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George Osborne is clearly determined to meet his election pledge of clearing the deficit by 2020. In the July Spending Review he ordered government departments to find ways to cut up to 40 per cent or around £20bn, from their budgets over the next five years. This is on top of the £17bn of welfare cuts and tax changes announced in the budget just a few weeks earlier.
The Chancellor said that the government must ‘take a step back and think about the shape of the state’, finding ways to ‘deliver more with less’. The clock is ticking - Cabinet ministers need to set out proposals for cuts to their departments in October and the detailed review will be published on 25 November.
Right across the public sector, the sound of squeaking pips has been heard for some time now, most noticeably in local government where it is accompanied by cries of, ‘services are bound to be affected’. The NHS is trying to achieve £22 billion of productivity savings by 2020, the fire service is facing a predicted gap in funding of £17.5 million by the end of the decade and central government funding to police and crime commissioners - who receive and allocate police funds - was reduced by £2.3bn between 2010-11 and 2015-16, according to a report from the National Audit Office.
But there is a choice for the beleaguered public sector, either make more cuts or fundamentally reinvent the way it works. No organisation can survive by repeatedly ‘slicing the salami’. Definitely not when it has a contract to deliver a service to a customer base, which it is obliged to serve. The core of the problem is the fact that the structure of the public sector is fundamentally unchanged over 50 years but our needs, and crucially the technology available to serve those needs, have changed beyond recognition.
It seems that politicians recognise that services must be delivered in different ways, such as integrated health and social care, but why is the underlying structure not being addressed? Some constitutional change is happening, such as the Manchester City region, with a £6bn shared health and social care budget. More devolved regional administrations are planned but where is the information sharing strategy to underpin these changes? The fact is we are saddled with a disparate fragmented public sector consisting of thousands of autonomous organisations desperately trying to get joined up around the citizen, with the information they need to share locked up in multiple silos, and with data owners too afraid to hand over the key.
Undoubtedly, the biggest blocker to the modernisation of public services is information sharing, or the lack of it. The problem can be broken down into three areas; Culture, Information Governance and Technology. Looking at Culture first, people are reluctant to make the data they ‘own’ available to other teams for many reasons but often because their objectives are different – protect the family unit versus preventing a crime from taking place, for instance. It is vital that CEOs of the respective authorities, trusts, and government departments recognise the issue and take responsibility. To shift cultural barriers we need to build trust between central government and local authorities, health, the police and of course the private and voluntary sector partners.
One of the few organisations to have seen an increase in spending is the Centre of Excellence for Information Sharing. With support from most of the ‘citizen facing’ departments it’s a useful initiative but its remit is only to help local areas find better ways of working within teams. One great initiative that is making ground across the country are the MASH’s, Multi-Agency Safeguarding Hubs. However, when the agencies come together, literally around the table, there is a huge reluctance to share what they know, mostly because of the threat that data sharing legislation represents when the rules are not properly understood.
There are around 40 laws that govern the way we are expected to handle information but the issue is much more complex than simple compliance and adherence to the rules. Applying Information Governance in the delivery of care on the front line involves a balanced approach, which meets the needs of the individual first and foremost, the organisation, and relevant laws on a proportional basis. Applied literally the rules that govern information sharing would probably make it impossible to achieve a joined up approach to care across local areas so guidance that allows practitioners to make sensible qualified decisions is vital.
It is vital that individual organisations ensure that their people are well trained and equipped to meet the increasingly complex information sharing challenges. The Information Governance Assurance Framework (IGAF) for health and social care is formed by elements of law and policy from which applicable information sharing standards are derived. It describes the activities and roles that individually and collectively ensure that people working in these areas can balance the challenges of their roles with the need to safeguard the privacy of the person under their care. However, this is an NHS document and does not address the pressing requirement for a consistent policy that can be applied in an integrated way across all areas of the public sector.
Moving to technology, we can at last claim some real progress. The Public Services Network (PSN) – one of government’s main technology success stories of the last few years – has delivered a trusted, safe and reliable network platform for data sharing between the agencies. The long awaited replacement for N3 is finally being specified although procurement still seems a long way off. This Health and Social Care Network will integrate with PSN at the network level but we are still left with the challenge of a common information assurance policy that everyone understands and can easily use in their day-to-day roles.
So where is the leadership on this issue from the centre? Innopsis, the industry association for companies working in the communications and information sharing sector, has been highlighting the need for the Government Digital Service to take a lead. Innopsis believes a ‘framework’ is needed, into which information sharing solutions can be integrated in the same way that PSN has allowed an open and competitive market of network services to thrive. There are some great technologies and applications out there in this field but time and time again suppliers hear that ‘it won’t work with the system we already use’.
Huge improvements to contact centre software and the ability of our networks to intelligently route calls, means that we can very cleverly and quickly find the subject matter expert, even in the largest organisation in the world – the UK public sector. Indeed the greatest resource the public sector has is its people. Around four million highly skilled workers representing a fantastic problem solving engine if only we knew how to get that knowledge in front of the citizen at the point of need. How to share expert skills rather than recreate them time and time again across different organisations. The benefits of doing this are manifest – think about the effectiveness of a team of 1,000 dementia support experts that were available universally across the UK in an integrated health and social care network. Outcomes would be transformed.
What’s more, these people could work when and where they wanted, reducing housing costs, child-care costs, increasing options for people with disabilities or those moving closer towards retirement. The benefits are manifest and the whole programme including state-of-the-art local offices for public sector teams could be funded by the sale of just one Thames-side Government edifice. Right now, we are a long way from this and it’s the old silo problem again. But what has changed is we now have PSN, a high performance network that can connect people with data irrespective of where they are located.
PSN has now delivered us a platform to create better, faster, cheaper services but the real benefits wont be seen until we start to link up our front and back office systems universally so that practitioners on the ground can access, use and share the information locked up in the silos.
The technology we now have gives us the opportunity to think radically about how the public sector is structured. Its time to create a new organisation that anyone in any agency can transfer to, with a culture of support and collaboration, where the skills are geographically independent and always available, where people live where they want to and where they have safe and secure access to all the data they need to deliver a fantastic service at far lower cost than we have now – The Department of You.