisa Hilder, Assistant Director for Strategic Planning at Humber and North Yorkshire ICB and the visionary architect behind Thrive.NEL says: “Participants report that the interaction with the social prescribing programme has been life changing.”
But the benefits don’t stop there.
People who successfully complete Thrive.NEL use secondary care much less than they did two years before accessing the service, reducing their cost to the system by 18.5%. Compare this with people locally who haven’t taken part in the programme* and the results are stark: their cost to the system increases by 16.2% over the same time period.
The total secondary care saving – including in patient and A&E – for each person accessing Thrive.NEL is 35%, and their primary care use is reduced by 11% on average.
The benefits of community power are real and measurable. It improves outcomes for local communities, strengthens the sense of local ownership over public services and significantly reduces demand on our already stretched health system.
Hilder adds: “I think this approach can be adopted for a whole range of clinical areas of practice and the ability to understand the outcomes and the impacts that we are achieving is quite significant both in terms of improving local people’s health and making the best use of our public sector investment.”
The question is no longer ‘how do we find the budget to embrace community approaches?’. The data is clear: we can’t afford not to. Every year the costs of not embracing community power continue to rise. The question now is simply ‘when can we get started?’.
For a longer analysis from Bridges Outcomes Partnership and further examples of community power in action, please visit People-powered Partnerships.
*Using a randomly selected, demographically similar comparison cohort in North East Lincolnshire.
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