Success Equals Failure innovation in public services Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ Sheffield Hallam University ￭ 21st February 2012
The Centre for Welfare Reform• voluntary fellowship of over 70 innovators• belief in human equality, and the value of diversity• welfare state is good, it’s just designed wrong• independent of political parties, government and big business
Key points• personalisation offers an interesting example of recent innovation• resistance to innovation in public services is extremely high• successful innovation is not totally impossible• the role of the researcher and academic is vital, but problematic
Personalisation...1972 first Centre for Independent Living1980s first Direct Payments1996 Direct Payments Act2003 In Control2007 “Putting People First”2013 100% of adult social care - with a budget
What is the innovation?1.Self-directed support2.Resource Allocation System (RAS)3.Support planning4.Tapered control5.Outcome-focused review6.Personalised support7.Community brokerage8.Individual budget - just one element
Jonathan’s health needs are complex.In the 3 years beforeleaving school Jonathan spent 150 days in hospital - respondingto problems with breathing. In the 3 years since leaving hospitalhe has spent only 2 nights in hospital - for elective dentaltreatments.Jonathan’s family have overseen the development of apersonalised package of support for Jonathan with ﬂexibility,employment and learning - but not learning in college - butlearning on the job. Over the last 3 years, Jonathan has acquiredtwo City & Guilds Qualiﬁcations and is now learning newindependent living skills. Over the last 3 years, the individualbudget system has enabled Jonathan and his family to makesigniﬁcant efﬁciencies in the costs of his care and support andsave the NHS:•Over £100,000 in hospital stays•Over £300,000 in residential care costs•Over £100,000 of funding contributed by the LSC
wonderful woman called Katrina. Shes got threedisabled sons. The oldest is Jonathan, a charming,warm hearted young man of 19. He cant walk ortalk clearly, or feed himself alone. Hes had abreathing tube in his neck since he was a toddler.Under a scheme the new Liberal Democrat councilin Sheffield is extending, Jonathans just got hisown individual budget and care plan.Now hes doing work with a local charity, attendinga music group, has his own personal assistant - achild whose potential seemed so limited. Finally asa young man, engaged in life in a way he and hismother never thought possible. Katrina told mewith the biggest smile Ive ever seen, she said:Weve gone from having nothing to havingeverything. I wish every childs needs would betaken this seriously. (Nick Clegg, 17 September
Diffusion of InnovationsDiffusion of Innovations Curve - Everett Rogers (amended by Duffy)
1. Out at the margins• Long-standing issue for advocates of Individualised Funding - how to define budget?• Early work in Southwark, Glasgow and North Lanarkshire failed to get traction.• In Control happened at the right time and the right place.• In Control was designed to maximise possibility of increased take-up.• A Trojan Horse strategy to transform a broken system - adult social care - from the inside...
success factors• experience and 10+ years intellectual property• branding, values and communication• social justice - empowerment, without privatisation• luck - retiring senior managers• luck - Ladyman visit to Wigan• luck - Life Chances of Disabled People• luck - VPST’s problems, CEO opportunity
2. Policy wars• In Control was highly controversial and challenged on: data, cost, ethics, legality, feasibility, policy...• Split between official Individual Budget Pilot Programme and In Control’s second phase and total transformation programmes.• War ended in 2007 - Putting People First changed the language to ‘Personal Budgets’ and defined future policy.
success factors• membership programme - over 100+ LAs• problem-solving and open source approach• temporary dependence of DH on In Control• difficulties inherent to the IBPP• luck - Ivan Lewis• luck - Charlie Leadbeater• luck - lack of money
3. Implementation• Shift to a centrally driven, funded (£0.5 billion) and defined government policy - paradoxically focusing on ‘making local government do it’• In Control’s outsider role becomes even more problematic.• No focus on underlying problems of law and rights• Haste to institutionalise first wave innovations
running out of luck...• government money funds the competition - inside and outside government• Ivan Lewis’ departure and collapse of the ‘social care funding debate’• DH needing to assert its ‘leadership’• Desire to make it an implementation issue - despite inherent flaws in legal framework• In Control had made it all seem ‘too easy’• In Control (and me) seen as ‘too challenging’
4. Success/Failure• Nominal success by 2013 high likely.• Value of success will be reduced by the inefficiency of the delivery and by the poor definition of the goal.• Not a transformation; but nevertheless a positive shift in perspective and a step forward.
Failure brings...• Opportunity to revisit the health-social care divide• Chance to build wider alliances and new public understanding of the issues• Build better supports for social innovators and critics of the current system• Think deeper, think longer - do better next time
Diffusion driven by1.Belief...2.Status...3.Usefulness...4.Necessity... motivation evolves with success, and success is not inevitable
Systems Resist Innovation1.Keep innovators at the margins2.Question evidence of success3.Make innovation adapt to current norms4.Water-down or make innovation optional this is not irrational, it reflects: differences in rationale and differences in belief
Innovation harder when:• Copyright has no value• Innovation has no commercial value• Permission, not forgiveness, is required• Innovation threatens politically powerful economic interests• Mass testing, rather than incremental experimentation is necessary• Key values or assumptions are threatened i.e. social innovation is very hard indeed
Social innovators oftenexperience success asfailure• a new level of threat to incumbent• innovators also threaten allies• radical shift in the ‘game’• innovators have different motives both are imposters...
Innovators oftenexperience research as1. Wedded to particular accounts of social value2. Highly ideological, with fixed paradigms3. Expensive, impossible to access4. Conservative, defends the status quo5. Subservient to government interests part of the resistance?
Research integrity is oftenthreatened by:1. Endless piloting2. Confused policy objectives3. Weakening the definition of the innovation4. Poor implementation5. Confused research methodologies6. Too expensive, too slow, no feedback7. Wrong questions asked
Questions for researchers• Do we know the purpose that the innovation is trying to achieve?• Do we understand how an innovation really works and are we able to ‘take it apart’?• Can we find methodologies that enable us to explore why an innovation works?• How can we shorten the cycle of improvement and development?• Is government the best guarantor of research integrity?• Does ideology get in the way of truth?